T h e T e x a s D e p a rtm e n t o f M e n ta l H e a lth a n d M e n ta l R e ta rd a tio n w a s a b o lishe d in 2 0 0 3

. See Act of J u n e 2, 1 20 03 , 78t h Le g. , R. S. , ch

. 198 , § 1. 26 , 200 3 T ex. G en. Laws 611 , 641

. T he s t at e h ospi t al progr ams ar e n ow un der the a u sp ic e s o f t h e D e p a rtm e n t o f S ta te H e a lth S e rv ic e s. See A c t o f Ju n e 2 , 2 0 0 3 , 7 8 th L e g ., ch . 1 9 8 , § 1. 19, 2003 T e x . G e n . L a w s 6 1 1 , 6 3 6

. 

## NO. 12-08-00207-CV

IN THE COUR T OF APP EALS
TWELFTH COURT OF APP EALS D ISTRICT

TYLER, TEX AS

TH E ST ATE OF TEX AS § APP EAL FRO

M T HE
FO R TH E BEST IN TER EST § CO UN TY CO UR T AT

LAW
AN D P RO TEC TI

ON OF R.L . § CHER OK EE CO UN

TY, T EXAS

MEMORA NDUM OPIN ION R.L . appea ls from an orde r of c ommitm ent for te mpo r a r y in p a tie nt mental health ser

vices a nd an orde r to administe r p s y ch o ac tive medication. Af ter a hear ing w ithout a jury , the trial cour t order ed R.L . committed to Rusk S tate Hospit al for a period not to exceed ninety day s and ente red an order authoriz ing the Texas Depa rtment of Mental Health and Me ntal Retardation to administer 1 ps y c ho a c tiv e me dic a tio n to R.L . In tw o is su e s, R.L . a sse rt s th e e vid e nc e is legall y and fa c tua lly ins uf fi c ie nt t o s up po rt

the or de rs . We a ff

ir m.

B ACKG ROUND On Ap ri l 24, 2008, an application for cour t ordere d temporar

y mental hea lth services w as fi le d re qu e sti ng the c ourt

c omm it R. L . to Rus k St a te Ho sp ita l f or a pe ri od no t to e xce e d n ine ty

da y s. The a pplication was supporte d by a ce rtificate of medica l examination for mental illness, prepare d by a phy sician, Dr. L arr y Ha wkins, who had e x amined R.L . on April 23. Dr. Ha wkins diag nosed R.L . a s su ff

e ri ngfr om p a ra

no id sc hizo ph re nia

. He fo un d that R. L . is me nta lly ill a nd lik e ly to c a us e2

se ri ou s h arm

to h ims e lf

. He a lso fo un d tha t R.L . is suf fe ri ng se ve re a nd a

bn or ma l me nta l, e mot ion a l,

or ph y sic a l di str e ss, is e xpe ri e nc ingsu bs tanti a l me nta l or

ph y sic a l de ter io rat io n o f h is a bil ity to fu nc tio n in de pe nd e ntl y , w hic h is e xhibi te d b y his ina bil ity to p ro vid e fo r h is b asic ne e ds , a nd is unable to make a rational and informed de cision as to whethe r o r n o t t o submit t o treatment. Dr. Ha wkins rea ched the se conc lusions because , on April 23, R.L . was e vasive a nd g uarde d, ha d p ara no id d e lus ion s, a nd

be lie ve d the po lic e we re pe rs e c uti ng him

. R.L . ha d b e e n g e tti ngint o
re pe a te d tr ou

ble wi th p oli c e fo r pu

bli c int oxic a tio n a nd tr e sp a ssi nga nd is una ble to c a re fo r h is b a sic

ne e ds . F or

tho se same re a so ns , D r. Ha wk ins a lso de te rm ine d th a t R. L . p re se nte d a su bs tanti a l r isk of ser ious harm to himself or others if not immediately restra ined. On April 28, 2008, R.L . was e x amined by Dr. G. Paul Ku l a wh o t h en also prepar ed a

