IN THE SUPREME COURT OF NORTH CAROLINA

2022-NCSC-123

No. 308A21

Filed 16 December 2022

IN THE MATTER OF C.G.

Appeal pursuant to N.C.G.S. § 7A-30(2) from the decision of a divided panel of 

the Court of Appeals, 278 N.C. App. 416, 2021-NCCOA-344, affirming an order 

entered on 7 February 2020 by Judge Doretta Walker in District Court, Durham 

County. On 27 October 2021, this Court allowed respondent’s petition for 

discretionary review to consider an additional issue. Heard in the Supreme Court on 

20 September 2022.

Joshua H. Stein, Attorney General, by James W. Doggett, Deputy Solicitor 

General, and South A. Moore, General Counsel Fellow, for the State.

Glenn Gerding, Appellate Defender, by Katy Dickinson-Schultz, for respondentappellant.

Disability Rights North Carolina by Lisa Grafstein, Holly Stiles, and Elizabeth 

Myerholtz for Disability Rights North Carolina, National Association of Social 

Workers, Promise Resource Network, and Peer Voice North Carolina, amici 

curiae.

ERVIN, Justice.

¶ 1 This case and its five companions raise an important issue regarding the 

constitutional rights of those who face the prospect of involuntary commitment as a 

result of mental illness. More specifically, these cases require us to address the 
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question of whether a trial court presented with a petition to have an individual 

involuntarily committed for additional inpatient treatment pursuant to N.C.G.S.

§ 122C-261 et seq. violates that person’s due process rights by conducting a hearing

concerning the petition in the absence of counsel representing the State on the 

grounds that the use of such procedures violates the respondent’s right to an 

impartial tribunal. In addition, respondent argues that, even if no due process 

violation occurred in this case, the trial court’s written findings of fact failed to

support its conclusion that respondent was mentally ill and posed a danger to himself

so that he could be involuntarily committed pursuant to N.C.G.S. § 122C-268(j).

¶ 2 A majority of the Court of Appeals held that the proceedings, as conducted, did

not result in a due process violation and that the trial court’s findings were sufficient 

to support a prima facie inference that respondent could not care for himself. In re 

C.G., 278 N.C. App. 416, 2021-NCCOA-344, ¶¶ 25, 36. The dissenting judge 

disagreed with his colleagues’ decision with respect to the due process issue without

directly commenting upon the sufficiency of the trial court’s findings. Id. ¶ 46

(Griffin, J., dissenting). After careful consideration of the arguments advanced in the 

parties’ briefs, we affirm the decision of the Court of Appeals with respect to the due 

process issue for the reasons set forth in In re J.R., ___ N.C. ___, 2022-NCSC-127, but

reverse the Court of Appeals’ decision to affirm the trial court’s order to have
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respondent involuntarily committed on the grounds that the record evidence and the 

trial court’s findings did not support that determination.

I. Background

A. Involuntary Commitment Statutory Scheme

¶ 3 Any person “who has knowledge of an individual who has a mental illness and 

is either (i) dangerous to self, as defined in [N.C.G.S. §] 122C-3(11)a., or dangerous to 

others, as defined in [N.C.G.S. §] 122C-3(11)b., or (ii) in need of treatment in order to 

prevent further disability or deterioration that would predictably result in 

dangerousness,” may file an affidavit delineating the facts upon which the affiant’s

opinion is based and seeking the entry of an order to have the respondent taken into 

custody for examination. N.C.G.S. § 122C-261(a) (2021). If, after reviewing the 

affidavit, a clerk or magistrate “finds reasonable grounds to believe that the facts 

alleged in the affidavit are true” and that the respondent appears to satisfy one of the 

three relevant statutory criteria, the clerk or magistrate shall order that the

respondent be taken into custody. N.C.G.S. § 122C-261(b).

¶ 4 After the respondent has been taken into custody, a commitment examiner has 

twenty-four hours within which to determine if the respondent “has a mental illness”

and “is dangerous to self . . . or others” so as to warrant inpatient commitment. 
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N.C.G.S. § 122C-263(c), (d)(2).

1 In the event that the examiner concludes that 

inpatient commitment is justified, the respondent will be admitted for treatment to a 

mental health unit known as a “24-hour facility,” N.C.G.S. §§ 122C-3(14)(g), -262(d) 

(2021), with the examiner being required to prepare a report that specifically

recommends that the respondent receive inpatient treatment and having the option, 

if no one has already sought to have the respondent involuntarily committed, to file 

an involuntary commitment petition after completing the examination, N.C.G.S. 

§ 122C-261(d). Within twenty-four hours after the respondent’s arrival at a 24-hour 

facility, a physician, other than the one that conducted the initial examination, must 

examine the respondent and, upon determining that the respondent is mentally ill 

and constitutes a danger to himself or others, hold the respondent at the facility 

pending a hearing before the district court, with the second examiner also being 

required to prepare a report containing his or her commitment recommendation. 

N.C.G.S. § 122C-266(a), (c).

¶ 5 Within ten days after the respondent has been taken into custody, the district 

court must hold a hearing for the purpose of determining whether the respondent 

should remain involuntarily committed. N.C.G.S. § 122C-268(a). At this hearing, 

 

1 The commitment examiner must be a physician, eligible psychologist, or other 

health, mental health, or substance abuse professional certified to perform evaluations by 

the Secretary of the Department of Health and Human Services. N.C.G.S. §§ 122C3(8a), -263.1.
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the respondent is entitled to be represented by counsel of his own choosing or 

appointed by the trial court, N.C.G.S. §§ 122C-268(d), -270(a); to have the 

commitment reports filed in support of the decision to commit the respondent and 

other relevant documents shared with the trial court, N.C.G.S. §§ 122C263(3), -266(c), -269(b); and to have the right to confront and cross-examine witnesses, 

including the commitment examiners, N.C.G.S. § 122C-268(f). As a prerequisite for 

the respondent’s continued involuntary commitment, the trial court must find “by 

clear, cogent, and convincing evidence” that the respondent is mentally ill and 

presents a danger to himself or others and make written findings of fact in support 

of that determination. N.C.G.S. § 122C-268(j). If the trial court makes the necessary 

findings, it is authorized to order that the respondent continue to be involuntarily 

committed in an inpatient facility for a period not to exceed ninety days. N.C.G.S. §

122C-271(b)(2).

B. C.G.’s Case

¶ 6 On 30 January 2020, Dr. Phillip Jones, a physician practicing at Duke 

University Medical Center, signed an affidavit and petition requesting that 

respondent be involuntarily committed on the grounds that he was mentally ill and 

presented a danger to himself. According to the affidavit, respondent had arrived at 

the emergency department earlier that day while exhibiting “psychotic and 

disorganized” behavior, with his Assertive Community Treatment team having been 
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“unable to stabilize his psychosis in the outpatient environment.”2 According to Dr. 

Jones, respondent needed to be hospitalized “for safety and stabilization” given that

he was “so psychotic [that] he is unable to effectively communicate his symptoms and 

[he] appears to have been neglecting his own self-care,” with his difficulties having

included a failure to take his prescribed medication. In addition, Dr. Jones completed 

a “First Examination for Involuntary Commitment” report that contained the same 

findings. Based upon this affidavit, a magistrate concluded that there were 

reasonable grounds to believe that respondent was mentally ill and a danger to 

himself and ordered that respondent be taken into custody for inpatient treatment at 

Duke.

¶ 7 On 31 January 2020, Dr. Miles Christensen completed a second examination,

during which he observed that respondent had “talk[ed] to other people in the room 

during [the] interview,” claimed that “god[’]s people [were] putting voices in [his] 

head,” and repeatedly stated that he was “[b]lessed and highly favored.” According 

to Dr. Christensen, respondent would begin crying intensely without any apparent 

cause and, when asked to identify the goals that his hospitalization was intended to 

 

2 An Assertive Community Treatment team is “a community-based group of medical, 

behavioral health[,] and rehabilitation professionals who use a team approach to meet the 

needs of an individual with severe and persistent mental illness.” Assertive Community 

Treatment, N.C. Dep’t of Health and Hum. Servs., https://www.ncdhhs.gov/divisions/mentalhealth-developmental-disabilities-and-substance-abuse/adult-mental-healthservices/assertive-community-treatment (last visited Nov. 15, 2022).
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accomplish, replied, “I don’t know, 90, 40, 50 pounds probably?” and stated that he 

wanted to gain weight. Dr. Christensen diagnosed respondent with schizoaffective 

disorder and concluded that respondent was a danger both to himself and to others.

¶ 8 On 7 February 2020, the trial court held a hearing for the purpose of 

determining whether respondent should be released or remain in the custody of Duke 

for further inpatient treatment. Although an assistant public defender was present 

to represent respondent, no counsel appeared on behalf of the State or Duke. At the 

outset, respondent’s trial counsel objected to proceeding with the hearing in the 

absence of counsel for the State or Duke, arguing that the trial court could not “on its 

own initiat[ive]—or volition . . . conduct the business of the State.” In overruling 

respondent’s objection, the trial court noted that, while the district attorney’s office, 

the attorney general’s office, and Duke had all declined to participate, it did not 

believe that it could ignore its own statutory obligation to conduct the required 

hearing “as a result of people failing to do their duty[.]” In addition, respondent’s 

trial counsel unsuccessfully sought dismissal of the involuntary commitment petition

on the grounds that the findings contained in the first and second commitment

examination reports were nothing more than conclusory statements that did not 

suffice to sustain an involuntary commitment order.

¶ 9 After the completion of these preliminary proceedings, the trial court called Dr. 

Max Schiff, a physician who was involved in respondent’s treatment, to inform the 
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court concerning “whether or not [he could] give [the trial court] enough evidence on 

this to go forward.” Although respondent’s trial counsel objected to the calling of Dr. 

Schiff as a witness on the grounds that Dr. Schiff had not performed either of the 

examinations that had resulted in respondent’s commitment, the trial court overruled 

respondent’s objection, explaining that, “if he doesn’t know anything about this case, 

you can keep making your objection and we will go from there.”

