Opinion ID: 2336032
Heading Depth: 4
Heading Rank: 3

Heading: Substantial risk of harm to self

Text: Joan does not contest the superior court's finding of a mental illness. Joan instead contends the superior court erred by finding that due to her mental illness she was likely to cause harm to herself, arguing: (1) there was no evidence illegal drug use physically harmed her and she did not make affirmative statements that she would use illegal drugs if released; and (2) she did not manifest a current intent to carry out a plan to seriously harm herself. [23] We decided a similar issue in E.P. v. Alaska Psychiatric Institute. [24] E.P. had a history of inhaling gasoline fumes and other substances to get high (huffing), [25] which caused organic brain damage. [26] He was involuntarily committed to API several times and maintained that, if discharged from API, he [would] likely go back to huffing. [27] We held E.P.'s organic brain damage was a condition apart from, and more than, his drug addiction and met the statutory definition of mental illness under AS 47.30.915(12). [28] We also held the evidence supported the multiple masters' reports and superior court orders, which found huffing gas damaged E.P.'s brain and E.P. would continue huffing gas if released. [29] Thus E.P.'s continued intent to huff gas, as a result of his impaired judgment and understanding, [met] the standards of AS 47.30.915(10)(A) and (C). [30] E.P.'s intent to huff gas constitute[d] intent to cause himself bodily harm, and ... result[ed] from his mental illness. [31] Here, the superior court expressly stated it was not finding Joan was likely to harm herself based on drug addiction alone. The superior court noted E.P., and, as we did in E.P., distinguished Joan's case from one in which an addicted person with full mental capacity chooses to continue abusing harmful substances, no matter how unwise one might consider that choice. [32] The superior court stated: I find that [Joan] is suffering from a mental illness. She has bipolar disorder, which according to Dr. Bell's testimony, renders her unable to perceive reality. Her bipolar disorder is manifesting itself in psychosis right now. She is feeling that she is experiencing the feelings of other people, both close and far away, that Fairbanks is at the center point between heaven and hell and that she is responsible for maintaining balance between heaven and hell and keeping the universe centered. She has advised Dr. Bell that she believes that she must take [amphetamines] and oxycontin to manage the stresses that are caused by her current situation; that is, by the fact that she is responsible for balancing the equal point between heaven and hell. ... [Joan] is not being detained because she is a drug addict. She is taking drugs because of her perception of reality caused by her bipolar disorder and ... she's being detained because her mental illness is causing her to take the drugs. The superior court's finding is amply supported by Dr. Bell's testimony. The superior court also heard evidence that illegal drug use would pose a substantial risk of bodily harm to Joan by exacerbating her mental illness. [33] Dr. Bell testified if Joan used illegal drugs in her current mental state, her thought process would get so completely disorganized that she would not know what she was doing. Illegal drug use would also cause further de-stabilization of [Joan's] mental and mood state, which would aggravate her ability to conform ... to reasonably safe behaviors. In short, Dr. Bell's testimony supported the conclusion that Joan's continued illegal drug use would exacerbate her mental illness and cause a self-destructive downward spiral of her mental and physical health. Finally, the superior court heard evidence regarding Joan's recent behavior causing, attempting, or threatening harm to herself by illegal drug use. [34] Although Dr. Bell and Dr. Parker both acknowledged Joan neither articulated a desire to harm herself nor did so beyond using illegal drugs, both thought she would continue using illegal drugs if she were not committed. Joan's emergency room toxicology report showed traces of amphetamines and cocaine in her system. Dr. Bell testified Joan showed symptoms of lethargy or torpor that follow stimulant abuse. Dr. Bell also testified Joan showed symptoms of opioid withdrawal. The plain text of AS 47.30.915(10)(A) directs courts to consider recent behavior and does not, as Joan argues, require affirmative statements regarding future drug use. [35] Even if affirmative statements were required, Joan told Dr. Bell he was prescribing the wrong medicines because she needed amphetamines and OxyContin. [36] This is sufficient to support the superior court's finding that Joan was likely to continue using illegal drugs if released. Based on these findings, the superior court did not err by finding clear and convincing evidence that, under AS 47.30.735 and AS 47.30.915(10)(A), Joan was likely to cause harm to herself due to her mental illness.