cer tificate of medical e x amination for menta l illness. Dr. Kula diag nosed R.L . with schizophrenia, pa ra no id ty pe, a nd a lc oh ol a bu se . H e a lso ind ic a te d th a t R. L . is me nta lly ill a nd lik e ly to c a us e
se ri ou s h arm

to h ims e lf

. H e fu rt he r d e te rm ine d th a t R. L . is suf fe ri ng se ve re a nd

a bn or ma l me nta l,

e mot i o n a l , o r p h y s i c a l d i s t r e s s , i s e xp e r i e n c i n g s u b s t a n t i a l m e n t a l o r p h y s i c a l d e t e r i o r a t i o n o f h is

a bil ity to f un c tio n in de pe nd e ntl y , w hic h is e xhibi te d by his ina bil ity to p ro vid e fo r h is b a sic ne e ds , and he is una

ble to m a ke a

ra tio na l and

inf or me d d e c isi on

a s to wh e the r o r n ot t o s ub mit to tr e a t m e n t

. D r
. K

u l a f u rt h e r d e t e r m i n e d t h a tR

. L

. p r e s e n t s a

s u b s t a n t i a l r i s k

o f s e r i o u s h a r

m to himself or others if not immediately restra ined, as demonstrated by R.L .’s behavior and evide nce of

sever e emotional distress and de terioration in his mental conditi o n to the extent that he cannot

re ma in at li be rt

y . H e c a me to t

he se c on c lus ion s b e caus e R. L . w a s g ua rd e d a nd e va siv e a nd

sa id po lic e we re pe rs e c uti nghim

. Al so , R.L

. wa s pa ra no id a nd ps y c ho tic a nd ha d re pe a te d c on ta c ts w ith police for public intox ication and tre spassing . Dr. Kula furth er s t ated R.L . is unable to ca re f or himself. Dr. Ha wkins testified at the hear ing, e x plaining that he diag nosed R.L . with schizophrenia, para noid ty

pe. H e te s ti f

ie d th a t R

. L

. is li k e ly

to c a u s e s e r io u s h a r

m t o h im s e lf

, a n d is s u f f e r ing

sever e and a

bnormal mental, e motional, or phy sical distress to the extent that he is unable to provide for his basic needs and make a rational decision whether to submit to treatment. He e x plained that he c a me to the se c on c lus ion s bas e d on a p a tte rn of be havio r t

hat la ste d at le a st thr e e or fo ur we e ks , an d p ro b ab l y l o n ger
. R

. L

. wa s arre s t edab o u tt h re e t i m es , o v er a t h re e w ee k

p er i o d , fo r t re s p as s i n g.3

He w a s l i v i n g i n a n a

b a n d o n e d h o u s e a n d k e p t r e tu r n i n g t h e r e
. H e m a d e t h o s e j u d g m e n t s a ndis unable to ca

re f or himself in the community in a re asonable manner

beca use he is quite par anoid and suspicious, a

nd believes the police are perse cuting him. He explained that R.L . is very evasive and g uarde d and has not be en able to me et his ow n needs in the community , take car e of himself, or kee p himself out of trouble with t h e p o lice. Many of these pr oblems are due to his ref usal to take medication. The doctor believes that all of these behavior s are connec ted to his mental illness. He explained that R.L . does not intentionally attempt to harm himself, but is ju s t not making g ood jud g me nts to t a ke c a re of him se lf a nd to sta y ou t of dif

fi c ult ie s in the c omm

un ity . D r. Ha

wk ins is not awar e of a

ny family support and believe s R.L . will further de teriorate without treatment. The doctor does not believe R.L

. is able to manag e to g et food and clothing for himself very well. The doctor’s dia g nosis was based on his pe rsonal examination of R.L ., a re view of R.L .’s medica l history , and reasonable medical probability

. He ex plained that R.L . might nee d to stay in the hospital three or four

wee ks after beg inning medication and that Rusk State Hospital is the least re strictive available medical tre atment option at this ti me. On cr oss examination, Dr. Hawkins testified that an ove rt ac t is going back to the same plac e and g etting a

rre sted for tre spassing . He c onsiders that t o b e h arming R.L . in a serious manne r be c a us e he ha s re pe ate dly no t so ug ht the he lp he ne e ds a nd e ve n in the ho sp ita l r e fu se s tr e a tme nt. When pressed, the doctor further explained that it is more likely than not that R.L . will be harme d be c a us e he pu ts h ims e lf

in a sit uatio n w he re he is in an a

ba nd on e d hou se that doe s n ot b e lon g to h im and the owne r mig ht harm him. Dr. Ha wkins also testified that R.L

