Opinion ID: 2761610
Heading Depth: 2
Heading Rank: 1

Heading: Involuntary Commitment and

Text: the History of the Requirement of Dangerousness ¶23 Up until the early 1970s, there were few requirements for the government to meet in order to commit a person involuntarily for mental treatment. In 1961, the American Bar Association published an analysis of then-existing state statutes governing involuntary hospitalization. In the late 1950s, just seven states required some sort of dangerousness (to self, others, or property) as justification for involuntary hospitalization. In twenty-two states, simply needing care or treatment was sufficient grounds, and seven other states permitted commitment if it seemed necessary for the patient's welfare or the welfare of others. Massachusetts permitted commitment of persons deemed likely to violate the established laws, ordinances, conventions, or morals of the community. Seventeen states had no specific statutory criteria for commitment, apparently leaving the choice of rationale entirely to legal decisionmakers. Douglas Mossman, M.D. et al., Risky Business Versus Overt Acts: What Relevance Do Actuarial, Probabilistic Risk Assessments Have for Judicial Decisions on Involuntary Psychiatric Hospitalization?, 11 Hous. J. Health L. & Pol'y 365, 373-76 (2012) (footnotes omitted). Wisconsin's statutory scheme for involuntary commitment at that time was characterized as follows: 14 No. 2013AP1638-FT it failed to require effective and timely notice of charges justifying detention; failed to require notice of rights including right to jury trial, permitted detention longer than 48 hours without hearing on probable cause; permitted detention longer than two weeks without full hearing on necessity for commitment; permitted commitment based on hearing in which person detained was not represented by adversary counsel, at which hearsay evidence was admitted, and in which psychiatric evidence was presented without patient having been given benefit of privilege against self-incrimination; permitted commitment without proof of mental illness and dangerousness beyond reasonable doubt; and failed to require those seeking commitment to consider less restrictive alternatives.17 ¶24 Then, two cases changed the landscape of involuntary commitment law dramatically. One was O'Connor v. Donaldson,18 which held that in order to commit a person involuntarily, the state must prove that a mentally ill person was dangerous to himself or others: The modern history of involuntary commitment began with the Supreme Court decision in O'Connor v. Donaldson in 1975. Donaldson, diagnosed with paranoid schizophrenia, was kept in a state-run mental hospital for nearly fifteen years following an involuntary commitment initiated by his father. He repeatedly asked for his release, arguing that he was not being treated for his mental condition and did not pose a danger to himself or others. The Supreme Court agreed, holding that in order to constitutionally commit and confine an individual, the state must show that the person is dangerous to himself or others and that they are not capable of living safely under the supervision of family or friends. 17 Lessard v. Schmidt, 349 F. Supp. 1078 (E.D. Wis. 1972) (vacated and subsequently reinstated). 18 O'Connor v. Donaldson, 422 U.S. 563 (1975). 15 No. 2013AP1638-FT Dan Moon, The Dangerousness of the Status Quo: A Case for Modernizing Civil Commitment Law, 20 Widener L. Rev. 209, 212 (2014) (footnotes omitted). ¶25 The other was Lessard v. Schmidt,19 a Wisconsin case that established substantive and procedural rights for those undergoing commitment procedures. In that case, a federal three-judge panel held that in order to satisfy due process guarantees, persons subject to involuntary commitment proceedings were entitled to written and oral notice of various rights, a probable cause hearing within a limited period of time with appointed counsel, written notice of the final hearing, and a full hearing within 14 days of the original detention. ¶26 The case is regarded as groundbreaking. The Wisconsin Supreme Court called the change resulting from Lessard radical: 19 The case has a complicated procedural history, but the substance of its holding was never overruled; the original order was altered to add more specificity and ultimately reinstated. The first order, Lessard v. Schmidt (Lessard I), 349 F.Supp. 1078 (E.D. Wis. 1972), generally held that the state's existing involuntary commitment statutory scheme was unconstitutional. When the order was appealed, the United States Supreme Court held that the injunctive relief granted needed to be specific and remanded to the district court for that purpose. Lessard II, 414 U.S. 473 (1974)). On remand, in Lessard III, 379 F.Supp. 1376, 1380-82 (E.D. Wis. 1974), the district court stated the injunctive relief from its original order in more specific terms. When the case was again appealed, the United States Supreme Court remanded for further consideration in light of another recently decided case. Lessard IV, 421 U.S. 957 (1975). On remand, the district court reinstated the prior order of the court. Lessard V, 413 F.Supp. 1318 (E.D. Wis. 1976). 