¶ 10 According to Dr. Schiff, respondent “has a long-standing history of mental 

illness with psychosis” and “currently carries a diagnosis of schizoaffective disorder, 

for which he’s been treated since his late teens.” In addition, Dr. Schiff stated that

respondent’s ACT team had initially brought him to the emergency room “in order to 

evaluate him for an acute change in his mental status with increasing 

disorganization, hallucinations, delusions, [and] abnormal psychomotor behavior,” 

including reports that respondent had been “wandering around the streets” and 

throwing away the medication that he needed in order to remain stable. At the time 

that he examined respondent following the latter’s arrival in the psychiatric unit, Dr. 

Schiff asserted that respondent “continued to demonstrate very profound 

disorganization of thought and behavior responding to hallucinations or internal 

stimuli,” that it was “very difficult to elucidate a narrative from [respondent],” and 

that respondent claimed that “thoughts were being inserted into his head and 

occasionally controlling him, as well as containing derogatory content that was quite 
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disturbing to him.” After the trial court asked for clarification about this aspect of 

his testimony, Dr. Schiff explained that respondent “was complaining of feeling that 

thoughts were being inserted into his head, that he could hear other people’s thoughts 

or voices in his head,” and that these thoughts or voices provided respondent “with 

derogatory content that was quite disturbing to him and made it difficult for

[respondent] to attend to a normal interview.”

¶ 11 According to Dr. Schiff, while respondent had been compliant with the 

treatment that had been provided to him at Duke, he had informed the hospital staff 

that he did not believe that he really needed medication or hospitalization and that 

he did not have any longstanding mental health problems. Dr. Schiff expressed 

concern that, despite respondent’s improvement while under Duke’s care, “if he were 

to be discharged, . . . there would be an immediate decompensation, given his 

continued level of disorganization and the hallucinations which are disturbing to him

and, in the past, have led him to have aggressive behaviors in the community.” In 

addition, Dr. Schiff informed the trial court that, during his time at Duke, respondent 

had “been the victim of assaults on a number of occasions as well as in the context of 

both his substance use and decompensated primary psychotic disorder.” In response 

to the trial court’s inquiry concerning how long Duke wished to retain respondent in 

involuntary commitment and what treatment plan Duke had in mind for respondent, 

Dr. Schiff indicated that Duke was seeking an additional thirty-day period of 
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involuntary commitment and that Duke would continue to administer the 

medications that had been provided to respondent since his arrival.

¶ 12 On cross-examination, Dr. Schiff testified that, while he had not conducted 

either of the evaluations that had been performed in connection with respondent’s 

commitment or signed either of respondent’s evaluations, he had attended 

respondent’s second evaluation and currently served as respondent’s attending 

physician. After acknowledging that respondent’s ACT team would be able to assist 

respondent outside the hospital, Dr. Schiff pointed out that, at the time that it had 

brought respondent to the emergency room, respondent’s ACT team had concluded

that “they could no longer support him in the community based on his level of 

disorganization and decompensation.” Dr. Schiff said he had no knowledge of any

efforts that respondent might have made to harm himself but noted that “there has 

been some aggression and aggressive behavior before” while stating that “[respondent 

has] put himself in situations that would place him in danger and could place him in 

danger again.”

¶ 13 After the completion of Dr. Schiff’s testimony, respondent’s trial counsel called 

respondent to testify. When asked if he lived with anyone, respondent replied that 

he lived with “[my] brother and my friend. My—he’s my brother first, but he’s my 

friend second. I was in a relationship with him for 8, 9, 10 years. But it wasn’t be 

nothing sexually wise like that with him again.” In addition, respondent testified 
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that, in the event that he was released, he would continue living with this man. 

Respondent denied having had any thoughts of self-harm or that he posed a threat to 

others but admitted that he sometimes got into arguments with a friend named 

“William,” who would sometimes get angry with him. In such instances, respondent 

said that he would just acquiesce in whatever William wanted in order to avoid 

further trouble. Although respondent could not tell whether the medication that he 

was taking had provided him with any relief, he committed to continue to take that 

medication in the event that he was released. At that point, respondent had the 

following colloquy with his trial counsel:

[Counsel]: What kind of assistance or help do you have 

in accessing medical help?

[Respondent]: My ACT team, Easterseals.

[Counsel]: And do you cooperate with them?

[Respondent]: Easter and seals. Yes, I do, yes.

[Counsel]: And if they ask you to take medications,

would you take them?

[Respondent]: Yes.

[Counsel]: And if they ask you to go see a doctor, would

you go see a doctor?

[Respondent]: They have. They have tried to get me 

to take care of my teeth more. They wanted me to go do 

that, but I didn’t want to do that. I just disregarded it.

[Counsel]: Why didn’t you want to take care of your 

teeth?
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[Respondent]: I brush my teeth at least once or twice 

a day. You are supposed to brush it three times and have 

three meals. I don’t get three meals a day, but they have 

started to give me at least breakfast, a meal for breakfast, 

but he’s been working on losing weight, and I’m trying to 

work with him, but I’m gonna have to eat more.

After claiming that his mother, who lived about fifteen or twenty minutes away, 

would help him remember to take his medications, respondent answered his trial 

counsel’s question concerning whether he would like to be released by stating that, “I 

see her ankles and Amy—the Amy at [Duke]—[Duke] remind me of my mom’s ankles, 

and she takes her water pills in the morning. I remind her.”

¶ 14 In response to questions posed by the trial court, respondent stated that he had 

contact with his ACT team on Mondays, Wednesdays, and Thursdays and that he 

attended a substance abuse group meeting on Friday “here and there, once in a blue.” 

Respondent told the trial court that he was provided with a bus ticket every time that

he went to a group meeting and that he received a weekly check from Easterseals

that he used to buy groceries. Respondent answered the trial court’s question 

concerning what had happened right before his ACT team brought him to the hospital

by stating, “I don’t—I don’t—I was—everything was the same, you know. It’s just 

probably one of my first family or my second family just probably wanted me there,” 

and reiterated that he did not know why he had been taken to the hospital except 

“just to eat and drink.”
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¶ 15 In response to the trial court’s questions concerning the hallucinations that Dr. 

Schiff had described, respondent said, “I see—I see angels, white dots. I see angels”

and “they just be like, white dots, different white dots floating in the air. I see them 

some, like not as much. I see black dots, but I see white dots more than the white 

dots.” Respondent said that he knew that the white dots were angels, but that “[t]he 

black[ ] one just might be hallucinations or—that is negativity.” When the trial court 

asked him whether he felt better inside or outside of the hospital, respondent 

answered that he had “bad habits,” including smoking cigarettes and marijuana, and

that he would pick up cigarette butts by his apartment “so nobody can slip and fall 

on it.”

¶ 16 After respondent’s counsel made her closing argument, during which she 

requested that respondent be released from involuntary commitment, the trial court 

announced, based upon “clear, cogent, and convincing evidence,” that respondent had 

a mental illness, that he posed a danger to himself and to others, and that he was 

unable to care for himself. As a result, the trial court ordered that respondent remain 

involuntarily committed for another thirty days. On the same date, the trial court 

entered a written order that incorporated the examination reports prepared by Dr. 

Jones and Dr. Christensen and found “by clear, cogent, and convincing evidence” that 

respondent

has [a] mental illness[,] that being schizoaffective disorder

[and] has [a] long-standing [history] of mental illness 
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which goes back to his late teens[,] he is 33 [years old] now. 

[Respondent] suffers from hallucinations, disorganized 

thoughts[, and] is noncompliant with medications when not 

in [the] hospital. His active psychosis causes him to be a

danger to himself and others. His ACT team initially had 

him committed as they were unable to see to his needs due 

to his decompens[ation]. [Respondent] [is] unable to 

sufficiently [take] care of [his] needs[,] that being dental 

[and] nourishment needs. [Respondent] lives with [a] 

person who has anger issues [and respondent] has been 

[the] victim of assaultive [behavior and] disturbing 

thoughts which cause deterioration [and] leaves him 

unable to perceive dangers to himself.

Based upon these findings, the trial court concluded that respondent was mentally ill 

and posed a danger to himself and others. Respondent noted an appeal to the Court 

of Appeals from the trial court’s order.

C. Court of Appeals Decision

¶ 17 In seeking relief from the trial court’s order before the Court of Appeals, 

respondent began by arguing that the trial court’s written findings of fact lacked

sufficient evidentiary support and did not support its conclusion that respondent

posed a danger to himself and others. Among other things, respondent contended 

that the trial court had violated his right to confront and cross-examine the witnesses

against him when it admitted the examination reports of Dr. Jones and Dr. 

Christensen into evidence even though neither of them had testified at the hearing

and that there was “no other clear, cogent, and convincing record evidence that 

[respondent] was dangerous to himself or others.” In addition, respondent argued
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that the trial court had violated respondent’s due process right to an impartial 

tribunal by “assuming the role of prosecutor by presenting the entirety of the State’s 

case.”