. has made verba l threats to har m h i m s el f an d m ad e co m m en t s t o fe m al es re gar d i n g h i s s ex u al d es i re s
. T h e do ct o r st at ed t h a t R

. L. does not requir e assistanc e or pr ompting to clothe himself within the s tructure d setting. Howeve r, the do ct o r b eli eves R.L . require s assistance or prompting to c lothe himself outside the hospital setting. He does not be lieve R.L

. can act appropr iately in a restaur ant to ge t service or would know to ge t attention for a broken arm. He might be able to make a peanut butter and jelly sandwich if he had what he neede d to do so. Be cause his judg ment is so impaired, he mig ht not know the inhere nt dang ers of

sitti ng on a fire ant hill. He makes irr ational dec isions about many things. The doctor said R.L . would not stay

in a structure d setting like the Salvation Army or a nur sing home , and he is curre ntly

not on medication. Wit hout me dication, R.L

. will ne ed to stay at Rusk State Hospital4

the full ninety

day s if committed. On re direc t examination, Dr. Hawkins explained that, befor e he was hospitalized, R.L . was not taking a

ppropriate car e of himself. H e wa s not eating proper ly and he put himself in ha rm’s wa y by being in abandone d fac iliti es. He has not exhibi ted the ability to provide pr o p er s h elter f or himself. The doc tor thinks R.L . is a risk t o h i m s el f. The long er he g oes without medication, the more he deter iorates. He has a history of injury to others when he has dete riorate d further than he has now. The ref

ore, he needs to be in the hospital if he is not being medicate d. On re cross e x amination, Dr. Ha wkins clarif

ied that “ther e wa s a murder” about twenty y ear s ag o. The re cent tre spass occ urre d when he lived inside a structur e without permission. The doctor

a l s o a c kn o w l e d g e d

t h a t , a l t h o u g h i t w a s i l l e g a l , h e w a s p r o v i d i n g h i m s e l f w i t h s h e l t e r
. W h e nR

. L.

arr ive d at th e ho sp ita l, h e wa s n ot s e ri ou sly ma lno ur ish e d o r d e hy dr a te d. B ut i t is ha rd to k no w i f he wa s pr ov idi ng him se lf wi th fo od a nd wate r be c a us e he wa s in ja il b e fo re he c a me to t he ho sp ita l. Dr. Ha wkins stated that R.L . was in ade quate phy sical hea lth. R.L . testified in his own behalf. He said he does not ag ree with Dr. Ha wkins’s testimony

and ha s n e ve r t

ri e d to hurt him se lf

. He ha s not inte nti on a lly , but may be g e ne ra lly , tri e d to hu

rt oth e rs
. He e x plained that he gets a social sec urity disability chec k and has be en re nting a place in Be aumont fo r a bo ut f ive y e a rs wh e re he liv e s a lon e . R. L . te sti fi e d th a t he ha s b e e n a rr e ste d twice fo r p ub lic intox ication and onc e for tres p assi ng . He e x plained that the tre spassing arr est occ urre d at an abandone d place near

wher e he lives. H e wa

nted to purcha se a piece of prope rty , but someone beat him to i t

. He h ad m et t he owne r some time ag o. He ha d not been g oing in a nd out of people’ s place s, but he did g et cur ious and enter this one place beca

use he mig ht want to buy it if he could. He d o es n o th av e a ch ec k i n g ac co u n t

