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## 2815SEP 21 m 9: | IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

In re the Detention of: C.L, Appellant. No. 72509-2-1 DIVISION ONE

UNPUBLISHED FILED: September 21.2015
Cox, J. - "Substantial evidence is 'evidence in sufficient quantum to 

### persuade afair-minded person ofthetruth ofthe declaredpremise.'"1 C.L. appeals the order committing him to involuntary treatment, arguing that 

### insufficientevidence supports the court'sfindings that he was "gravely disabled" and that treatment in a less restrictive setting was not in his best interest. Here, 

### the State presented testimony demonstrating that C.L. could notprovide for his essential needs of health or safety and could notadhere to treatment outside an 

### inpatientpsychiatricfacility. Thus, substantial evidence supports thetrial court's 

### findings. And thosefindings support its conclusions oflaw. Weaffirm. In July2014, C.L. was admitted into a hospital after a less restrictive order hadexpired earlierthatmonth. In August2014, the State petitioned for C.L.'s initial detention, and he was detained. Thereafter, the State petitioned for 14 

### days ofinvoluntarytreatment, and thecourtentered anagreed order. Beforethe 1InreDet. of A.S.. 91 Wn. App. 146, 162, 955 P.2d 836 (1998) (quoting Holland v. Boeing Co.. 90Wn.2d 384, 390, 583 P.2d 621 (1978)).No. 72509-2-1/2 14 day period ended, the State petitioned for 90 days ofmore restrictive involuntary treatment. The petition alleged that C.L. was "gravely disabled" due to a mental disorder. At trial, the State presented testimony from mental health counselorAlexandra Hughes. Hughes testified to her interviews with C.L. and
notes contained in his medical chart. The courtfound that C.L. was gravely disabled and thattreatment in a less restrictive setting was not in his best interest. The court entered an order committing C.L. for an additional 90 days. The court later entered supplemental findings offact and conclusions of law. C.L. appeals. SUFFICIENCY OF EVIDENCE C.L. argues that insufficient evidence supports the court's findings. We disagree. "[T]he State must prove its case by clear, cogent and convincing 

### evidence"in order to commit a person to 90 days ofinvoluntarytreatment.2 "[W]here the trial court has weighed the evidence, appellate review is limited to determining whether substantial evidence supports the findings and, ifso, whetherthe findings in turn supportthe trialcourt's conclusions of lawand 

### judgment."3 Ifthe State's burden of proof is by "clear, cogent and convincing evidence, the evidence must be more substantial than inthe ordinary civil case"

2In re Pet, of LaBelle. 107 Wn.2d 196, 209, 728 P.2d 138 (1986); accord RCW 71.05.310. 3 LaBelle. 107 Wn.2d at 209.No. 72509-2-1/3 where the burden of proof is "by a preponderance ofthe evidence."4 The trial court's findings "must be supported by substantial evidence in light ofthe 'highly 

### probable' test."5 "Substantial evidence is 'evidence in sufficient quantum to persuade a fair-minded person ofthe truth ofthe declared premise.'"6 "[W]ewill not disturb the trial court's findings
... if [it is] supported by substantial evidence which the
. .. court could reasonably have found to be clear, cogent and convincing."7 Here, the State demonstrated that C.L. could not provide for his essential needs of health or safety and could not adhere to treatment outside an inpatient 

### psychiatric facility. Thus, substantial evidence supported the trialcourt's findings. Gravely Disabled C.L. first argues that insufficient evidence supports the court's finding that he was gravely disabled. We disagree. 

### Aperson can be committed for involuntarytreatment ifthat person is 

### gravely disabled.8 Gravely disabled "means a condition in which a person, as a result of a mental disorder, . . . [i]s indanger ofserious physical harm resulting

4lo\ 5]d (quoting Inre Pawling. 101 Wn.2d 392, 399, 679 P.2d 916 (1984)). 6AJL, 91 Wn. App. at 162 (quoting Holland. 90 Wn.2d at 390). 7 LaBelle. 107 Wn.2d at 209. 8RCW 71.05.280(4).No. 72509-2-1/4 from a failure to provide for his or her essential human needs of health or 