¶ 18 The Court of Appeals began by addressing respondent’s due process argument, 

with a majority of the Court of Appeals having concluded that “the trial court only 

elicited evidence that would otherwise be overlooked as no counsel for the State was 

present,” that “[t]he trial court did not ask questions meant to prejudice either party

or impeach any witness,” and that, as a result, “the trial court did not violate 

[r]espondent’s right to an impartial tribunal.” C.G., ¶ 25. Judge Griffin dissented

from his colleagues’ conclusion with respect to the due process issue on the grounds 

that respondent had been “deprived of his liberty by an officer of the court who, after 

expressing some reluctance, offered and admitted evidence against that individual, 

called an adverse witness to testify on his adversary’s behalf, and examined that 

witness to elicit the State’s evidence.” C.G., ¶ 46 (Griffin, J., dissenting).3

¶ 19 Next, the Court of Appeals evaluated whether the trial court’s written findings 

of fact were supported by competent evidence and supported its determination that 

respondent should be involuntarily committed for additional inpatient treatment. As 

an initial matter, the Court of Appeals held that the trial court had erred by 

 

3 As a result of the fact that we have addressed respondent’s due process claim in 

detail in our opinion in a companion case, we will refrain from further discussion of the Court 

of Appeals’ evaluation of that issue in this opinion.
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incorporating the commitment examination reports into its written findings of fact

given that, even though such reports are generally admissible in involuntary 

commitment proceedings, respondent had been deprived of the right to confront and 

cross-examine the persons who had prepared those reports. Id. ¶¶ 27–28 (citing 

N.C.G.S. § 122C-268(f) (2019)). According to the Court of Appeals, neither Dr. Jones 

nor Dr. Christensen had been present at respondent’s involuntary commitment 

hearing, so that the trial court had violated respondent’s confrontation rights by

incorporating the contents of those reports into its written findings of fact. Id. ¶ 28.4

¶ 20 Nevertheless, the Court of Appeals concluded that the testimony provided by 

Dr. Schiff and the trial court’s remaining findings of fact were sufficient to support 

its decision to involuntarily commit respondent, so that the trial court’s error in 

incorporating the examiners’ reports into its findings of fact constituted harmless

error. Id. ¶ 29 (citing State v. Ferguson, 145 N.C. App. 302, 307 (2001)). More 

 

4 Although Judge Griffin appeared to agree with his colleagues that the trial court had

erred by incorporating the relevant reports into its written findings, he seems to have reached 

this conclusion on the grounds that, in light of the trial court’s failure to formally admit the 

relevant reports into evidence, it had violated respondent’s due process rights when it 

incorporated those reports into its written findings. C.G., ¶ 54 (Griffin, J., dissenting). Judge 

Griffin did not, however, address the issue of whether the evidence and the trial court’s 

written findings sufficed to support the trial court’s decision to involuntarily commit 

respondent for additional inpatient treatment. As a result of the fact that the State did not 

note an appeal based upon this aspect of Judge Griffin’s dissent or seek discretionary review 

of the Court of Appeals’ decision with respect to this issue, the question of whether the Court 

of Appeals erred by holding that trial court improperly incorporated the contents of the 

examination reports into its written findings of fact is not properly before us for decision. See 

N.C. R. App. P. 10(a) (providing that issues not raised in a party’s brief are deemed 

abandoned).
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specifically, the Court of Appeals held that the record contained sufficient evidence, 

consisting of respondent’s own testimony, to support the trial court’s determination

that respondent was a danger to himself because of his “inability to care for his own 

nourishment and dental needs.” Id. ¶ 34. In addition, the Court of Appeals held that 

the trial court’s finding that respondent’s ACT team was unable to adequately ensure 

that his needs for nourishment and dental care would be met “created the [required]

nexus between [r]espondent’s mental illness and future harm to himself.” Id. ¶ 35. 

Finally, the Court of Appeals concluded that “[a] showing of behavior that is grossly 

irrational, of actions that the individual is unable to control, . . . or of other evidence 

of severely impaired insight and judgment shall create a prima facie inference that 

the individual is unable to care for himself or herself.” Id. ¶ 36 (quoting N.C.G.S. 

§ 122C-3(11)(a)(1)(II) (emphasis added by Court of Appeals). In the Court of Appeals’

view, Dr. Schiff’s testimony concerning respondent’s hallucinations and disturbed 

thinking, his description of the assaults that had been previously perpetrated upon

respondent, and his concern that respondent would decompensate following 

discharge sufficed to support an inference that respondent would be unable to care 

for himself. Id. As a result, the Court of Appeals concluded that the trial court did 

not err by determining that respondent posed a danger to himself. Id.

5 Respondent 

 

5 As a result of its conclusion that the evidence supported a finding that respondent 

posed a danger to himself, the Court of Appeals did not reach the issue of whether the trial 
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noted an appeal to this Court from the Court of Appeals’ decision with respect to the 

due process issue based on Judge Griffin’s dissent, and we allowed respondent’s 

request for discretionary review of the Court of Appeals’ determination that the

record evidence and the trial court’s written findings sufficed to support the trial 

court’s decision to have respondent involuntarily committed for additional inpatient 

treatment.

II. Analysis

A. Standard of Review

¶ 21 According to well-established North Carolina law, this Court reviews decisions 

of the Court of Appeals for errors of law. N.C. R. App. P. 16(a); State v. Melton, 371 

N.C. 750, 756 (2018). “When constitutional rights are implicated, the appropriate 

standard of review is de novo.” In re Adoption of S.D.W., 367 N.C. 386, 391 (2014); 

see also Dorsey v. UNC-Wilmington, 122 N.C. App. 58, 66 (1996) (utilizing a de novo 

standard of review in determining whether the trial court had violated a party’s due 

process right to an “impartial decisionmaker”). In addition, as the Court of Appeals 

has correctly held, an involuntary commitment order is reviewed on appeal for the 

purpose of determining whether the trial court’s findings of fact are supported by 

sufficient evidence and whether the trial court’s findings support its determination 

 

court’s determination that respondent posed a danger to others had sufficient support in the 

record evidence and the trial court’s findings of fact. C.G., ¶ 33.
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that the respondent should be involuntarily committed for additional inpatient 

treatment, In re N.U., 270 N.C. App. 427, 430 (2020), with the latter of these 

determinations also being subject to de novo review on appeal. “Under a de novo 

review, the court considers the matter anew and freely substitutes its own judgment 

for that of the lower tribunal.” State v. Williams, 362 N.C. 628, 632–33 (2008) 

(cleaned up). Although the involuntary commitment order at issue in this case has 

long since expired, respondent’s appeal is not moot. See In re E.D., 372 N.C. 111, 114 

n.8 (2019) (concluding that “[t]he possibility that [the] respondent’s commitment in 

this case might likewise form the basis for a future commitment, along with other 

obvious collateral consequences, convinces us that this appeal is not moot” (quoting 

In re Hatley, 291 N.C. 693, 695 (1977))).

B. Due Process

¶ 22 In his first challenge to the Court of Appeals’ decision, respondent argues that 

the trial court violated his due process right to an impartial tribunal when it “called

the case, elicited all the evidence in favor of involuntarily committing [respondent], 

and then, based on the evidence [that] the [trial court] introduced, decided to 

involuntarily commit [respondent].” For the reasons set forth in our opinion in In re 

J.R., ___ N.C. ___, 2022-NCSC-127, we hold that no due process violation occurred in 

this case given that nothing about the manner in which the trial court conducted

respondent’s involuntary commitment hearing tended to cast doubt upon the trial 
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court’s impartiality. “The trial court simply presided over the hearing, asking 

questions to increase understanding and illuminate relevant facts to determine 

whether respondent met the necessary conditions for commitment.” Id. ¶ 24. As a 

result, we affirm the decision of Court of Appeals with respect to the due process

issue.

C. Sufficiency of Written Findings Supporting Commitment

¶ 23 In his second challenge to the trial court’s involuntary commitment order, 

respondent argues that the trial court’s findings of fact were not supported by 

competent evidence and that those findings were not sufficient to support a 

determination that respondent posed a danger to himself. As we have already noted, 

in order to involuntarily commit an individual for inpatient treatment, the trial court 

must “find by clear, cogent, and convincing evidence that the respondent is mentally 

ill” and that he or she is either “dangerous to self” or “dangerous to others.” N.C.G.S. 

§ 122C-268(j).6 A respondent poses a danger to himself when, “[w]ithin the relevant 

past,” he or she has (1) acted in a manner that presents a reasonable probability that 

 

6 As a result of the fact that respondent has not contested the validity of the trial 

court’s finding that he was mentally ill, that determination is binding for purposes of 

appellate review. See State v. Fuller, 376 N.C. 862, 2021-NCSC-20, ¶ 8 (holding that “[a] trial 

court’s finding of an ultimate fact is conclusive on appeal if the evidentiary facts reasonably 

support the trial court’s ultimate finding”). In addition, we conclude that the trial court’s 

determination concerning respondent’s mental illness is supported by Dr. Schiff’s testimony 

that respondent suffers from a schizoaffective disorder and has a “long-standing history of 

mental illness with psychosis” and by respondent’s admission that he had been diagnosed 

with a mental illness.
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he or she will suffer serious physical debilitation in the near future; (2) attempted or 

threatened suicide and there is a reasonable probability of suicide; or (3) mutilated 

or attempted to mutilate himself or herself and there is a reasonable probability of 

serious self-mutilation, absent intervention and treatment. N.C.G.S. § 122C-3(11)(a).

With respect to the first of these three scenarios, which is the only one that appears 

to be relevant for purposes of this case, the relevant statute provides that an 

individual poses a danger to himself if:

I. The individual would be unable, without care, 

supervision, and the continued assistance of others not 

otherwise available, to exercise self-control, judgment, and 

discretion in the conduct of the individual’s daily 

responsibilities and social relations, or to satisfy the 

individual’s need for nourishment, personal or medical 

care, shelter, or self-protection and safety.

II. There is a reasonable probability of the individual’s 

suffering serious physical debilitation within the near 

future unless adequate treatment is given pursuant to this 

Chapter. A showing of behavior that is grossly irrational, 

of actions that the individual is unable to control, of 

behavior that is grossly inappropriate to the situation, or 

of other evidence of severely impaired insight and 

judgment shall create a prima facie inference that the 

individual is unable to care for himself or herself.

N.C.G.S. § 122C-3(11)(a)(1). In addition, the relevant statutory language provides

that “previous episodes of dangerousness to self, when applicable, may be considered 

when determining reasonable probability of physical debilitation, suicide, or selfmutilation.” N.C.G.S. § 122C-3(11)(a). A trial court must make findings of fact that 
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support both prongs of this test in order to support an involuntary commitment order. 

N.C.G.S. § 122C-268(j).