. He d o es h i s o wn cl ea n i n g, s h o p p i n g, an d co o k i n g, al t h o u gh sometimes a neig hbor fix es him a plate of food. He said he planted some potatoes and last y ear he

r a i s e d s o m e c h i c k e n s
. F o r c l o t h i n g , h e g o e s t o r e s a l e s h o p s o r t o th e p l a c e s t h a tg i v e c l o t h e s a w a y. H e d o e s n o t h a v e a d o c to r h e s e e s r e g u la r ly , b u t a d o c to r c a me to h is p la c e
. H e h as see n a psy chiatrist for e valuation. He sa id he loves to sociali z e and sometimes g oes somewhe re to mee t people. B asica lly , he hang s around his plac e and the re a re g irls that come ar ound his place nowand t h en
. I f he h ad a br o k en ar m , h e wo u l d ca l l E

. M

. S

. I f he h ad a st o m ac h ac h e th at wo u l d n o t go
awa y , he would g o see a

doctor. He said it w ould not be wise to sit on a fire ant hill because they5

will bite and it would be painful. He said that would be stupid. He sa i d he would like to be discharg ed and r eturne d to his place in B eaumont. On cross examination, R.L

. said his history of mental illness has chang ed over the y ear s. The la st t ime he wa s a t Ru sk

State Ho sp ita l w a s o ve r a y e a r a g o. Th e Jef

fe rs on Cou nty sh e ri ff se nt h im there beca

use he w as intox icated. H e said he was r el ea s ed o ff his medication and back to the community

and that he has been doing fine. He c larified that the doctors had sug g ested that he take

a me dic a tio n fo r his thy

ro id, bu t he did

no t ha ve to t a ke me dic a tio ns fo r h is m e nta l il lne ss. He sa id he did not take the thy

roid medicine. Prior to c oming to Rusk State Hospital last y ear , he wa s treate d at a ha lfway

h o u s e wh ere they

g ave him medica

tion. He was at Vernon State H ospital about ten y ear s ag o. The last time he wa s there, he stay ed about two y ear s. He claimed t o have be en set up on the murder

char g e, which ha

ppened a long time a g o. He wa s fo und not guilty by virtue of insanity and he did more than two y ear s, which he felt was too muc h time for it. He sa id he was not

nece ssarily

g uilty , but not blaming it on insanity

. He testified that, about ten y ear s ag o, he wa s
rec overingfrom his mental illness. Today he is of sound mind and body . He be lieves he ha s g ood

me nta l he a lth

. Re g a rd ing his a rr e st fo r tr e sp a ssi ng , he sa id the re c a n be dif fe re nt r e a so ns fo r t

hat, like looking fo r an other plac e. He said some of the pla ces a re a vailable a nd the place had bee n
a ba nd on e d f or qu ite so me tim e . H e ex pla ine d th e re wa s a dis c re pa nc y a bo ut w ho c ou ld g ive him pe rm iss ion

to b e the re a nd wh y he wa s a c tua lly pic ke d up fo r tr e sp a ssi ng . H e sa id t he re a bs olute ly may not be any criminal char g e whatsoeve r for trespassing beca use of the rea l e state situation in that

are a. He said somebody

called the fire depar

tment twice when he cooked outside. But as for why the police we re c alled, he sa id “it looks l i k e s o m eb o dy in the neig hborhood is too busy on the phone.” H e denie d curr ently needingany

treatment for mental illness. H e s aid he ha d a mental ill ne ss i n the pa st, bu t it c le a re d up
. He a lso state d that his dia g no se s have c ha ng e d o ve r t

he y e a rs
. W h e n a s k e d

i f h e t h o u g h th e h a d

p e r m i s s i o n t o g o t o t h a t p r o p e rt y , h e s a i d “ y e s a n d n o
. ” In

e xplanatio n, he sa id i t w a s im pli e d b y rumor that he ha d p e rm iss ion

to b e on the pr op e rt

y . H e sa id he under stands that he could g et harme d if he g oes onto some one’s proper ty without permission and he does not usually

make it a pr actice

. The trial c ourt enter ed an or der f or tem porar

y inpatient mental hea lth services a fter de te rm ini ngthat th e e vid e nc e su pp or ts the a lle g a tio ns that R. L . is me nta lly ill a nd that he is l ike ly6

to cause serious harm to himself. The c ourt also found that R.L . is suffer ing se vere and abnor mal mental, emotional, or phy sical distress, experienc ing substantial menta l or phy sical dete rioration of the a bil ity to f un c tio n in de pe nd e ntl y , a

nd is una ble to m a ke a

ra tio na l and inf or me d d e c isi on

a s to whether to submit to treatment. The court ordere d R.L . committed to Rusk S tate Hospital for a period not to exceed nine ty day s. A sepa rate hear ing w as then held on the S tate’s a pplication for c ourt order ed administration of psy choac tive medication. Dr. Hawkins testified that R.L