### safety."9 The State must show "a substantial risk ofdanger of serious physical 

### harm."10 Specifically, "the State must present recent, tangible evidence of failure or inability to provide for such essential human needs as food, clothing, shelter, and medical treatmentwhich presents a high probability of serious physical harm 

### within the nearfuture unless adequate treatment is afforded."11 This risk of harm does not have to be "evidenced by recent, overt acts."12 The State is not required to show that the "danger of serious harm" is 

### imminent.13 Requiring imminence "could result inthe premature release of 

### mentally ill patients who are still unable to provide for their essential health and safety needs outside the . . . hospital setting but who, because of theirtreatment 

### there, are no longerin 'imminent'danger of serious physicalharm."14 Further, "uncertainty ofliving arrangements or lack of financial resources 

### will not alonejustify continued confinementin a mentalhospital."15 A person can be gravely disabled ifevidence indicates thatperson's "deterioratedcondition"

9RCW 71.05.020(17)(a). 10LaBelle. 107 Wn.2d at 204. 11 id at 204-05. 12 Id at 204. 13_ld at 203. 14 ]d 15 Id. at 210.No. 72509-2-1/5 renders him "unable to make a rational choice with respect to his ability to care for his essential needs."16 Here, Hughes testified that C.L. was gravely disabled due to his mental disorder. Specifically, she stated that C.L. had "fixed delusions, poor insight, poor impulse control, [and] inappropriate boundaries with others. He . . . [was] 

### not able to maintain his activities of daily living independently."17 Hughes also read several notes from C.L.'s medical chart into the record. A psychiatric evaluation note described C.L.'s behavior afterthe less restrictive order expired. This note stated that C.L. stopped taking his medication, became increasingly aggressive towards other residents where he lived, and believed the FBIand CIAwere looking for him. The note also stated that C.L. punched another resident and threatened other residents and staff. 

### Hughes also read intothe record a note written at the end of the 14 day commitment period. This note stated that C.L. was "unable to carry out 

### directions," made "paranoid statements," and was "aggressive and verbally abusive" towards other patients.18 Italso stated that C.L.'s appearance was 

### "unkept," that his activities of dailyliving "need[ed] prompting," and that he was "not oriented to the situation."19 The next day's note stated that C.L. was "still

16 id 17 Report ofProceedings (August 25, 2014) at 9. 18Id at 14. 19 Id.No. 72509-2-1/6 

### positive for significant psychotic behavior."20 Importantly, Hughes stated that C.L. had not been organized enough to participate in his own discharge planning. She read another note intothe record stating that C.L. did not have housing or an outpatient providerfor his discharge and "will not survive at a shelter or on the street. He would probably end up in 

### jail because he is not prepared for that muchindependence."21 Hughes also stated that C.L. had notmade any plan without "delusional content."22 Hughes further testified that she did not believe C.L. "could meet his basic 

### needs for safety" if he were to leave the hospital because "he would not know 

### where to go to get his basic needs met."23 C.L.'s mother is his social security protective payee, and Hughes believed C.L.'s mother and familywere not in 

### Western Washington orSeattle. Hughes stated C.L. was homeless and she did not believe he knew how to access his money or housing by himself. She also did not believe C.L. could relocate to Wenatchee by himselfto "access any sort ofservices."24 

### Hughes's testimony demonstrated a substantialrisk of danger thatC.L. was unable to provide for his essential needs of food, clothing, shelter, and medical treatment on his own because he continually expressed psychotic 

### behavior and poor impulsecontrol up to three days before trial. Thus, this

20 1^ at 15.

21 id at 17.

22 Id, at 21.

23 ]d

24 Id.No. 72509-2-1/7 testimony constitutes substantial evidence to supportthe trial court's finding that C.L. was gravely disabled. C.L. argues that he was not gravely disabled. He does not contestthat he has a mental condition. Rather, he cites two other reasons. They are unpersuasive. C.L. first argues that he was not gravely disabled because his behavior in 

### the hospital improved. The State satisfied its burden of proofbecause itwas 

### required onlyto show "a substantialriskof danger of serious physical harm."25 Additionally, the State was not required to show that the "dangerofserious harm" was imminent.26 Although the testimony demonstrated that C.L. had generally been "medication-compliant" and his behavior improved inthe hospital, the State 

### showed a substantial risk ofdangerwith evidence that C.L. wouldstill be unable 

### toprovidefor his essential needs outsidethehospital.27 Specifically, Hughes's testimony illustrated the aggressive and psychotic behaviorthat led toC.L.'s detainment after the less restrictive order expired. 

