IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON In the Matter ofthe Detention of H.L. STATE OF WASHINGTON, Respondent,

v. H.L, Appellant. ) FILED: November 9,2015 Schindler, J. — H.L. appeals a 90-day involuntary commitment order. H.L. contends insufficient evidence supports finding she was "gravely disabled" under RCW 71.05.020(17)(a). We disagree, and affirm. 

### On September25, 2014, a designated mental health professional, Navos Inpatient Services clinical psychologist Dr. Julia Singer, filed a petition to commit H.L. for up to 14 days oftreatment. The petition alleged H.L. posed "a likelihood ofserious harm to others," and H.L. was gravely disabled as a result of a mental disorder and "in 

### danger ofserious physical harm, resulting from a failure to provide for. . . her essential human needs ofhealth or safety." H.L. did not dispute the allegations inthe petition. On September 26, the superiorcourt entered an agreed 14-day involuntary commitment order for treatment at Navos. No. 72634-0-1 DIVISION ONE

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### On October6, Dr. Singerfiled a 90-day petition to commit H.L. for additional treatment. The petition alleged that H.L. "was taken into custody as a result ofconduct 

### in which . . . she attempted or inflicted physical harm upon the person ofanother or.. . herself..
. and continues to present, as a result of a mental disorder, a likelihood of serious harm," and that H.L. was "gravely disabled." The petition states, in pertinent part: [H.L.] has a mental disorderwith paranoia, delusional thinking, mood lability, agitation, auditory hallucinations, and impairedjudgment and impulse control. She has a history of hospitalizations, as well as a history ofassaultive behavior. She reportedly went missing several months ago and ended up psychiatrically hospitalized for six months in Paris. Upon her return to Seattle she went to the [emergency room] seeking help, but became angry and threw her purse at the social workerwithoutwarning. She threatened to slap her mother, whom she has assaulted inthe past. She stated she could not go to her apartment because ofthe ghosts there. She was too impaired to formulate a plan for meeting her basic needs safely. Inthe hospital she is gradually stabilizing but herthinking remains delusional and tangential. She continues to report auditory hallucinations and is observed responding to internal stimuli. She is unwilling to return to her apartment due to her continued beliefthatthe ghosts are related to the apartment rather than to her illness. Although she is medication compliant, herjudgment and insight remain impaired. Ifshe were released prematurely she would be at risk ofdiscontinuing her medications and deteriorating further, endangering others and remaining 

### unable to care safelyfor her basic needs inthe community. [90-day more restrictive involuntary treatment] is currently recommended, until she is 

### sufficiently stabilized to engage incourt-ordered outpatienttreatment. The superior court held a bench trial on the 90-day involuntarytreatment petition beginning at 1:30 p.m. on October22. Throughoutthe entire trial, H.L. interrupted
numerous times by "yelling and screaming."No. 72634-0-1/3 

### Atthe beginning ofthe trial, the State moved to amend the petition to allege H.L. threatened, inflicted, or attempted to inflict physical harm to others and herselfafter commitmentforevaluation and treatment. H.L. did not objectto amending the petition. Dr. Singertestified that H.L. suffered from paranoid schizophrenia and exhibited "[d]elusional thinking" and "auditory hallucinations." Dr. Singer stated H.L. "is labile to the point ofagitation. Her thought process is tangential. Recently she has been voicing depression and suicidal ideation." Dr. Singer stated that although H.L. was initially 

### "calm" and cooperative," "[r]ecently she has been significantly worse" and "alloverthe map . .. with plans for how she willcare for herself." Dr. Singertestified regarding H.L.'s behaviorwhile hospitalized at Navos. On 

### October 16, Navos staffplaced H.L. inseclusion after observing H.Lkissing a male patient. On October 17, H.L "threw a tray at staff." The psychiatric progress notes from October 19 indicated that H.L. refused all morning medications and "hugged and kissed [a male patient] without any evident context." Dr. Singertestified that on October 20, H.L. repeatedly yelled that she was going to kill herself. A shorttime later, Dr. Singerobserved H.L. "screaming" at the American Medical Response (AMR) drivers and threatening to kill them. During a meeting with social services on October 21, H.L. yelled that she wished her mom would die. When the social service worker explained that H.L. would be unable to obtain housing ifshe continued to yell when stressed, H.L. said that she "wanted to die, that she did not want this life." H.L. stated that she wanted to killherself and did not want medications. H.L. yelled and banged on a chair so loudly that Navos staffresponded out of concern for the safety ofthe staffmember.No. 72634-0-1/4 

### Dr. Singertestified the morning ofOctober22, H.L. was "verbally abusive" and threw her shower supplies at Navos staff. When the staffattempted to direct H.L. to her room, she punched a staffmember in the chest and left arm. 