. is unde r an order for tempor ary

mental health ser

vices a nd has re fused to ac cept medic ati o n
. He s t ated that R.L ., who suffe rs from schizophrenia, par anoid ty pe, lac ks the ca

pacity to make a de cision reg ardingthe administration of psy choac tive medications. The doc tor b eli eves that the reque sted medications are in the pr oper
c ours e of tr e a tme nt f

or R.L

. a nd in his be st int e re st. I f tr e a te d, the patie nt wi ll be ne fi t, the be ne fi ts outweig h the risks, and R.L .’s hospital stay will likely

be shortene d. On cr oss examination, Dr. Hawkins said R.L . does not be lieve he is mentally ill or that he

ne e ds me dic ine . H os pit a l pe rs on ne l w ou ld w a tc h h im f or sid e e ff e c ts a nd c ha ng e the me dic a tio n if

ne c e ssa ry . T he do c tor

state d th a t the re a re no a lte rn a tiv e s to med ic a tio n tha t c ou ld r e nd e r t he same or similar results for R.L .’s i llness. He e x plained that it could take thr ee to f our we eks of tre atment to ge t a re sponse ade quate f or re lease from the hospital. R.L . te sti fi e d, e xpla ini ngthat h e woul d r a the r n ot h a ve ps y c ho tr op ic me dic a tio ns be c a us e they result in side eff

ects that c ause discomf

ort. He sa id that he pre viously experience d numerous side eff ects. He also explained that if he thought he really neede d those medications, he would not mind taking the m. H e s tate d th a t h e h a d

b e e n ta k in g c a lc ium, w h ic h g a v e h im e xtr a e n e r g y a nd motivation and made him fee l more stout and strong er. A nd he does not mi nd taking antibiotics for the flu. At the close of e vidence , the cour t entere d an orde r to administer psy choac tive medication fo r t he pe ri od of te mpo ra ry c omm itm e nt.

S U FF I C I ENC Y OF THE E VI DE NCE I n his f irst issue, R.L . asser

ts the evidenc e is neither le g ally nor fa ctually

sufficie nt to support the orde r of c ommitm ent. He a rg ues that the e vidence does n o t s h o w an overt a ct or c ontinuing pattern of behavior tending to c onfirm that he is likely to c ause serious har m to hims elf or w ould be7

unable to provide for his basic needs. Thus, he arg ues, t he S tate failed to meet it s evidentiary burden under the statute. I n his second issue, R.L . asser ts the evidenc e is leg ally and fa ctually insufficient to support the orde r authorizing a dminist ration of psy choac tive medication. He argues that beca use the orde r for c ommitm ent was not supported by sufficie nt evidence , that order is not valid and the order for administration of psy choac tive medication ca nn o t s t an d . He f

urther a rg ues that the State did not prese nt evidence that he lac ks the ca pacity to make a decision reg ardingthe use of psychoac tive medication or that treatment with the propose d medication is in his best interest. Stand ard of Re view I n a leg al suffic iency

revie w wher e the burden of proof is cle ar a

nd convincing evidenc e, the

re vie wi ngc ourt

mus t cons id er a ll o f t

he e vid e nc e in t

he lig ht m os t f

a vo ra ble to t he fi nd ingto de te rm ine wh e the r a

re a so na ble tr ie r o f f

a c t c ou ld h a ve fo rm e d a

fi rm bel ief or c on vic tio n th a t it s finding was true

. In r eJ. F.C
. , 96 S.W.3 d 256 , 266 (T e x. 20 02 ). Th e re vie wi ngc ourt mus t a ssume that the fa ctfinder

