Opinion ID: 2061070
Heading Depth: 2
Heading Rank: 2

Heading: Was There Clear and Convincing Evidence to Support the Order of Commitment?

Text: A person who is seriously mentally impaired may be the subject of an involuntary civil commitment. Iowa Code § 229.6. The Code defines seriously mentally impaired as: Seriously mentally impaired or serious mental impairment describes the condition of a person with mental illness and because of that illness lacks sufficient judgment to make responsible decisions with respect to the person's hospitalization or treatment, and who because of that illness meets any of the following criteria: a. Is likely to physically injure the person's self or others if allowed to remain at liberty without treatment. b. Is likely to inflict serious emotional injury on members of the person's family or others who lack reasonable opportunity to avoid contact with the person with mental illness if allowed to remain at liberty without treatment. c. Is unable to satisfy the person's needs for nourishment, clothing, essential medical care, or shelter so that it is likely that the person will suffer physical injury, physical debilitation, or death. Id. § 229.1(14). The definition of serious mental impairment has three elements. The respondent must be found to have (1) a mental illness, consequently (2) to lack sufficient judgment to make responsible decisions with respect to the person's hospitalization or treatment and (3) to be likely, if allowed to remain at liberty, to inflict physical injury on the person's self or others, to inflict serious emotional injury on a designated class of persons, or be unable to satisfy the person's physical needs. Id.; Foster, 426 N.W.2d at 376-77. The first element of serious mental impairment is that the person have a mental illness. At the hearing before the judicial hospitalization referee Dr. Thampy, the court-appointed psychiatrist, testified Jane suffered from a psychotic disorder. While he stated he was not able to determine the exact nature of the disorder, he opined that it was probably either a delusional disorder or a major depression. No medical report as required by Iowa Code section 229.10(2) was received by the court. On appeal Jane does not challenge the finding that she had a mental illness, therefore we need not determine if this element was proven. The existence of a mental illness, by itself, does not establish grounds for commitment. Oseing, 296 N.W.2d at 801. A mental illness does not preclude an individual's ability to make rational judgments in all cases or with respect to all matters. Randall Bezanson, Involuntary Treatment of the Mentally Ill in Iowa: The 1975 Legislation, 61 Iowa L.Rev. 262, 275 n. 68 (1975). The second element that must be proven is that because of the mental illness the person lacks sufficient judgment to make responsible decisions with respect to the person's hospitalization or treatment. Iowa Code § 229.1(14). Virtually no evidence was presented on this element. There was no finding by the court that Jane lacked sufficient judgment to make responsible decisions in regard to her hospitalization or treatment. The State argues her decision not to take prescribed medication is indicative of a lack of responsibility. We disagree. In determining whether a decision is responsible, the focus must be on whether the grounds for the decision are rational or reasonable not what conclusion is reached. A decision, although medically inadvisable, may be rationally reached, and if so, it is not the court's place to second guess the decision. Jane discontinued taking medication because she was concerned about its side effects. She testified: I have requested that I know exactly what [the] side effects are and everything from it ... it's supposedly a new drug and so I really would like to know more what it's going to do to me and what it's used for before [I take it] because I think I have a right to know what it's going to do to my body. Concern about the potential side effects of a medication is a reasonable apprehension. Jane also indicated she preferred psychotherapy to chemotherapy. Given her educational background in psychology and counseling, this decision had a reasonable basis. We find there was not clear and convincing evidence to support the district court's finding that Jane lacked the ability to make responsible decisions regarding her treatment. The third element of serious mental impairment involves likely physical injury to one's self or others or the infliction of serious emotional injury on specified persons. Id. The referee found: [Jane] is a danger to others only as to her delusional disorder and acting upon said delusional thought process. Further, the court finds that [Jane] has placed an emotional trauma upon those unable to avoid contact, namely spouse and children. Most significantly, on date of admission [Jane] had taken the child[ren] to the battered women's shelter and although there may be certain domestic stressors involved in this case, the court finds that the emotional trauma to the family has been significant. We have said the endangerment element requires a predictive judgment, based on prior manifestations but nevertheless ultimately grounded on future rather than past danger. Mohr, 383 N.W.2d at 542. The danger the person poses to herself or others must be evidenced by a recent overt act, attempt or threat. Id. In this case there is no evidence of any overt act, attempt or threat by Jane. Dr. Thampy testified she has not really presented as a hazard to ... herself or others. John testified that Jane never threatened the children, himself or anybody else with harm. The referee found Jane had placed emotional trauma upon those unable to avoid contact. We note that a finding of emotional trauma is an insufficient basis for involuntary hospitalization. The Code requires serious emotional injury. Iowa Code § 229.1(13). Serious emotional injury is defined as: Injury which does not necessarily exhibit any physical characteristics, but which can be recognized and diagnosed by a licensed physician or other qualified mental health professional and which can be causally connected with the act or omission of a person who is, or is alleged to be, mentally ill. Id. No finding of serious emotional injury was made by the court. In finding that Jane placed emotional trauma on the family, the referee relied on Jane's removing herself and the children to the battered women's shelter as a source of the trauma. We are concerned by this reliance. Domestic abuse against women is a serious problem in Iowa and the nation as a whole. Final Report on the Supreme Court Task Force on Courts' and Communities' Response to Domestic Abuse, at 2 (1994). A woman who removes herself to a shelter on the basis of an actual or perceived threat should not have to fear the action she took to protect herself will have negative repercussions. Any emotional trauma that resulted from Jane's availment of the battered women's shelter should not have been considered in the decision of whether to order involuntary treatment. REVERSED.