### Dr. Singertestified H.Lwas recently psychiatrically hospitalized for six months in Paris, France. While hospitalized in France, H.L. received a prescription for 

### Olanzapine. After the United States Embassy transported H.L. backto the United States, she "immediately ended up back inthe hospital." Dr. Singertestified that due to her mental impairment, H.L. was unable to develop a consistent and coherent plan for taking care ofherselfoutside ofthe hospital setting. Dr. Singertold the courtthat H.L. had an apartment but refused to live there. Dr. Singer stated that the alternatives H.L. suggested regarding where she would live if released from the hospital "vary minute by minute" and there seemed to be a "high likelihood" she would "tak[e] off, once again, when she is really not able to care for herself, even here with supports." Dr. Singertestified that as a result ofher mental disorder, H.L. presented a "substantial risk of physical harm to others," was "indanger of serious physical harm from a failure or inability to provide for heressential needs ofhealth and safety," and
was "gravely disabled." Dr. Singer stated that her conclusion was based in part on H.L.'s inability to present a coherent and consistent plan regarding where she would live 

### after leaving the hospital. Dr. Singeralso believed H.L.'s "sexually aggressive behavior" could lead to H.L. being sexually assaulted ifshe leftthe Navos facility. H.L. testified that her prescribed medication made herfeel physically ill, emotional, and depressed.No. 72634-0-1/5 

### At the conclusion of the testimony, the Statewithdrew the allegations related to precommitment acts creating a risk ofharm. 

### The courtfound Dr. Singer credible and thatthe Navos medical records supported hertestimony. The courtfound that H.L. suffered from a mental impairment, 

### paranoid schizophrenia. The courtfound by clear, cogent, and convincing evidence that H.L. continued to present a likelihood ofserious harm to herselfand others1 and that H.L.was gravely disabled under RCW 71.05.020(17)(a). The court also finds that she is gravely disabled. She remains highly delusional, psychotic, angry, and hostile. She continues to scream and yell when met with restraints or limits or stressful situations. Because of her mental impairment, she is unable to develop a coherent plan for 

### taking care ofherselfoutside of a hospital setting. She is unable to find housing on her own, refuses to return to her apartment because she believes it's inhabited by ghosts.

. . . She has fled the country once, leading to her hospitalization in France
. . . and being prescribed
. . . Olanzapine. She is verbalizing a plan to leave the country again
... ifdischarged. . . . But she has demonstrated that she is unable to care for herself if she were released.

.. . She has no other housing atthe moment, and attimes insists she will not go to a shelter

— ... at othertimes she says she willgo to a shelter. The court agrees with Dr. Singer's opinion that she currently is too symptomatic to be able to find adequate shelter on her own without substantial assistance through hertreatment provider. The court entered an order remanding H.L. into the custody of Navos for "a further period of intensive treatment notto exceed 90 days from the date of judgment."

1 The court ruled: The court also finds that as a result ofthis mental impairment, she does currently present a substantial risk of harm to herselfand to others, based on the following findings: She is currently highly impulsive and has been in seclusion at Navos very recently because of her uncontrolled behavior. She is throwing items at staffat Navos. She physically struck a staffmemberthis morning. She has gotten agitated extremely easily. She has repeatedly threatened to harm herself, her mother, and the AMR crewmembers. She remains highly labile, yelling and screaming throughout even the court proceedings. This is sufficientto establish that she presents currently a risk of harm to herself and to others.No. 72634-0-1/6 

### H.L. appeals the 90-day commitment order. H.L. contends insufficient evidence supports the finding that she was "gravely disabled" under RCW 71.05.020(17)(a). 

### Preliminarily, the State asserts the appeal is moot. We disagree. "An individual's release from detention does not render an appeal moot where collateral consequences flow from the determination authorizing such detention." In re Pet, of M.K., 168 Wn. 