resolved disputed f

acts in favor of its finding if a re asonable fac tfinder c ould do

so. Id. A court should disreg ard all evidenc e that a reasonable fac tfinder c ould have disbelieve d or found to have been inc redible. Id. I n addre ssing a

fac tual sufficie ncy o f t h e evidence c halleng e, we must consider all the evidenc e in the re cord, both that in support of and c ontrary to the trial court’ s findings. In r eC.H
. , 89 S.W .3d 17, 2 7 -2 9 (Tex. 2002). This court must g ive due c onsideration to evidenc e that the fac tfinder could re asonably have f ound to be clea

r and c onvincing

. Id. at 25. W e must determine whether the evidenc e is such that a f actf inder c ould rea sonably

form a f irm belief or conviction about the t ruth of t he S tate’s a lleg ations. Id. We m us t c on sid e r w he the r d isp ute d e vid e nc e is s uc h th a t a
rea sonable trier of fa ct could not have rec onciled that disputed evide nce in f avor of its finding. In

re J. F.C
. , 96 S.W

. 3 d at 2 6 6. Appellate c ourts reta in defe renc e for the constitutional roles of the fac tfinder. In r eC.H

. , 89 S.W .3d at 26. The trier of fact i s the ex clusive judg e of the cre dibilit y of the witnesses and the weig ht to be g iven their testimony

. See id. a t 27 ; In re J.J.O. , 131 S.W .3d 618, 632 (Tex. App–For

t Worth 2004, no pet.). Com m itm ent Order The trial judg e may

o rd er a proposed patient to rec eive c ourt order ed tempora ry inpatient8

mental hea lth services if the judge or jury finds, from cle ar an d co n v i n cing evidenc e, that the proposed patient is mentally ill and, as a re sult of the mental illness he is likely to cause serious har

m to h ims e lf

, is lik e ly to c a us e se ri ou s h a rm

to o the rs , o r i s (i) su ff

e ri ng se ve re a nd a

bn or ma l me nta l,

e mot ion a l, or

ph y sic a l di str e ss, (i i) e xpe ri e nc ingsu bs tanti a l me nta l or

ph y sic a l de te ri or a tio n o f h is ability to function independe ntly , which is exhibi ted by his inabilit y , except for r easons of indige nce, to provide for

his basic nee ds, including f ood, clothing, hea l t h , or saf ety , and (iii) unable to make

a rational and informed de cision as to whether or not to s u b m i t t o treatment. T EX
. H EA L TH & S AF ETY C ODE ANN . § 574.034(a) (Ve rnon 2003). To be c lear and convinc ing unde r the statute, the evidenc e must include expert testimony and, unless wa ived, evidenc e of a rec ent overt act or a continuing pattern of be havior that tends to conf irm either the likelihood o f serious harm to the pr op os e d p a tie nt o r oth e rs , or the pr op os e d p a tie nt’ s d istre ss a nd the de te ri or a tio n o f h is a bil ity to function. T EX
. H EA L TH & S AF ETY C ODE ANN . § 574.034(d) ( Ver non 2003). The State provide d expert testimony explaining that R.L . is menta l l y i l l

. Dr. Ha wkins descr ibed a pattern of behavior involving a rec urring poor decision to attempt to live on property that do e s n ot b elo ng to h im, wh ic h r e su lte d in re pe a te d a

rr e sts fo r t

re sp a ssi ng . T his be havio r e xhibi ts R.L .’ s in a bil ity to fi nd pr op e r s he lte r e ve n th ou g h h e re c e ive s so c ia l se c ur ity c he c ks a nd

the ina bil ity to understand that his ac tions are inappr o p ri at e and lea d to neg ative conse quence s. Dr. Ha wkins testified that R.L