¶ 24 In seeking to persuade us to overturn the trial court’s involuntary commitment 

order, respondent argues that the Court of Appeals’ decision in this case 

“dramatically changed the test for what constitutes ‘danger to self’ ” by “essentially

[holding] that a person may be found to be dangerous to himself based solely on 

current self-care issues without any forward-facing showing of ‘serious physical 

debilitation.’ ” According to respondent, the trial court was required to make specific 

findings concerning the probability that respondent would experience serious 

physical debilitation if released given that the Court of Appeals has previously held

that “courts may not disregard the second prong of the definition of ‘danger to self,’ ”

citing In re Monroe, 49 N.C. App. 23, 29 (1980), superseded on other grounds by 

statute, An Act to Recodify the Mental Health, Mental Retardation, and Substance 

Abuse Laws of North Carolina, ch. 589, §§ 1–2, 1985 N.C. Sess. Laws 670, 672, as 

recognized in In re J.P.S., 264 N.C. App. 58 (2019); In re W.R.D., 248 N.C. App. 512, 

516 (2016); In re Whatley, 224 N.C. App. 267, 273 (2012). In respondent’s view, 

“[u]nder Monroe, Whatley, W.R.D., and the plain language of the involuntary 

commitment statutes, being mentally ill and exhibiting symptoms of that mental 

illness, without more, are insufficient to support a finding of dangerous to self.”
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¶ 25 According to respondent, “none of the trial court’s findings specifically 

addressed the future harm prong” of the statute. In addition, respondent contends 

that the record contains insufficient record evidence to support the trial court’s order, 

with the Court of Appeals having erred by relying on Dr. Schiff’s testimony that 

respondent “was still experiencing symptoms of his mental illness and that 

[respondent] told [Dr. Schiff] that he didn’t think he needed his medication or had a 

long-standing mental illness,” citing C.G., ¶ 36. In respondent’s view, “this evidence 

reflected the trial court’s ultimate finding that [respondent] had a mental illness and 

described [respondent’s] condition and symptoms at the time of the hearing, [but it 

does] not indicate that [respondent] presented a threat of ‘serious physical 

debilitation’ in the near future.”

¶ 26 Finally, respondent argues that a “prima facie inference” that he lacked the 

ability to care for himself, which the trial court was entitled to make in the event that 

respondent displayed certain behaviors or actions, see N.C.G.S. § 122C-3(11)(a)(1)(II), 

did not relieve the trial court of its obligation to make a finding that respondent would 

have likely experienced serious physical debilitation in the event that he was not 

involuntarily committed. Respondent argues that a person’s inability to take care of 

his or her daily needs is not equivalent to facing a reasonable possibility that he or 

she would sustain serious harm and that the Court of Appeals’ conclusion to the 

contrary “erodes the constitutional assurance that we don’t involuntarily commit 
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someone for having a mental illness,” citing O’Connor v. Donaldson, 422 U.S. 563, 

575 (1975). As a result, for all these reasons, respondent urges us to reverse the Court 

of Appeals’ holding that the trial court’s findings of fact sufficed to support its

determination that he posed a danger to himself.

¶ 27 In seeking to persuade us to uphold the trial court’s order, the State begins by 

arguing that respondent “does not contest the [trial] court’s finding that he was not 

able to satisfy his basic needs and exercise self-control” and that, even if he had done 

so, those findings had sufficient record support. In addition, the State contends that 

the trial court “properly found that there was a reasonable probability of 

[respondent’s] physical debilitation in the near future absent treatment.” After

acknowledging that the trial court is required to find that respondent would likely 

suffer physical debilitation in the near future in the event that he was released from 

involuntary commitment, the State argues that the trial court “need not say the 

magic words ‘reasonable probability of future harm’ ” in order to make the required 

determination, quoting J.P.S., 264 N.C. App. at 63.

¶ 28 According to the State, the trial court “specifically found that [respondent’s]

current psychosis will persist and endanger him in the near future” and “that [he] 

was likely to repeat his previous self-endangering conduct.” First, the State contends 

that the trial court found that respondent had “ ‘active psychosis’ ” that “ ‘causes him 

to be a danger to himself and others’ ” and that, “unless committed, [respondent] was 
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likely to continue to experience self-endangering psychosis, hallucinations, and 

disorganized thoughts.” (emphasis added in brief). In addition, the State argues that

the trial court found that respondent “was noncompliant with his medicine when he 

was not in inpatient treatment,” a fact that “indicate[s] that, if released, there was a 

reasonable probability that the symptoms causing [respondent’s] physical 

debilitation would continue.” The State contends that these findings are supported 

by Dr. Schiff’s testimony that respondent had “very profound disorganization of 

thought and behavior responding to hallucinations,” that his thoughts “contain[ed] 

derogatory content that was quite disturbing to [respondent],” and that respondent

had thrown away his medications.

¶ 29 Second, the State argues that the trial court “made findings that indicate that, 

absent treatment, [respondent] was likely to engage in conduct that had harmed him 

in the past.” More specifically, the State asserts that the trial court found that 

“[respondent] lives with a person who has anger issues . . . and that [he] has, in fact, 

become a victim of assaultive behavior and disturbing thoughts, which caused 

deterioration and leaves him unable to perceive dangers to himself resulting in his 

being assaulted.” (emphasis added in brief). According to the State, these findings 

“indicate that, absent treatment, [respondent’s] disturbing thoughts would have 

persisted and there was a reasonable probability that [respondent] would both behave 

in ways that instigated others to violence and been unable to perceive the danger of 
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being assaulted” given that respondent “lived with a roommate who struggled with 

anger management and with whom [respondent] had previously gotten into fights, 

and because, before he was committed, [respondent] had started wandering the 

streets.”

¶ 30 Finally, the State argues that “the inference that [respondent] was unable to 

care for himself provides further support for the conclusion that there was a 

reasonable probability that [respondent] would suffer serious physical debilitation 

absent treatment,” citing N.C.G.S. § 122C-3(11)(a)(1)(II). In the State’s view, 

respondent’s behavior warrants such an inference in light of the trial court’s finding 

that respondent “suffers from hallucinations” and “disorganized thoughts” and the 

testimony presented at the hearing both by Dr. Schiff and by respondent. In addition, 

the State argues that the trial court’s other findings, including its determination that 

respondent’s ACT team had been unable to care for him, “combined with the inference 

that [respondent] was unable to care for himself, further indicate that [respondent]

was likely to suffer physical debilitation in the near future.”

¶ 31 After carefully reviewing the record, we hold that the trial court’s written 

findings were insufficient to support its ultimate finding that respondent constituted

a danger to himself. As we have already noted, the involuntary commitment statutes 

provide that “the court shall find by clear, cogent, and convincing evidence that the 

respondent is mentally ill and dangerous to self.” N.C.G.S. § 122C-268(j) (emphasis
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added). For that reason, the required finding “must actually be made by the trial 

court” and “cannot simply be inferred from the record.” State v. Morgan, 372 N.C. 

609, 616 (2019) (holding that, “when the General Assembly has inserted the phrase 

‘the court finds’ in a statute setting out the exclusive circumstances under which a 

defendant’s probation may be revoked, the specific finding described in the statute 

must actually be made by the trial court and cannot simply be inferred from the 

record”). However, “[t]hese ultimate findings, standing alone, are insufficient to 

support the trial court’s order,” since “the trial court must also ‘record the facts upon 

which its ultimate findings are based.’ ” In re N.U., 270 N.C. App. at 430 (quoting In 

re Collins, 49 N.C. App. 243, 246 (1980)). As a result, our review of the sufficiency of 

the trial court’s order in this case must begin with an examination of its written 

findings.

¶ 32 As we have already noted, the trial court found in its written order that

Respondent has [a] mental illness[,] that being 

schizoaffective disorder [and] has [a] long-standing 

[history] of mental illness which goes back to his late 

teens[,] he is 33 [years old] now. [Respondent] suffers from 

hallucinations, disorganized thoughts[, and] is 

noncompliant with medications when not in [the] hospital. 

His active psychosis causes him to be a danger to himself 

and others. His ACT team initially had him committed as 

they were unable to see to his needs due to his 

decompens[ation]. [Respondent is] unable to sufficiently 

[take] care of [his] needs[,] that being dental [and] 

nourishment needs. [Respondent] lives with [a] person 

who has anger issues [and respondent] has been [the] 

victim of assaultive [behavior and] disturbing thoughts 
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which cause deterioration [and] leaves him unable to 

perceive dangers to himself.

As an initial matter, we observe that, contrary to the State’s assertion, the trial court 

never found that “[respondent] was unable to satisfy his basic needs and exercise selfcontrol.” On the contrary, the trial court found that respondent could not take care 

of his “dental” and “nourishment” needs, rather than his “basic” needs, and said 

nothing about respondent’s ability to exercise self-control. In addition, we note that 

the trial court did not find that, in the event that respondent was released from 

involuntary commitment, he would immediately decompensate or place himself in 

danger or that respondent’s ACT team could not manage respondent’s level of 

functioning in an outpatient environment. As a result, under the applicable legal 

standard, we are required to take the trial court’s findings as they stand without 

reference to any other information that might be contained in the record, including 

Dr. Schiff’s testimony that “there would be an immediate decompensation” upon 

discharge; that, in the absence of inpatient treatment, respondent “would 

immediately decompensate, be into a hospital,” or “into a situation placing himself or 

others in danger;” and that respondent’s ACT team could not support respondent in 

an outpatient environment. 

¶ 33 The trial court’s findings, as written, cannot be deemed sufficient to support a 

determination that respondent posed a danger to himself given its failure to find that 

there was “a reasonable probability of [respondent] suffering serious physical 
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debilitation within the near future” unless he was involuntarily committed. N.C.G.S. 

§ 122C-3(11)(a)(1)(II). As the Court of Appeals has consistently held for several 

decades, the relevant statutory provision “mandates a specific finding of a probability 

of serious physical debilitation resulting from the more general finding of lack of selfcaring ability.” Monroe, 49 N.C. App. at 29; see also W.R.D., 248 N.C. App. at 515 

(holding that, in order to support a determination that the respondent posed a danger 

to himself, the trial court must find that the respondent cannot care for himself or 

herself and that there is a reasonable probability that the respondent will experience

serious physical debilitation in the absence of continued inpatient treatment); 

Whatley, 224 N.C. App. at 273 (holding that “the trial court’s findings reflect [the] 

[r]espondent’s mental illness, but they do not indicate that [her] illness or any of her 

aforementioned symptoms will persist and endanger her within the near future”).