16 No. 2013AP1638-FT Wisconsin law regarding the institutionalization of the mentally disabled underwent radical change with the landmark federal district court decision in Lessard v. Schmidt, in which Wisconsin's involuntary civil commitment law was held unconstitutional. In response to Lessard, the legislature enacted three new civil commitment laws . . . [including] one for persons who are acutely mentally ill . . . . [T]hese laws authorize court ordered institutionalization of mentally disabled individuals for the purpose of care and custody. Watts v. Combined Cmty. Servs. Bd. of Milw. Cnty., 122 Wis. 2d 65, 72, 362 N.W.2d 104 (1985) (citations omitted). But the changes reverberated far beyond Wisconsin. Lessard's legal model launched a sweeping trend toward stricter commitment criteria and greater procedural protection not only in the courts, but in the state legislatures as well. Ronald L. Wisor, Jr., Community Care, Competition and Coercion: A Legal Perspective on Privatized Mental Health Care, 19 Am. J.L. & Med. 145, 150 (1993). Passage of . . . statutes [encouraging community treatment rather than institutionalization] coincided with several court decisions that elaborated the substantive and procedural due process rights of individuals subject to civil commitment. . . . [T]he most significant of these cases is Lessard v. Schmidt, a 1972 Wisconsin federal district court decision that sparked a nationwide transformation in civil commitment statutes. Mossman, supra at 373-376 (footnotes omitted). ¶27 Lessard's requirements have generally stood the test of time, although the burden of proof it imposed was lowered in a subsequent case by the United States Supreme Court to the 17 No. 2013AP1638-FT clear and convincing evidence standard.20 Addington v. Texas, 441 U.S. 418, 419-20 (1979). B. What it Takes to Satisfy the Wisconsin Statute's Requirement of Dangerousness ¶28 As noted, Wisconsin involuntary commitment statutes, which did not previously contain a requirement of dangerousness, were accordingly revised. Wisconsin Stat. § 51.20, the 20 The United States Supreme Court's analysis on the issue is summarized thus: The question of what standard of proof courts should apply to satisfy the Due Process Clause of the Fourteenth Amendment in an involuntary civil commitment proceeding remained unanswered until the Supreme Court addressed the issue in Addington v. Texas, 441 U.S. 418, 419-20, 432-33 (1979). . . . The Court balanced the individual's interest in not being involuntarily committed for an open-ended period of time against the state's interest in confining the dangerous mentally ill. The Court carefully considered the criminal standard of proof of beyond a reasonable doubt but rejected that standard, finding it practically impossible to prove in the context of the uncertain and imperfect character of psychiatric diagnosis. The Court similarly rejected the preponderance of the evidence standard as too minimal to satisfy due process requirements, given the serious deprivation of freedom involved in the involuntary civil commitment process. Instead, the Court held that the intermediate standard of clear and convincing satisfies due process requirements in cases of involuntary civil commitment. Alison Pfeffer, Imminent Danger and Inconsistency: The Need for National Reform of the Imminent Danger Standard for Involuntary Civil Commitment in the Wake of the Virginia Tech Tragedy, 30 Cardozo L. Rev. 277, 285-86 (2008) (citations omitted). 18 No. 2013AP1638-FT involuntary commitment statute, requires the county to prove by clear and convincing evidence that the individual whose commitment is sought is mentally ill and is a proper subject for treatment, and that the person is dangerous to himself or herself, or others. Wis. Stat. §§ 51.20(1)(a)1., (1)(a)2. ¶29 The statute identifies five ways the county can meet its burden to prove dangerousness, two of which are relevant here. (As previously noted, Michael does not contest that he meets the first qualification for commitment, that he is mentally ill and a proper subject for treatment.) ¶30 The County can demonstrate that [t]he individual is dangerous because he or she . . . [e]vidences a substantial probability of physical harm to himself or herself as manifested by evidence of recent threats of or attempts at suicide or serious bodily harm. Wis. Stat. §51.20 (1)(a)2.a. ¶31 The County can also demonstrate dangerousness by showing clear and convincing evidence of a pattern of acts showing such impaired judgment that he was dangerous to himself: The individual is dangerous because he or she . . . [e]vidences such impaired judgment, manifested by evidence of a pattern of recent acts or omissions, that there is a substantial probability of physical impairment or injury to himself or herself. The probability of physical impairment or injury is not substantial under this subd. 2. c. if reasonable provision for the subject individual's protection is available in the community and there is a reasonable probability that the individual will avail himself or herself of these services, if the individual may be provided protective placement or protective services under ch. 55 . . . . Wis. Stat. §51.20 (1)(a)2.c. 19 No. 2013AP1638-FT C. Whether Credible Evidence Supported the Commitment Under 2.a., Relating to Threats of Suicide or Self-harm ¶32 The first of Michael's challenges is to the jury's verdict that the evidence was sufficient to find him dangerous if that is demonstrated under the (1)(a)2.a. standard, which bases dangerousness on recent threats of . . . suicide or serious bodily harm. The evidence that he answered yes when he was asked if he was suicidal is not evidence of a recent threat of suicide, he contends, because thoughts are not threats and because he took no act in furtherance of the thoughts. He points to the