. does not make good judgments t o take c are of himself, is not able to g et food a nd clothing f or hi mself very well, and he does not g et t he help he needs. His judgme nt is im paire d and he make s irrational de cisions. Furthe r, without medication, he w ill continue to deteriorate. Thus, the re cord c ontains expert testimony of a r ece nt continuing pattern of be hav i or,
re pe a te dly

re tur nin g to a n a

ba nd on e d ho us e to liv e e ve n th ou g h h e is r e pe a te dly a rr e ste d f or tr e sp a ss, that tends to confirm R.L .’s di stress and the deterioration of his ability to function as exhibited by h is in a b il it y to p r o v id e f

o r h is b a s ic n e e d s , in c lu d in g h e a lt h a n d safe ty

. See K.L .M . v . St ate , 735 S.W .2d 324, 326 (Tex. App.–For t Worth 1987, no writ). T h e t ri al court could have disbelieve d R.L .’s testimony

to the contra

ry
. See In r eJ. F.C

. , 96 S.W .3d at 266. Considering all the evidenc e in the lig ht most favorable to the find i n gs , we c onclude a

rea sonable trier

of fa ct could have formed a firm belief or convic tion in the truth of the finding s that R.L . is l i k e l y

t o c a u s e s e r i o u s h a r

m t o h i m s e l f

a n d i s s u f f e r i n g s e v e r e a n d

a b n o r m a l m e nta l,9

emotional, or phy sical distress, and is experienc ing substantial deterioration of his ability to function independe ntly , exhibi ted by his inabilit y to provide for

his basic nee ds. Id

. The evidence prese nted

s at i s fies the statutory

require ment for c lear

and convinc ing e vidence in support of the orde r for temporar y inpatient mental hea lth services. See T EX
. H EA L TH & S AF ETY C ODE ANN . § 574.034(d). The e vidence is leg ally sufficie nt to support the trial court’s or der. See In r eJ. F.C
. , 96 S.W .3d at 266. I n addre ssing R.L .’s fac tual sufficie ncy complaint, we consider the evidenc e the f actf inder could reasonably have found to be clear a nd convincing

. In r eC.H
. , 89 S.W .3d at 25. R.L . testified that he re nts the place he lives in and wa s arr ested only once for trespassing at an abandone d place he had c onsidered pur chasing . He a lso said he knew he could g et har med if he is on someone else’s pro p e rty w it

h o u t p e r mi s s io n
. T h e tr ia l c o u rt w a s e n ti tl e d to d is b e li e v e R. L

. ’ s te s ti mo n y and disreg ard e vidence contra ry to the State’s position. See id. at 27. I n light of the entire r ecor d, the evidenc e that the tria l court could not have cre dited in favor of its finding s is not so signific ant that it c ou ld n ot r e a so na

bly fo rm a fi rm be lie f or c on vic tio n tha t R.L . is like ly to c a us e se ri ou s h a rm

to him se lf and is su ff e ri ng se ve re dis tr e ss, a nd e xpe ri e nc ing su bs ta nti a l de te ri or a tio n o f t

he a bil ity to function, that is, to provide for his health and saf

ety needs. See id. Thus , th e e vid e nc e is f a c tua lly sufficie nt t o support the trial cour t’s finding . Be cause we hold the e vidence is both lega lly and fac tually sufficie nt to support the trial court’s or der, w e over rule R.L .’s first issue. P sychoactive M edication Th e c ourt may e nte r an or de r au tho ri zing the a dmi nis tr a tio n o f p sy c ho a c tiv e me dic a tio n if it f ind s b y c le a r a nd c on vin c inge vid e nc e that th e patie nt i s und e r a n o rd e r f or inp a tie nt m e nta l he a lth service s, the patient lac ks the ca pacity to make a de cision reg ardingth e adminis tration of the proposed medic ation , and tre atment with the proposed me dication is in the best interest of the patient. T EX
. H EA L TH & S AF ETY C ODE ANN
. § 574.106(a- 1) (Ve rnon Supp. 2008). The He alth and Safety Code define s capa city

as a patient’s ability

to understand the nature a nd conseque nces of

a proposed tre atment, including the ben efits, risks, and a lternatives to the pr oposed treatment, and make a decision whether to unde rg o the proposed treatment. T EX
. H EA L TH & S AF ETY C ODE ANN
. § 574.101(1) ( Ver

non 2003). As we de te rm ine d th a t th e or de r f or co mm it ment is s up po rt e d b y le g a lly and fa c tua lly10

s u f f i c i e n te v i d e n c e , R

. L. ’ s a r g u m e n tt o t h e c o n t r a r y i s w i t h o u t m e r i t

. D r
. H a w k i n s t e s t i f i e d t h a tR

. L.