¶ 34 In Monroe, the respondent’s brother sought to have the respondent 

involuntarily committed on the grounds that he posed a danger to himself and others. 

49 N.C. App. at 24. At the conclusion of the involuntary commitment hearing, the 

trial court determined that respondent was mentally ill and a danger to himself and 

others7 based upon the following findings of fact:

 

7 The statutory definition of “dangerous to self” at the time that the Court of Appeals

decided Monroe was, for all relevant purposes, identical to the one that applies in this case. 

Compare N.C.G.S. 122-58.2(1) (1979) with N.C.G.S. 122C-3(11)(a) (2021). 
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1. The Respondent has been hospitalized at Dorothea 

Dix Hospital two times since 1975 prior to his current 

admission.

2. At the time of his last discharge from the hospital 

the Respondent’s physician prescribed medicine for him to 

take, and his brother purchased the medicine for him. The 

Respondent took the medicine for only three weeks. The 

Respondent then refused to take any more of his medicine 

and stated to his brother, “You might as well give me the 

money because I will not take that. I don’t need it.”

3. As long as Respondent was taking his medicine he 

was in control of himself; but, once he stopped taking his 

medicine he started going down.

4. He has become uncontrollable at times.

a. During the night he is irregular in his 

sleeping. He is up from three to six times a night.

b. At other times he is in his front yard or on his 

porch making all kinds of loud noises or calling 

inappropriately to anyone passing by and telling 

them to hold their head up or telling them how they 

should do.

. . . .

5. Respondent disregards his nutritional needs by 

fasting for some periods and then eating a whole chicken 

or a whole loaf of bread. Respondent eats about five pounds 

of sugar every two days. He will sometimes consume five 

or six glasses of sweet water.

. . . .

8. Respondent has the paranoid and delusional belief 

that his family is sexually seducing him and he has accused 

them of that. He believes that all of his relatives are 

against him.
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9. On a previous hospital admission, Respondent was 

noted to be lying in bed all day staring up at the ceiling. 

He wouldn’t move. This same type of behavior has been 

exhibited on his present admission.

10. Respondent has refused medication on this 

admission.

Id. at 26–27. On appeal, the Court of Appeals held that “neither the facts recorded 

by the trial court nor the record supports a conclusion or ultimate finding of 

dangerousness to self” on the basis that, “even if indicative of some danger, the facts 

do not support the finding that there is a reasonable probability of serious physical 

debilitation to the [r]espondent within the near future.” Id. at 29 (cleaned up). The 

Court of Appeals also noted that, while the respondent’s disregard of his nutritional 

needs “may be evidence of mental illness” or even characteristic of an “inability to 

‘exercise self-control, judgment, and discretion in the conduct of his daily 

responsibilities,’ ” the record evidence did not show a “reasonable probability of 

serious physical debilitation to [the respondent] within the near future,” with the 

State having failed to elicit any evidence “showing the present or future effect of these 

irregular dietary habits on respondent” and with the existence of “[u]nusual eating 

habits alone [ ] do not amount[ing] to danger as contemplated in the controlling 

statute.” Id. (quoting N.C.G.S. 122-58.2(1)(a)(1)(I) (1979))
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¶ 35 In Whatley, the trial court involuntarily committed the respondent for 

additional treatment after finding “by clear, cogent, and convincing evidence” that 

she

was exhibiting psychotic behavior that endangered her and 

her newborn child. She is bipolar and was experiencing a 

manic stage. She was initially noncompliant in taking her 

medications but has been compliant over the past 7 days. 

Respondent continues to exhibit disorganized thinking 

that causes her not to be able to properly care for herself. 

She continues to need medication monitoring. Respondent 

has been previously involuntarily committed.

224 N.C. App. at 271. On appeal, the Court of Appeals held that “none of the [trial] 

court’s findings demonstrate that there was ‘a reasonable possibility of [the 

respondent] suffering serious physical debilitation within the near future’ absent her 

commitment” and that, while “[e]ach of the trial court’s findings pertain to either [the] 

[r]espondent’s history of mental illness or her behavior prior to and leading up to the 

commitment hearing,” they “do not indicate that these circumstances rendered [the] 

[r]espondent a danger to herself in the future.” Id. at 273. In addition, the Court of 

Appeals held that, even though the trial court had determined that the respondent 

“needed medication monitoring and that she did not plan to follow up as an 

outpatient,” the trial court had made “no finding that connect[ed] these concerns with 

the court’s ultimate finding of ‘dangerous to self’ as defined in [N.C.G.S.] § 122C3(11)(a)(1).” Id.
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¶ 36 In W.R.D., the Court of Appeals determined that the trial court’s involuntary 

commitment order contained only two findings that could reasonably be construed as 

relevant to the issue of whether the respondent posed a “danger to self.” 248 N.C. 

App. at 515.

First, the trial court found that “it is not medically safe for 

Respondent to live outside of an inpatient commitment 

setting” because “Respondent maintains a belief that 

another doctor is his treating physician and will not be 

treated by Dr. Weigel”; “Respondent is diagnosed 

with paranoid schizophrenia, for which Respondent has 

refused treatment”; and “Respondent has heart health 

related issues, for which he is not compliant with 

prescribed medical treatment.” Second, the trial court 

found that Respondent was “unable to take [sic] maintain 

his nutrition.” The trial court did not include any 

additional findings of fact concerning Respondent's 

nutrition.

Id. at 515–16. After concluding that the record did not contain any evidence tending 

to show that the respondent’s “refusal to acknowledge his mental illness” or his 

“refusal to take his prescription medication” created a “reasonable probability of his 

suffering serious physical debilitation within the near future” in the absence of

immediate involuntary commitment, the Court of Appeals determined that the trial 

court’s findings with respect to the respondent’s “inability to ‘maintain his nutrition’ 

[were] not supported by competent evidence.” Id. at 516.
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¶ 37 Most recently, in J.P.S., the Court of Appeals vacated an involuntary 

commitment order in which the trial court had found that the respondent posed a 

danger to himself based on evidence tending to show that

(1) Respondent maintained grandiose thoughts that he had 

a military staff providing him with intelligence 

information; (2) Respondent ingested a large number of 

pills in an apparent suicide attempt; (3) Respondent had “a 

high dose of Adderall [and] Valium meds”; (4) Respondent 

presented with an agitated manner and required forced 

medication and restraints; (5) Respondent refused 

medication for mania and psychosis; and (6) Respondent 

suffered from post-traumatic stress disorder as a result of 

prior military service.

264 N.C. App. at 63. In declining to uphold the trial court’s involuntary commitment

order “because of the trial court’s failure to include a finding of reasonable probability 

of some future harm,” the Court of Appeals explained that, “[a]s in Whatley, the trial 

court’s findings in this case ‘reflect [the] [r]espondent’s mental illness, but they do not

indicate that [the] [r]espondent’s illness or any of [his] aforementioned symptoms will 

persist and endanger [him] within the near future.’ ” Id. (quoting Whatley, 224 N.C. 

App. at 273). According to the Court of Appeals, while “the trial court need not say 

the magic words ‘reasonable probability of future harm,’ it must draw a nexus between 

past conduct and future danger.” Id. (emphasis added) (quoting Whatley, 224 N.C. 

App. at 273).

¶ 38 The consistent theme in each of these decisions is that trial court’s findings 

that an individual suffers from a mental illness, exhibits symptoms associated with
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that mental illness, and may not be able to take care of his or her needs are not 

sufficient to satisfy the second prong of the statutory test for the presence of a “danger 

to self.” In this case, the trial court found that respondent suffered from 

schizoaffective disorder, hallucinations, and disorganized thoughts; that his ACT 

team had initially had respondent committed because “they were unable to see to his 

needs due to his decompensating;” that he was “noncompliant with medications” 

when he was not in the hospital; and that he was not able to sufficiently attend to his 

“dental [and] nourishment needs.” A critical analysis of these findings and the 

underlying record evidence shows that they “[do] not demonstrate a ‘reasonable 

probability of [respondent] suffering serious physical debilitation within the near 

future’ without immediate, involuntary commitment,” W.R.D., 248 N.C. App. at 516, 

with the trial court having failed to couple its findings concerning respondent’s past 

and current condition with any findings regarding the extent to which respondent 

faced a risk of “serious physical debilitation” in the event that he did not remain in 

inpatient care.

¶ 39 In seeking to persuade us to reach a different result, the State contends that 

the trial court’s findings “show that [respondent’s] symptoms were likely to persist” 

given that those findings use “present tense verbs” to describe respondent’s symptoms 

and indicate that respondent “has an active psychosis’ that makes him ‘a danger to 

himself.’ ” (emphasis added in brief). We do not find this argument persuasive. As 
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an initial matter, the trial court findings in each of the Court of Appeals’ decisions 

described above were also written in the present tense, but that fact did not convince 

the Court of Appeals to uphold the challenged orders. In addition, and more 

importantly, the fact that a respondent had significant mental health difficulties in 

the past and currently exhibits symptoms of mental illness, standing alone, does not 

tend to establish that these symptoms will necessarily occur or persist in the future 

or that he or she will suffer serious physical debilitation in the near future in the 

absence of additional inpatient treatment. See J.P.S., 264 N.C. App. at 62 (stating 

that “[a] trial court’s involuntary commitment of a person cannot be based solely on 

findings of the individual’s ‘history of mental illness or . . . behavior prior to and 

leading up to the commitment hearing’ ” (quoting Whatley, 224 N.C. App. at 273)).