common definition of threat cited in State v. Perkins, an expression of an intention to inflict injury,21 and argues that his statements fall short of expressing an intention. He cites to two cases to illustrate the contrast between specific intentional plans and a lack of evidence of specific dangerous conduct. In support of the former, he cites R.J. v. Winnebago County, 146 Wis. 2d 516 (Ct. App. 1988), in which the court held that graphic threats to seriously harm another person were sufficient to support involuntary commitment even if the intended person was unaware of the threat. As an illustration of the latter, he cites to Milwaukee County v. Cheri V., unpublished slip op. (Ct. App., Dec. 18, 2012), which held that evidence was insufficient on the dangerousness prong where all the evidence showed was that the person was upset, 21 Perkins, 243 Wis. 2d 141, ¶43. 20 No. 2013AP1638-FT angry, and agitated but made no statements regarding harm to herself or others.22 ¶33 The County argues that the evidence on this point was sufficient to support the verdict. It argues that the four witnesses were credible. It notes that he answered that he was suicidal, and in a separate conversation he told police he wanted to harm himself, and those answers did constitute evidence of a threat of suicide or serious bodily harm. The County notes that in addition to the narrow definition of threat discussed by Michael, the word has common meanings that are more broad, such as an indication of impending danger or harm. It also argues that in response to his mother's question about a suicide plan, it would have been reasonable to expect him to deny having a plan, if that were the case; instead, his answers were evasive, and he fled the room. The County argues that a narrow interpretation of the word threat would undermine the purposes of the involuntary commitment statute by limiting such commitments to situations where a person articulates a clear intention of plans for self-harm. 22 Michael also cites to two involuntary commitment cases from the Oregon Court of Appeals as instructive. Michael does not address the fact that the statutes involved, Oregon Rev. Stats. §§ 426.005 and 426.130, differ significantly from the Wisconsin statute; the statute does not provide what constitutes grounds for a finding of dangerousness, for example, so there is no provision comparable to the ones we consider here. For that reason the cases are of little help in interpreting the provision concerning threats of self-harm in Wis. Stat. § 51.20. 21 No. 2013AP1638-FT ¶34 As noted, the statute does not define threat. Perkins merely recited a common meaning of the word in contrast to the more narrow meaning given to it in a particular criminal statute; therefore, that case provides little guidance for purposes of defining threat in this context. The ordinary definitions of threat include an indication of impending danger or harm, and under that definition, the jury could reasonably have considered Michael's statements to be threats. ¶35 As the County correctly points out, one of the purposes of Chapter 51 is to facilitate treatment for the dangerous mentally ill who will benefit from it. It would be unreasonable to expect a person who is in a poor or confused mental state to be capable of making a clear and coherent statement of intention of what his or her plans are. Doing so would render the statute unworkable for the very people for whom it is designed. ¶36 Michael did undisputedly acknowledge that he was suicidal. The meaning of suicidal, according to mental health professionals and established instruments for treatment, encompasses both suicidal ideation that is without intent and suicidal ideation that is made with intent to harm. The Columbia Suicide Severity Rating Scale (C-SSRS)23 is a 23 The Columbia Suicide Severity Rating Scale (C-SSRS) involves a series of probing questions to inquire about possible suicidal thinking and behavior. 3 Draft Guidance For Industry Suicidality: Prospective Assessment Of Occurrence In Clinical Trials, Food and Drug Administration, Center for Drug Evaluation and Research (September 2010). 22 No. 2013AP1638-FT questionnaire in extensive use by mental health professionals to assess suicide risk. In the category of suicidal ideation, the scale lists five categories, some without intent to act and some with intent to act: wish to be dead, suicidal thoughts, suicidal thoughts with method (but without specific plan or intent to act), suicidal intent (without specific plan), and suicidal intent with specific plan. There is extensive debate in the mental health treatment community about how to predict which suicidal patients are at highest risk of killing themselves.24 It is within the realm of ordinary experience that some suicidal people have an intent to follow through and harm themselves and others do not. The jury could have drawn the inference from Michael's statement and the other evidence presented that he was not making a threat of suicide or bodily harm. But it did not draw that inference. ¶37 We see no reason to hold that an articulation of a specific plan is necessary in order to constitute a threat for purposes of this statute. Therefore, we conclude that the 24 The challenge posed by the lack of useful, universal nomenclature for the study and prevention of suicide was discussed in one seminal academic writing that noted what it called a basic, almost incredible reality: Despite hundreds of years of writing and thinking about suicide, and many decades of focused suicide research, there is to this day no generally accepted nomenclature for referring to suicide-related behaviors——not even at the most basic, conversational level. Patrick W. O'Carroll, et al., 238 Beyond the Tower of Babel: A Nomenclature for Suicidology, Suicide and Life-Threatening Behavior, Vol. 26(3), Fall 1996. 