wa s, a t th e tim e of

the he a ri ng , und e r a

n o rd e r for tem po rar

y me nta l he a lthse rv ic e s d ue to h is schizophrenia and r efuse s to acc ept medications volunt arily . The doc tor stated that R.L

. lacks the capa city to make a decision reg ardingthe administration of psy choac tive medication. The reque sted

m e d i c a t i o n s a r e i n t h e p r o p e r c o u r s e o f t r e a t m e n t a n d a r e i n R

. L

. ’ s b e s t i n t e r e s t s , th e be ne fi ts outweig h the risks, and his hospital stay will likely

be shortene d if medications are use d. Fur ther, the re are no a lte rn a tiv e s to me dic a tio n to tr e a t R. L .’ s il lne ss. Considering al l the evidenc e in the lig ht most favorable to the finding s, we c onclude a

re a so na ble tr ie r o f f

a c t c ou ld h a ve fo rm e d a fi rm be lie f or c on vic tio n that R.L . la c ke d th e c a pa c ity to m a ke a de c isi on re g a rd ing a dmi nis tr a tio n of the pr op os e d me dic a tio n a nd that the tr e a tme nt w ith the proposed me dication is in R.L .’s best intere st. See In re J. F.C
. , 9 6 S. W.3 d at 26 6. Th is evidenc e satisfies the statutory require ment for clear and convinc ing e vidence in support of the orde r for a dminist ration of psy choac tive medication. See T EX
. H EA L TH & S AF ETY C ODE ANN
. § 574.106(a- 1). The e vidence is leg ally sufficie nt to support the t rial court’s order

. See In r eJ. F.C
. , 96 S.W .3d at 266. I n addre ssing R.L .’s fac tual sufficie ncy complaint, we consider all the evidenc e, g iving due

co n s i d eration to evidence the fa ctfinder could re asonably

have f ound to be clea

r and c onvincing. In re C.H. , 8 9 S. W. 3 d a t 2 5

. R. L

. te s ti f ie d th a t h e c h o o s e s n o t to ta k e me d ic a ti o n b e c a

u se it has adver se side ef

fec ts. Dr. Haw kins assured the c ourt that the hosp i t al has medica l personnel

mon ito ri ngR.L . a

nd , if he we re to expe ri e nc e a dv e rs e sid e e ff e c ts f ro m th e me dic a tio n, the y

wo uld chang e his medication. I n light of the entire rec ord, t he evide nce that the trial court c ould not have

c re dit e d in

fa vo r o f i ts f

ind ing s is no t so sig nif

ic a nt that the tr ia l c ourt

c ou ld n ot r e a so na

bly fo rm a firm belief

or convic tion that R.L

. lacks the capa city to make a decision reg ardingthe administration of the pr op os e d me dic a tio n a nd that tr e a tme nt w iththe pr op os e d med ic a tio n is in h is b e st i nte re st. S ee id. Thus, the evidenc e is fac tually sufficie nt to support the trial court’s f indings. See T EX
. H EA L TH & S AF ETY C ODE ANN . § 574.106(a) . Be cause we hold the e vidence is both lega lly and fac tually sufficie nt to support the trial court’s or der to a dminist er psy choact i v e medication, we

overr ule R.L .’s sec ond issue.11 C ONCL US I ON The e videnc e i s l eg ally

and fa ctually

sufficie nt to support the trial court’s or der of commitment for tempora ry inpatient mental hea lth services a nd the ord er fo r ad minist ration of psy choac tive medication. We af fi rm the tr ia l c ourt’s or de rs of c omm itm e nt f

or te mpo ra ry inp a tie nt m e nta l he a lth service s and for

administration of psy choac tive medication.



### S AM GRI FF I T H J ustice

Opinion delivere d October 31, 2008. Pane l co ns i s t ed of

Wor t hen , C. J. , Gri

f f i t h, J. , an d Hoyl e, J.

(PUBL I SH)