8

In addition, the trial court’s finding that respondent’s “active psychosis causes him to 

be a danger to himself” fails to explain how respondent’s psychosis precludes him 

from attending to his physical needs or causes him to face a risk of serious physical 

debilitation in the near future. Simply put, findings or evidence that one has been or 

 

8 The State relies on Carr v. United States, 560 U.S. 438, 448 (2010), for the proposition 

that “words used in the present tense include the future as well as the present.” Carr involved 

the interpretation of a federal sex offender registration statute, with the quoted language 

having come directly from 1 U.S.C. § 1, which provides guidance for “determining the 

meaning of any Act of Congress.” Id. We are unable to see how Carr has any relevance to

the issue that is before us in this case, which involves the interpretation of a state court’s 

handwritten factual findings contained in an involuntary commitment order.
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currently is mentally ill, or has, in the past, “decompensat[ed],”

9 without more, does 

not make one dangerous to himself or others, with the trial court’s findings to that 

effect and the underlying record evidence failing to account for the fact that the 

second prong of the relevant statutory test requires proof that future physical harm 

is probable in the absence of involuntary commitment. See O’Connor, 422 U.S. at 575 

(holding that “[a] finding of ‘mental illness’ alone cannot justify a State’s locking a 

person up against his will and keeping him indefinitely in simple custodial 

confinement”).10

¶ 40 We are equally unpersuaded by the State’s claim that respondent’s involuntary 

commitment was justified by the trial court’s finding that respondent lived with a 

roommate who had anger problems and that respondent had previously been 

assaulted by others. As respondent points out, these facts “[do] not justify his

 

9 In our understanding, “decompensation” is a term of art within the psychiatric 

profession that Dr. Schiff never defined during his testimony. Although the American 

Psychological Association defines “decompensation” as “a breakdown in an individual’s 

defense mechanisms, resulting in a progressive loss of normal functioning or worsening of 

psychiatric symptoms,” American Psychological Association Dictionary of Psychology, 

https://dictionary.apa.org/ decompensation (last visited December 6, 2022), neither the trial 

court’s order nor Dr. Schiff’s testimony demonstrates specifically how a likelihood of 

“decompensation” tended to show the existence of a “reasonable probability of [respondent] 

suffering serious physical debilitation within the near future” absent treatment in an 

inpatient facility.

10 More specifically, while the record does contain evidence tending to show that 

respondent suffered from active psychosis, was at a risk of decompensation, and had shown 

a level of decompensation in the recent past, that generalized evidence, without more, does 

not tend to show that respondent is at a risk of substantial debilitation in the near term in 

the event that he is released from involuntary commitment. 
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commitment” against his will, with the Court of Appeals having rejected a virtually 

identical argument more than forty years ago in the course of considering the 

sufficiency of psychiatric testimony that the respondent “was imminently dangerous 

to herself and others” because the respondent’s mental health difficulties might cause 

others to engage in assaultive behavior. See In re Hogan, 32 N.C. App. 429, 434 

(1977). As the Court explained,

it is abundantly clear from his testimony given at the 

hearing that [the psychiatrist] arrived at his opinion that 

[the] respondent was imminently dangerous to herself or 

others solely because he felt that her persistence in trying 

to convert someone on the street might cause that person 

to resist the idea, so that “they could become physically 

aggressive toward her.” If so, it would seem more 

appropriate to commit her aggressor rather than the 

respondent.

Id.; see also Monroe, 49 N.C. App. at 29–30 (holding that “[t]he chance that someone 

will harm [the] respondent in response to [his] action[s] cannot be found to be 

evidence of danger to self”). As a result, we hold that a risk that someone else might 

engage in unlawful conduct by assaulting respondent cannot support a determination 

that respondent poses a danger to himself sufficient to support the respondent’s

involuntary commitment for inpatient mental health treatment.

¶ 41 Finally, the State argues that “the inference that [respondent] was unable to 

care for himself provides further support for the conclusion that there was a 

reasonable probability that [respondent] would suffer serious physical debilitation 
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absent treatment,” citing N.C.G.S. § 122C-3(11)(a)(1)(II). Admittedly, the record in 

this case could support a determination of “grossly irrational” or “grossly 

inappropriate” behavior on the part of respondent and contains “other evidence of 

impaired insight and judgment” on respondent’s part that is sufficient to “create a 

prima facie inference that [respondent] is unable to care for himself.”11 N.C.G.S. 

§ 122C-3(11)(a)(1)(II). As the State acknowledges, however, “an inference that 

respondents are unable to care for themselves cannot alone satisfy the second prong” 

of the statutory definition of “danger to self.” In addition, as we have already 

explained, an inference that someone is “unable to care for himself” does not 

necessarily mean that that person is at risk of “suffering serious physical debilitation 

within the near future” in the absence of inpatient mental health treatment, with the 

fact that the respondent is “unable to care for himself” being insufficient to obviate 

the need to “draw a nexus between [the respondent’s] past conduct and future 

danger.” J.P.S., 264 N.C. App. at 63.

¶ 42 Thus, for all these reasons, we hold that the Court of Appeals erred by

concluding that the trial court’s findings and the record evidence were sufficient to 

support a determination that respondent posed a danger to himself and that 

 

11 Interestingly, it was the Court of Appeals that first drew this inference. There is 

no indication in the record that the trial court did so.
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Opinion of the Court

respondent’s involuntary commitment could be justified on that basis.

12 As a result, 

we reverse the trial court’s involuntary commitment order and remand this case to 

the trial court for further proceedings not inconsistent with this opinion.

13 We take 

this action with the understanding that, as the Court of Appeals observed in W.R.D., 

 

12 An examination of the sufficiency of the evidence concerning the extent to which 

respondent posed a danger to himself is necessary in order to permit the Court to determine 

whether this case should be remanded to the trial court for the purpose of allowing the trial 

court to consider whether, in the event that the trial court had made proper findings of fact 

that were supported by the evidence, respondent should have been involuntarily committed. 

13 Although the trial court also found that respondent was a danger to others, the 

Court of Appeals did not review the sufficiency of this finding or whether the evidence 

supported it in light of its determination that the trial court had properly found that 

respondent posed a danger to himself. C.G., ¶ 33. Although the State made a relatively brief 

argument in the Court of Appeals that the trial court’s findings and the record evidence would 

have supported a determination that respondent posed a danger to others, it made no effort 

to present any such argument before this Court and has not requested that, in the event that 

we did not uphold the trial court’s involuntary commitment order on the grounds that 

respondent posed a danger to himself, we remand this case to the Court of Appeals for the 

purpose of allowing it to determine whether the trial court’s involuntary commitment order 

could be upheld on the basis that respondent posed a risk to others. Aside from the issue of 

whether the remand approach remains viable as a matter of appellate procedure, we note 

that the relevant statute provides that a respondent is “dangerous to others” if, “[w]ithin the 

relevant past, the individual has inflicted or attempted to inflict or threatened to inflict 

serious bodily harm on another, or has acted in such a way as to create a substantial risk of 

serious bodily harm to another, or has engaged in extreme destruction of property; and that 

there is a reasonable probability that this conduct will be repeated.” N.C.G.S. § 122C3(11)(b). The trial court made no written findings that tend to suggest that respondent’s 

conduct would satisfy this statutory definition, and nothing in the record evidence appears 

to us to be sufficient to support such a determination. Dr. Schiff’s assertion that respondent’s 

hallucinations have in the past “led him to have aggressive behaviors in the community,” 

without explaining what those behaviors were, and respondent’s vague statement that he 

and William had “gotten into it” are hardly “clear, cogent, and convincing evidence” of the 

infliction, attempted infliction, threatened infliction, or creation of a substantial risk of 

“serious bodily harm on another.” As a result, we decline to remand this case to the Court of 

Appeals for consideration of the extent to which, if at all, the trial court’s involuntary 

commitment order should be upheld on the basis of a determination that respondent posed a 

danger to others.
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Opinion of the Court

our decision “does not mean that [r]espondent is competent, or that he cannot 

properly be committed at some future hearing.” 248 N.C. App. at 513. Instead, “[w]e

simply hold that the trial court’s findings and the evidence in the record are 

insufficient to satisfy the statutory criteria for involuntary commitment,” id., with a 

firm adherence to the relevant statutory requirements in these cases being essential 

given the “massive curtailment of liberty” and “stigmatizing consequences” that 

accompany involuntary commitment. Vitek v. Jones, 445 U.S. 480, 491–92 (1980).

III. Conclusion

¶ 43 Thus, for the reasons set forth in In re J.R., ___ N.C. ___, 2022-NCSC-127, we 

affirm the Court of Appeals’ decision with respect to the due process issue while 

holding that the record evidence and the trial court’s written findings of fact do not 

suffice to support the trial court’s involuntary commitment order. As a result, we

reverse the Court of Appeals’ decision, in part, and remand this case to that Court for 

further remand to the District Court, Durham County, for further proceedings not 

inconsistent with this opinion.

AFFIRMED, IN PART; REVERSED, IN PART; AND REMANDED.
Chief Justice NEWBY concurring in part and dissenting in part.

¶ 44 I agree with the majority’s conclusion that respondent’s due process right to an 

impartial tribunal was not violated for the reasons stated in In re J.R., 

2022-NCSC-127. I write separately, however, because the trial court did make 

forward-looking findings of fact that draw a nexus between respondent’s past conduct 

and a reasonable probability of future harm. Because the trial court’s findings of fact 

are supported by competent evidence and are sufficient to indicate a reasonable 

probability of respondent suffering future harm without adequate treatment, the 

Involuntary Commitment Order should be affirmed. Accordingly, I respectfully 

concur in part and dissent in part.

¶ 45 On 30 January 2020, respondent was taken to the emergency department by 

his outpatient care team, the Assertive Community Treatment (ACT) team. An ACT 

team consists of various mental health care providers who assist respondent when he 

is not in the hospital and monitor him weekly to ensure that he is taking his 

medication and that his dental and nourishment needs are met. Phillip Jones, M.D. 

first examined respondent when he arrived at the hospital and reported that 

respondent was “so psychotic [that] he [was] unable to effectively communicate his 

symptoms.” Dr. Jones completed a commitment report, concluding that respondent 

was dangerous to himself, and petitioned for respondent’s involuntary commitment. 

The next day, Miles Christensen, M.D. conducted a second examination of respondent
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Newby, C.J., concurring in part and dissenting in part

and completed a second commitment report. He observed that respondent was 

hearing voices, experiencing hallucinations, and “crying intensely.” Dr. Christensen 

diagnosed respondent with schizoaffective disorder and recommended that 

respondent be committed.

¶ 46 The trial court held an involuntary commitment hearing on 7 February 2020. 