23 No. 2013AP1638-FT verdict as to the basis in Wis. Stat. § 51.20 (1)(a)2.a. is supported by credible evidence and we will not disturb it. D. Whether Credible Evidence Supported the Commitment Under 2.c., Relating to a Pattern of Acts Indicating Impaired Judgment ¶38 Wisconsin Stat. § 51.20 (1)(a)2.c., the second grounds for dangerousness relevant here, states: The individual is dangerous because he or she . . . [e]vidences such impaired judgment, manifested by evidence of a pattern of recent acts or omissions, that there is a substantial probability of physical impairment or injury to himself or herself. The probability of physical impairment or injury is not substantial under this subd. 2. c. if reasonable provision for the subject individual's protection is available in the community and there is a reasonable probability that the individual will avail himself or herself of these services, if the individual may be provided protective placement or protective services under ch. 55 . . . . The question is therefore whether the evidence was sufficient to support the jury's finding that Michael was dangerous to himself if that finding was based on facts demonstrating that he had shown such impaired judgment, manifested by evidence of a pattern of recent acts or omissions, that there [was] a substantial probability of physical impairment or injury to himself or herself. ¶39 We repeat the evidence noted above that the jury heard about Michael's behavior because in this case, the same evidence supporting the finding of dangerousness demonstrated under (1)(a)2.a. also supports a finding of dangerousness demonstrated under (1)(a)2.c. because the pattern of his paranoia and 24 No. 2013AP1638-FT increasing distress is relevant to both ways of demonstrating dangerousness: - He had made repeated statements to his mother and sister that nobody's safe. - He had acknowledged that he was suicidal to a nurse and made ambiguous statements about being suicidal to his mother. - He had acknowledged to a police officer that he wanted to harm himself. - He had delusional behavior and behaved in a paranoid manner, stating to his mother that she and his father should not sleep at home because unnamed persons were after him and would also be after them. - He owned a knife that he had received that week as a belated Christmas gift and usually carried it with him. - He had access to guns. - He had walked with a young child through the snow for two miles based on his fear that one of his sisters was in danger. - He had purchased several cell phones and explained that he did so to avoid being tracked by unnamed persons; he had thrown one phone out the car window believing it to be bugged. - He had been unable to sleep. - He had repeatedly told his mother that his head was not right and that he could not think straight and was lonely and sad. 25 No. 2013AP1638-FT - He had refused medication, and according to a doctor who examined him, he could [be dangerous] without treatment. ¶40 Michael argues that the only pattern of recent acts was the repeated trips to the hospital to seek help. But as the facts recited above make clear, other inferences could also be drawn about patterns of recent acts that week. The jury was not obligated to see only the pattern Michael describes. Jurors might reasonably have seen a pattern of delusional paranoia, a pattern of telling family members that people were out to get him, a pattern of refusing medication and rejecting medical treatment, a pattern of telling people that something was wrong with his head, and so on. Based on the testimony they heard about the week's events, there was credible evidence from which jurors could conclude that Michael's symptoms were worsening and he was becoming distressed to the point that there was a substantial probability of injury to himself——the testimony of Michael's mother, for instance, made clear that the statement he made to the nurse was the first time he had ever spoken of suicide. ¶41 We also note that this provision of the statute makes an exception for a person exhibiting such judgment if . . . there is a reasonable probability that the individual will avail himself . . . of [community] services. Wis. Stat. § 51.20(1)(a)2.c. Although there was evidence of Michael's repeated trips to the hospital during the week, there was also overwhelming evidence that he was unwilling to take medication and to avail himself of the help that was offered. The evidence 26 No. 2013AP1638-FT showed that on three occasions he left after going to a hospital without accepting medication. The evidence showed that on the fourth visit to a hospital, he left almost immediately, following an intake interview, before a doctor or crisis worker could be summoned. We decline to hold that, as a matter of law, merely going to a hospital and declining help satisfies the statute's exception concerning a person's willingness to avail himself of community services; nor does Michael assert that we should. ¶42 Viewing the evidence most favorably to the jury verdict, we conclude that credible evidence supports the verdict if dangerousness is based on the grounds stated in Wis. Stat. 51.20(1)(a) 2.c.