### Hughes also observed "currentthreatening behaviors" and had "littleto 

### no[]" confidencethatC.L. knewwhereto obtain medication, food, orshelter.28 More importantly, Hughesdid notknow ifC.L. could continue hismedication 

### compliance "outside
... an impatient setting" and noted the difference between

25 LaBelle. 107 Wn.2d at 203-04 (emphasis added). 26 id at 203. 27 Report of Proceedings (August 25, 2014) at 26-31. 28 id at 22, 25.No. 72509-2-1/8 

### meeting one's basic needs in a structured inpatient setting versus being outside the hospital.29 Second, C.L. argues that the State's focus on his potential difficulty returning to Wenatchee or inability to access a shelter inWestern Washington does not demonstrate that he was gravely disabled. He specifically argues that the State's claim that he "would be homeless if released" was insufficient to involuntarily detain him. This understates the full scope ofthe evidence. C.L.'s psychotic behavior "rendered him unable to make a rational choice 

### with respectto his ability to care for his essential needs."30 The testimony showed that C.L. would not know where to go to access a shelter inWestern 

### Washington on his own. Similarly, C.L. did not know how to return to Wenatchee to access his money, housing, or services. This testimony constitutes substantial 

### evidence of C.L.'s inability to provide for his essential needs. Beinghomeless if released was not the focus ofthe State's argument. 

### Additionally, C.L.'s argument is not supported by the case he cited. C.L. argues that "[i]nvoluntary commitment of an individual is a significantdeprivation ofliberty that may not be imposed simplybecause the State believes the individual will be betteroff in a hospital than on the street."31 C.L. then cites In re Detention ofHarris32 to support his argument. But the issues inthat case were
29 id at 22, 35. 30 LaBelle. 107 Wn.2d at 210. 31 Brief ofAppellant at 9. 32 98 Wn.2d 276, 278, 654 P.2d 109 (1982).

8No. 72509-2-1/9 

### whether dangerousness could "serve as the basis for depriving an individual of his liberty" and whether "the summons procedures of RCW 71.05.150(1) 

### violate[d] constitutional safeguards of procedural due process."33 Thus, that case is not analogous to this case. Accordingly, C.L.'s argument is unpersuasive. Treatmentin Less Restrictive Setting C.L. argues that insufficient evidence supports the trial court's finding that treatment in a less restrictive setting was not in his best interest. We disagree. A person may be committed for 90 days ofinvoluntary treatment ifthe State shows that "the best interests ofthe person or others will not be served by
a less restrictive treatment which is an alternative to detention."34 RCW 71.05 

### does notcreate a statutory rightto less restrictive treatment.35 Further, a person is not entitled to treatment in a less restrictive setting when continued treatment 

### is "amply supported byprofessionaljudgment."36 A court"'maytake into account the availability of treatment optionsor.. . the resources necessary to supply . . . 

### theseoptions'" when determining ifthere areacceptabletreatmentalternatives.37 Here, the State presented substantial evidence that treatment in a less 

### restrictive setting was notin C.L.'s best interest. Specifically, Hughestestified

33 Harris. 98 Wn.2d at 280, 285. 34 RCW 71.05.320(1); accord In re Pet, ofT.A.H.-L. 123 Wn. App. 172, 184,97 P.3d 767 (2004). 35 In re Pet, of J.S.. 124 Wn.2d 689, 701, 880 P.2d 976 (1994). 36 id 

### 37 ]d at 700(quoting Jacksonv. Fort StantonHosp. &Training Sen., 964F.2d 980, 992 (10th Cir. 1992)).No. 72509-2-1/10 that C.L. could not survive in shelters, based on her review of C.L.'s progress notes and interactions with him. One progress note characterized C.L. as 