Max Schiff, M.D., respondent’s attending physician, testified. Dr. Schiff explained 

that respondent’s ACT team brought respondent to the hospital because the team 

“could no longer support him in the community” as an outpatient due to “an acute 

change in his mental status with increasing disorganization, hallucinations, 

delusions, abnormal psychomotor behavior, . . . [and] wandering around the streets.” 

Dr. Schiff described that respondent was still demonstrating “very profound 

disorganization of thought and behavior responding to hallucinations” during his 

evaluation of respondent. According to Dr. Schiff, respondent had not taken his 

medications, “which had previously stabilized him[,]” and respondent informed him 

that “thoughts were being inserted into his head and [were] occasionally controlling 

him.” Dr. Schiff expressed concern that, if respondent was discharged, he “would 

immediately decompensate . . . into a situation placing himself or others [in] danger.” 

¶ 47 Respondent also testified at the hearing. Respondent explained that he sees 

black dots and angels, which he described as white dots. Respondent stated that he 

had been taking his medication and would continue to do so, but he could not “tell a
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Newby, C.J., concurring in part and dissenting in part

difference” if the medication was helping him.

¶ 48 At the close of the hearing, the trial court concluded that respondent was 

mentally ill and a danger to himself and others. The trial court recorded the following 

findings of fact: 

Respondent has [a] mental illness that being 

schizoaffective [disorder and] has long[-]standing [history] 

of mental illness which goes back to his late teens[.] [H]e is 

33 [years old] now. Resp[ondent] suffers from 

hallucinations, disorganized thoughts[, and] is 

noncompliant with medications when not in [the] hospital. 

His active psychosis causes him to be a danger to himself 

and others. His ACT team initially had him committed as 

they were unable to see to his needs due to his 

decompensating [and] unable to sufficiently take care of 

needs that being dental [and] nourishment needs. 

[Respondent] lives with [a] person who has anger issues 

[and respondent] has been [a] victim of assaultive 

[behavior and] disturbing thoughts which cause 

deterioration [and] leaves [respondent] unable to perceive 

dangers to himself.

¶ 49 The trial court ordered that respondent be involuntarily committed for thirty 

days. Respondent appealed.

¶ 50 On appeal, respondent challenged the trial court’s conclusion that he was a 

danger to himself or others under N.C.G.S. § 122C-3(11)(a). The Court of Appeals 

concluded that the “trial court properly found Respondent was a danger to himself.”

1

In re C.G., 278 N.C. App. 416, 2021-NCCOA-344, ¶ 33. The Court of Appeals reasoned 

 

1 Accordingly, the Court of Appeals did not reach the issue of whether the trial court’s 

conclusion that respondent is a danger to others was supported by sufficient evidence.
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Newby, C.J., concurring in part and dissenting in part

that the finding that respondent’s ACT team was unable to care for his dental and 

nourishment needs “created the nexus between Respondent’s mental illness and 

future harm to himself.” Id. ¶ 35. Therefore, according to the Court of Appeals, “the 

trial court satisfied the requirement [that] it find a reasonable probability of future 

harm absent treatment.” Id. The Court of Appeals thus affirmed the commitment 

order. Id. ¶ 37.

¶ 51 Respondent petitioned this Court to consider whether the Court of Appeals 

erred in concluding that the trial court’s written findings of fact were supported by 

competent evidence and were sufficient to support its conclusion that respondent is 

dangerous to himself. This Court allowed respondent’s petition.2

¶ 52 The task here is to determine whether the Court of Appeals properly held that 

the trial court’s findings of fact were supported by competent evidence and, in turn, 

supported its conclusion that respondent is a danger to himself. This Court reviews 

decisions of the Court of Appeals for legal error. State v. Brooks, 337 N.C. 132, 149, 

446 S.E.2d 579, 590 (1994). Appellate review of a commitment order “is limited to 

determining ‘(1) whether the court’s ultimate findings are indeed supported by the 

“facts” which the court recorded in its order as supporting its findings, and (2) 

whether in any event there was competent evidence to support the court’s findings.’ ” 

 

2 Respondent also appealed to this Court as of right based upon the dissenting opinion 

at the Court of Appeals, regarding the due process issue. Because the due process issue was 

resolved based upon the holding in the lead case, that issue is not further discussed herein. 
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Newby, C.J., concurring in part and dissenting in part

In re Moore, 234 N.C. App. 37, 42–43, 758 S.E.2d 33, 37 (quoting In re Hogan, 32 N.C. 

App. 429, 433, 232 S.E.2d 492, 494 (1977)), disc. rev. denied, 367 N.C. 527, 762 S.E.2d 

202 (2014). 

¶ 53 “To support an inpatient commitment order, the court shall find by clear, 

cogent, and convincing evidence that the respondent is mentally ill and dangerous to 

self . . . or dangerous to others . . . .” N.C.G.S. § 122C-268(j) (2021). An individual is a 

danger to himself if he has acted in a way that shows all of the following: 

I. The individual would be unable, without care, 

supervision, and the continued assistance of others not 

otherwise available, to exercise self-control, judgment, and 

discretion in the conduct of the individual’s daily 

responsibilities and social relations, or to satisfy the 

individual’s need for nourishment, personal or medical 

care, shelter, or self-protection and safety. 

II. There is a reasonable probability of the individual’s 

suffering serious physical debilitation within the near 

future unless adequate treatment is given pursuant to this 

Chapter. A showing of behavior that is grossly irrational,

of actions that the individual is unable to control, of 

behavior that is grossly inappropriate to the situation, or 

of other evidence of severely impaired insight and 

judgment shall create a prima facie inference that the 

individual is unable to care for himself or herself.

N.C.G.S. § 122C-3(11)(a)(1) (2021). 

¶ 54 Thus, the trial court must make findings that address both respondent’s 

current inability to care for himself and the probability that respondent would suffer 

serious physical debilitation in the future without treatment. 
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Newby, C.J., concurring in part and dissenting in part

¶ 55 Specifically at issue here is whether the trial court made forward-looking 

findings sufficient to support a reasonable probability of respondent suffering serious 

harm in the future without adequate treatment. To satisfy this prong, the trial court’s 

findings must simply “indicate that respondent is a danger to himself in the future.” 

See In re Moore, 234 N.C. App. at 44–45, 758 S.E.2d at 38 (emphasis added). The trial 

court “must draw a nexus between past conduct and future danger”; however, it “need 

not say the magic words ‘reasonable probability of future harm.’ ” In re J.P.S., 264 

N.C. App. 58, 63, 823 S.E.2d 917, 921 (2019) (citing In re Whatley, 224 N.C. App. 267, 

273, 736 S.E.2d 527, 531 (2012)). 

¶ 56 The majority contends the trial court’s findings of fact are insufficient to 

support the conclusion that respondent is dangerous to himself. According to the 

majority, the trial court’s findings do not indicate a reasonable probability of 

respondent suffering serious physical debilitation in the future. Rather, the majority 

contends the trial court’s findings focus on respondent’s behavior prior to the 

commitment hearing and fail to draw a nexus to a risk of future harm. 

¶ 57 Here the trial court did make findings about respondent’s likely future conduct 

and risk of harm without adequate treatment. The trial court found that respondent 

“suffers from hallucinations [and] disorganized thoughts” and has “active psychosis” 
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Newby, C.J., concurring in part and dissenting in part

which “causes him to be a danger to himself.”3 The trial court’s findings thus indicate 

that respondent poses a danger to himself by drawing a nexus between respondent’s 

present symptoms—hallucinations, disorganized thoughts, and active psychosis—

and the risk of dangerousness if the symptoms remained untreated. 

¶ 58 Dr. Schiff provided forward-looking testimony that supports the trial court’s 

findings. Dr. Schiff testified that if respondent were discharged, “there would be an 

immediate decompensation, given [respondent’s] continued level of disorganization 

and . . . hallucinations.” Dr. Schiff explained that without inpatient treatment, 

respondent would “immediately . . . plac[e] himself . . . [in] danger.” See In re Moore, 

234 N.C. App. at 44–45, 758 S.E.2d at 38 (affirming a commitment order where the 

trial court’s finding of a “high risk of decompensation if released and without 

medication” supported the conclusion that respondent posed a danger to himself in 

the future). Dr. Schiff’s concerns thus support the trial court’s finding that 

 

3 The majority correctly recognizes that the trial court must actually find that 

respondent is a danger to himself; it “cannot simply be inferred from the record.” Yet, the 

majority faults the trial court in its order for connecting respondent’s active psychosis and 

his present symptoms to the risk that respondent poses a danger to himself but for failing to 

explain how respondent’s symptoms lead to such a risk. Additionally, the majority contends 

that “the findings or evidence that one has been or currently is mentally ill, or has, in the 

past, ‘decompensat[ed],’ without more, does not make one dangerous to himself or others.”

Here, however, the trial court also found that (1) both respondent and the ACT team were 

unable to treat respondent’s outpatient needs; (2) respondent is unable to perceive dangers 

to himself; (3) respondent is unable to obtain sufficient nourishment; and (4) respondent has 

been a victim of assaultive behavior which causes deterioration. These findings demonstrate 

how respondent’s present symptoms affect his behavior and cause him to be a danger to 

himself.
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Newby, C.J., concurring in part and dissenting in part

respondent’s symptoms caused him to be a danger to himself.

¶ 59 The trial court also found that respondent is noncompliant with his medication 

when he is not in the hospital and that respondent’s ACT team brought him to the 

hospital because the team was unable to attend to his decompensation and his dental 

and nourishment needs. Dr. Schiff’s testimony supports these findings. Dr. Schiff 

explained that respondent admitted he was not taking his medication, “which had 

previously stabilized him[,]” and that the ACT team was unable to support 

respondent’s current “level of disorganization and decompensation” in the outpatient 

environment. Respondent’s testimony also supports the trial court’s finding that 

respondent and the ACT team were unable to meet respondent’s dental and 

nourishment needs. Respondent testified that the ACT team had “started to give 

[him] at least breakfast,” but he does not “get three meals a day” when he is not in 

the hospital. Thus, respondent was unable to obtain proper bodily nourishment, 

which is essential for respondent to sustain himself. Additionally, respondent 

testified that he “disregarded” the ACT team’s suggestion that he take care of his 

teeth. Therefore, despite the ACT team’s efforts, respondent was unwilling to take 

care of his dental needs. Therefore, the trial court’s findings, supported by Dr. Schiff’s 

testimony, indicate that respondent’s symptoms, level of active psychosis, and dental 
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Newby, C.J., concurring in part and dissenting in part

and nourishment needs could not be treated with outpatient resources.4 As such, 

there is a reasonable probability that respondent’s present symptoms would persist 

and increase his risk of suffering physical debilitation and further decompensation 

without inpatient care, and thus would cause him to be a danger to himself.