### App. 621, 626, 279 P.3d 897 (2012). Underchapter71.05 RCW, the superiorcourt considers the history ofrecent prior civil commitments. See RCW 71.05.012 

### ("consideration of priormental history is particularly relevant indetermining whetherthe person would receive, ifreleased, such care as is essential for his or her health or 

### safety"); RCW71.05.212(1 )(d) ("Whenever a designated mental health professional.
.. is conducting an evaluation underthis chapter, consideration shall include all reasonably available
. . . records regarding .
.. [p]riorcommitments underthis chapter."); RCW71.05.245 ("(1) In making a determination ofwhethera person is 

### gravely disabled, presents a likelihood of serious harm, or isin need ofassisted outpatient mental healthtreatment. . . , the court must consider the symptoms and behaviorof the respondent in light of all available evidence concerning the respondent's 

### historical behavior.
... (3) In making a determination ofwhetherthere is a likelihood of serious harm . . . , the court shall give greatweight to any evidence before the court 

### regarding whetherthe person has: . . . (b) a recent history ofone or more commitments."). 

### Becausethe appeal is not moot, we address the merits of the appeal. The State 

### allegedH.L. was gravelydisabled underRCW71.05.020(17)(a). RCW 71.05.020(17)(a) provides that an individual is "gravelydisabled" when, as a result of aNo. 72634-0-1/7 

### mental disorder, the individual "[i]s indangerofserious physical harm resulting from a failure to provide for his or heressential human needs ofhealth or safety." To meetthe burden ofestablishing an individual is gravely disabled under RCW 71.05.020(17)(a), the State must present "recent, tangible evidence offailure or inability 

### to provide for such essential human needs as food, clothing, shelter, and medical treatment." In re Pet, of LaBelle. 107 Wn.2d 196, 204-05, 728 P.2d 138 (1986). The 

### State must also show the failure or inability to provide for essential needs presents "a high probability of serious physical harm within the nearfuture unless adequate
treatment is afforded." LaBelle, 107 Wn.2d at 204-05. "[W]e willnot disturb the trial court's findings of 'grave disability' ifsupported by substantial evidence which the lower court could reasonably have found to be clear, cogent and convincing." LaBelle, 107 Wn.2d at 209. Substantial evidence is the quantum ofevidence sufficientto persuade a rational fair-minded person the premise is true. InreDetofH.N.. 188 Wn. App. 744, 355 P.3d 294, 303 (2015). H.L. contends the court based the finding ofgrave disability, in part, on her lack of housing and ignored the evidence showing she was willing to work with hertreatment team to find housing, stay with a friend, or live in a shelter. We disagree. The record shows sufficient evidence supports finding that H.L. was gravely disabled under RCW 71.05.020(17)(a). The courtfound that H.L. was gravely disabled based on the undisputed evidence that H.L. remained delusional, psychotic, angry, and hostile. As a result of her mental disorder, the courtfound H.L. was unable to develop a 

### consistent and coherent plan for taking care ofherselfoutside ofthe hospital setting andNo. 72634-0-1/8



### was too symptomatic to find adequate shelteron herown. The record supports this finding.

### Dr. Singertestified that H.L. provided varying explanations ofwhere she would liveafter her hospitalization. Dr. Singerstated that H.L. had an apartment butwas "a hundred percent consistent" inrefusing to live inthe apartment because she "saw 

### ghosts and heard voices there." In September, H.L. expressed interest in mental health housing. On October9, H.L. stated that she "could go stay with her mother's friend until she could get anotherapartment." On October20, H.L. said that she planned to "live with her father on DelridgeWay" butthe telephone numbers she provided Dr. Singerdid 

### not belong to her father. Later on October20, H.L. told Dr. Singerthat ratherthan 

### finding housing, she "was going to go on a vacation" to Canada. On October 21 when asked by a social workerwhere she would live after leaving Navos, H.L. stated she "wouldjust be homeless" but insisted that she would not live in a shelter. 

### Dr. Singer noted that because H.L. refused to return to her apartment, she had "nootheralternative" source of housing. Dr. Singertestified that the alternatives H.L. offered "seem to be made up" and "vary minute by minute." The fact that H.L. had "no 

### clear shelterplans and [a] propensity for fleeing the country" was "very concerning." According to Dr. Singer, H.L. was "just clutching at ideas" and had "noreality basis on what it wouldmean to go out in the currentweatherand find her way to a place to stay warm and dry tonight, letalone down the road." 

### The evidence supports the court's determination that H.L. "has no otherhousing 

### at the moment" and "is too symptomatic to be able tofind adequate shelteron herown." The evidence supports the determination that H.L. was in dangerof serious physical

8No. 72634-0-1/9 

### harm resulting from a failure to provide for her essential human needs and was gravely disabled under RCW71.05.020(17)(a).
We affirm. 

# Vrfifl^,
WE CONCUR 

# £