### "agitated, threatening, [and] hyperverbal."38 The note also described his thought 

### process as "grandiose, tangential, [and].
.. delusional."39 C.L.'s riskassessment that day was "[significant for psychotic behavior."40 Other notes stated that C.L. complained that he was in the hospital for the 

### wrong reasons and continuallypresented "with poor insight."41 The next day's note described C.L.'s thought process as delusional and his behavior as "anxious, isolative, and withdrawn."42 The note also stated C.L. was "not oriented 

### to place."43 Hughes further testified that C.L. "has shown
... no insight into his current 

### condition" and she recommended "inpatient psychiatric care."44 C.L. would not "be able to adhere to treatment outside ofan inpatient psychiatric facility" or have 

### "the capabilityto carefor himselfoutside ofa structured residential setting."45

38 Report ofProceedings (August 25, 2014) at 18.

40 id 41 id 42]dat19. 43 id 44 id at 22-23. 45 Id. at 23.

10No. 72509-2-1/11 Hughes also noted that C.L.'s shouting ofdelusional statements in court demonstrated his "poor impulse control."46 Hughes's testimony showed that C.L. continually expressed psychotic behavior and had no insight into his mental disorder up to three days before trial. Most importantly, hertestimony showed that C.L. would not be able to maintain treatment outside the hospital. Thus, the State presented substantial evidence to support the trial court's finding that treatment in a less restrictive setting was not in C.L.'s best interest. C.L. argues that the trial court could not "find the State met its burden 

### based only on a lack ofavailable resources."47 Specifically, C.L. argues thatthe court "improperly focused on the resources available" to him and thatthe State "could not meet its burden simply by suggesting no services were available" to him.48 C.L. cites Inre Detention ofT.A.H.-L.49 to support his argument that "the appropriate inquirywhen considering a less restrictive option is not whetherthere is a specific resource available to the individual but instead whetherthe person 

### presents a danger of serious physical harmin a less structuredenvironment."50 This argument is unpersuasive. 

### As previously stated, the court may determine iftreatment is acceptable by looking at "'the availability oftreatment options or. . . the resources necessary 46 id at 35. 47 Brief ofAppellant at 12. 48 id at 11-12. 49123 Wn. App. 172, 187, 97 P.3d 767 (2004). 50 Brief ofAppellant at 10.
11No. 72509-2-1/12 

### to supply . . .these options.'"51 Here, the court acknowledged C.L.'s ability to live outside a hospital when he had access to "structured supportive housing" and 

### "mental health services" in Wenatchee.52 But the court's finding that treatment in
a less restrictive setting "would not be appropriate" for C.L. was supported by evidence ofC.L.'s inability to locate and obtain his essential needs on his own andthe unavailability of structured housing and mental health services in Seattle.53 C.L. also cites Inre Detention ofJ.S.54to support his argument that requiring him "to engage inthe services on 'the other side ofthe mountains' or participate in comparable services in [W]estern Washington pursuantto a less restrictive orderwas appropriate regardless ofwhetherthe court was aware of a 

### specific facility thatwould currently accept him."55 This argument is unpersuasive. C.L. is correctthat the trial court's ability to order less restrictive treatment is not restricted when no such treatment is available.56 Treatment in a less restrictive setting "can be ordered even when
... no facilityhas agreed to

51 JJL, 124 Wn.2d at 700 (quoting Jackson. 964 F.2d at 992). 52 Clerk's Papers at 37. 53 id 54 124 Wn.2d 689, 699, 880 P.2d 976 (1994). 55 Brief ofAppellant at 12. 56 J.S.. 124Wn.2dat698.

12No. 72509-2-1/13



### assume the responsibility."57 Butas previously stated, RCW 71.05 does not 

### create a statutory right to less restrictive treatment.58 Thus, the court is not required to "create a facility specifically designed for.. . [a person's] unique needs."59 In sum, C.L.'s arguments are unpersuasive. We affirm the 90-day involuntary commitment order.

# CcrkJ.

WE CONCUR: 

# I/,'^ y;A

57 Inre Pet, ofRAW., 104 Wn. App. 215, 222, 15 P.3d 705 (2001). 58 J.S., 124Wn.2dat701. 59 T.A.H.-L. 123 Wn. App. at 187.
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