¶ 60 In sum, the trial court’s findings of fact directly link respondent’s past behavior 

and current symptoms to a risk of future harm. Respondent’s history of mental illness 

and noncompliance with medication coupled with his current hallucinations, 

disorganized thoughts, active psychosis, and decompensation that could not be 

treated with outpatient resources indicate a reasonable probability of respondent 

suffering serious physical debilitation in the future. The Court of Appeals thus 

properly affirmed the commitment order. Accordingly, I concur in part and dissent in 

part.

Justice BERGER joins in this concurring in part and dissenting in part 

opinion.

 

4 The majority concedes that the record could support a prima facie inference that 

respondent is unable to care for himself based on respondent’s “grossly irrational” or “grossly 

inappropriate” behavior. The majority acknowledges, though, that such an inference alone 

cannot satisfy the second prong of the “dangerous to self” definition. Here, however, such a 

prima facie inference does not stand alone and is supported by Dr. Schiff’s testimony that the 

ACT team is also unable to support respondent due to his decompensation and treat 

respondent’s needs in the outpatient environment. Not only is respondent unable to care for 

himself, but the ACT team, the outpatient team specifically designed to assist respondent 

when he is not in the hospital, is also unable to see to respondent’s needs. Thus, absent 

inpatient treatment, the trial court correctly concluded that respondent is a danger to 

himself. 
Justice EARLS concurring in part and dissenting in part.

¶ 61 I dissent from the majority’s holding on the due process issue in this case for 

the reasons stated in my dissenting opinion in In re J.R., 2022-NCSC-127.

Justices HUDSON and MORGAN join in this opinion concurring in part and 

dissenting in part.

Justice BARRINGER concurring in part and dissenting in part.

¶ 62 Although I agree with the majority’s conclusion that respondent’s due process 

right to an impartial tribunal was not violated for the reasons stated in In re J.R., 

2022-NCSC-127 and that the written findings of fact are insufficient to support the 

trial court’s determination that respondent posed a danger to himself, I cannot agree 

with the conclusion that the evidence in the record in this matter is insufficient to 

satisfy the statutory criteria for involuntary commitment. Not only is this issue not 

before us, but the record is more than sufficient to satisfy the statutory criteria for 

involuntary commitment if proper findings of fact had been made. Therefore, I 

respectfully concur in part and dissent in part.
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2022-NCSC-123

Barringer, J., concurring in part and dissenting in part

¶ 63 The only issue that respondent petitioned for review1 by this Court is whether 

“the Court of Appeals err[ed] by concluding that the trial court’s written findings of 

fact were supported by evidence and were sufficient to support its conclusion that 

[respondent] was dangerous to himself.” We allowed respondent’s petition for 

discretionary review on this issue, and that is the issue respondent briefed. The 

majority answered this question in the negative, and I agree with that conclusion. 

The trial court’s written findings of fact were as follows:

Respondent has [a] mental illness that being 

schizoaffective [disorder and] has long[-]standing [history] 

of mental illness which goes back to his late teens[.] [H]e is 

33 [years old] now. Resp[ondent] suffers from 

hallucinations, disorganized thoughts[, and] is 

noncompliant with medications when not in [the] hospital. 

His active psychosis causes him to be a danger to himself 

and others. His [Assertive Community Treatment (ACT)] 

team initially had him committed as they were unable to 

see to his needs due to his decompensating [and] unable to 

sufficiently take care of needs that being dental [and] 

nourishment needs. [Respondent] lives with [a] person who 

has anger issues [and respondent] has been [a] victim of 

assaultive [behavior and] disturbing thoughts which cause 

deterioration [and] leaves [respondent] unable to perceive 

dangers to himself.

¶ 64 As identified by my colleagues, the trial court specifically found that 

respondent “suffers from hallucinations [and] disorganized thoughts” and has “active

 

1 Respondent also appealed as of right to this Court on account of the dissenting 

opinion at the Court of Appeals. The dissent in the Court of Appeals disagreed with the Court 

of Appeals majority with respect to the due process issue.
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Barringer, J., concurring in part and dissenting in part

psychosis” which “causes him to be a danger to himself.” Psychosis is “[a]n acute or 

chronic mental state marked by loss of contact with reality, disorganized speech and 

behavior, and often by hallucinations or delusions, seen in certain mental illnesses, 

such as schizophrenia.” Psychosis, The American Heritage Dictionary (5th ed. 2018). 

However, the trial court’s other findings focused on the respondent’s state and his 

outpatient team’s (ACT team) inability to care for him at the time of his commitment, 

rather than his outpatient team’s ability to care for him and the consequences if 

respondent was released out of inpatient care at or around the time of the hearing.

¶ 65 Going further than assessing the findings of fact is neither necessary nor 

appropriate under Rule 16 of our Rules of Appellate Procedure. N.C. R. App. P. 16(a) 

(“[R]eview in the Supreme Court is limited to consideration of the issues stated in the 

notice of appeal filed pursuant to Rule 14(b)(2) or the petition for discretionary review 

and the response thereto filed pursuant to Rule 15(c) and (d), unless further limited 

by the Supreme Court, and properly presented in the new briefs required by Rules 

14(d)(1) and 15(g)(2) to be filed in the Supreme Court.”).

¶ 66 However, if we reach the issue of whether the record is sufficient to satisfy the 

statutory criteria for involuntary commitment, specifically the “dangerous to self” 

portion of the statute, this Court should conclude that the testimony from 

respondent’s attending physician and respondent himself, as reflected in the 

transcript, is sufficient to support a conclusion that respondent is dangerous to 
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Barringer, J., concurring in part and dissenting in part

himself.

¶ 67 The relevant subsection of the statute is as follows:

a. Dangerous to self. — Within the relevant past, the 

individual has done any of the following:

1. The individual has acted in such a way as to show 

all of the following:

I. The individual would be unable, without care, 

supervision, and the continued assistance of 

others not otherwise available, to exercise 

self-control, judgment, and discretion in the 

conduct of the individual’s daily 

responsibilities and social relations, or to 

satisfy the individual’s need for nourishment, 

personal or medical care, shelter, or selfprotection and safety.

II. There is a reasonable probability of the 

individual’s suffering serious physical 

debilitation within the near future unless 

adequate treatment is given pursuant to this 

Chapter. A showing of behavior that is grossly 

irrational, of actions that the individual is 

unable to control, of behavior that is grossly 

inappropriate to the situation, or of other 

evidence of severely impaired insight and 

judgment shall create a prima facie inference 

that the individual is unable to care for 

himself or herself.

. . . .

Previous episodes of dangerousness to self, when 

applicable, may be considered when determining 

reasonable probability of physical debilitation, 

suicide, or self-mutilation.
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2022-NCSC-123

Barringer, J., concurring in part and dissenting in part

N.C.G.S. § 122C-3(11)(a) (2021) (emphases added).

¶ 68 At the hearing, Dr. Max Schiff testified that he was concerned that “if 

[respondent] were to be discharged, that there would be an immediate 

decompensation.” He explained that immediate decompensation would lead to 

respondent being placed “into a hospital or into a situation placing himself or others 

at danger at this point.” Decompensation in psychiatry is “the failure to generate 

effective psychological coping mechanisms in response to stress, resulting in 

personality disturbance or disintegration, esp[ecially] that which causes relapse in 

schizophrenia.” Decompensation, New Oxford American Dictionary (3rd ed. 2010); see

also Decompensation, The American Heritage Dictionary (5th ed. 2018).

¶ 69 Dr. Schiff also testified that just the week prior to the hearing he and 

respondent’s Assertive Community Treatment team met with respondent and the 

ACT team “felt that [respondent was] quite far from his baseline last week.” Dr. Schiff 

explained that he continues to work with the ACT team “in attempting to assess 

[respondent’s] baseline and whether or not they are able to support him in the 

community.” Dr. Schiff testified that the ACT team felt that “they could no longer 

support [respondent] in the community based on his level of disorganization and 

decompensation last week.” Dr. Schiff further testified that respondent’s behavior 

was “disorganized and psychotic in nature” and that “there has been some aggression 

and aggressive behavior before.” While Dr. Schiff has been “pleased with 
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Barringer, J., concurring in part and dissenting in part

[respondent’s] response [to treatment] so f[a]r,” Dr. Schiff stated, “[H]e remains with 

a high level of psychosis that makes me concerned about his decompensation, were 

he . . . to be released and not in the monitored setting.”

¶ 70 Respondent also testified at the hearing. When asked by his counsel with 

whom he lived, respondent stated:

My brother and my friend. My — he’s my brother first, but 

he’s my friend second. I was in a relationship with him for 

8, 9, 10 years. But it wasn’t be nothing sexually wise like 

that with him again. And his best friend, which is my 

roommate, which is my brother.

¶ 71 When asked whether he would like to be released from commitment, 

respondent did not answer the question but instead responded, “I see her ankles and 

Amy — the Amy at Williams Ward — Williams Ward remind me of my mom’s ankles,

and she takes her water pills in the morning. I remind her.” Respondent also 

acknowledged that he was having hallucinations and explained that he “see[s] angels, 

white dots . . . floating in the air” and “black dots,” which “just might be 

hallucinations or . . . negativity.”

¶ 72 Given this record, there was more than sufficient testimony to support a 

conclusion that respondent is dangerous to himself. The trial court could have made 

findings of fact that linked respondent’s past behavior and current symptoms to a 

risk of future harm if inpatient treatment was discontinued. Therefore, I concur in 

part and dissent in part.