Opinion ID: 2586091
Heading Depth: 4
Heading Rank: 1

Heading: The constitutionality of AS 47.30.915(7)(B)

Text: The United States Supreme Court has characterized involuntary commitment for a mental disorder as a massive curtailment of liberty [11] that cannot be accomplished without due process of law. [12] Although the State has a legitimate interest in providing care to those who represent a threat to themselves or the community, or who are unable to care for themselves, [13] mental illness alone is insufficient to form a constitutionally adequate basis for involuntary commitment. [14] The Supreme Court has therefore determined that before a person can be involuntarily committed, the court must find in addition to mental illness either: (1) that the person presents a danger to self or others; or (2) that the person is helpless to avoid the hazards of freedom either through his own efforts or with the aid of willing family members or friends. [15] The precise wording of these two additional requirements is left to the states, so long as they meet the constitutional minimum. [16] The two findings required in addition to a finding of mental illness are each aimed at different types of harm. The first finding, of danger to self or others, is concerned with active forms of harm, where the respondent has demonstrated the affirmative ability or inclination to inflict harm to self or another person. [17] The second finding is concerned with a more passive condition, whereby the respondent is so unable to function that he or she cannot exist safely outside an institutional framework due to an inability to respond to the essential demands of daily life. [18] Alaska statutes address both types of harm. Alaska Statute 47.30.735(c) permits the court to commit the respondent to a treatment facility for not more than thirty days if it finds, by clear and convincing evidence, that the respondent is mentally ill and as a result is likely to cause harm to the respondent or others or is gravely disabled. In this case, Wetherhorn was found to be gravely disabled. Alaska Statute 47.30.915(7) defines gravely disabled as follows: (7) gravely disabled means a condition in which a person as a result of mental illness (A) is in danger of physical harm arising from such complete neglect of basic needs for food, clothing, shelter, or personal safety as to render serious accident, illness, or death highly probable if care by another is not taken; or (B) will, if not treated, suffer or continue to suffer severe and abnormal mental, emotional, or physical distress, and this distress is associated with significant impairment of judgment, reason, or behavior causing a substantial deterioration of the person's previous ability to function independently[.] Wetherhorn concedes that subsection A is constitutional, but she challenges subsection B's definition of gravely disabled as reflecting a standard insufficient to justify the curtailment of liberty involved in involuntary commitment. Subsection B was added to AS 47.30.915(7) by the legislature in 1984. [19] The addition was part of a major revision of the civil commitment statutes undertaken to more adequately protect the legal rights of persons suffering from mental illness. [20] In testimony before the House Health, Education and Social Services Standing Committee discussion on the revisions, the Director of the Division of Mental Health and Developmental Disabilities of the Department of Health and Social Services explained that the then-current law only allowed Alaska Psychiatric Institute (API) to hold people with violent tendencies and that the addition of the gravely disabled language would allow API to hold people that need to [be held], but haven't shown a violent tendency enough to hold them. There is a very significant number who don't fit into [the] present standard, but can walk out. [21] The expert concluded, [o]ur hands are tied behind our back, when [a] patient walks out. We only attempt to hold people who are gravely in danger. [22] The committee discussion reveals that the gravely disabled language was added so that a person can be committed before it's too late. [23] The addition of subsection B was thus intended to broaden the scope of civil commitment standards in order to reach those persons in need of treatment who did not fit within the pre-1984 statutory criteria, which required a showing of violent tendencies before a person could be held involuntarily. [24] Essentially, then, the dispute between Wetherhorn and API is whether API must wait until the danger caused by a person's mental illness rises to the level indicated by AS 47.30.915(7)(A) before a person may be involuntarily committed. According to Wetherhorn, only the level of harm described in [AS 47.30.915(7)(A)], i.e., ` serious accident, illness, or death highly probable if care by another is not taken,' is sufficient to justify the `massive curtailment of liberty' which is involuntary commitment. API, on the other hand, relies on language in Addington v. Texas , which states that a person need only pose  some danger to self or others [25] to argue that the commitment standard has been properly expanded. We disagree with both arguments. API's citation to Addington's use of the phrase some danger [26] ignores the United States Supreme Court's repeated admonition that, given the importance of the liberty right involved, a person may not be involuntarily committed if they are dangerous to no one and can live safely in freedom. [27] This standard is certainly higher than the requirement that a person merely present some danger to herself. API allows that the language of subsection B requires that the respondent must suffer distress that rises to the level of genuine and serious suffering. Moreover, the plain language of subsection B requires that there be a significant impairment causing a substantial deterioration. [28] Given that subsection B was added nearly ten years after O'Connor v. Donaldson, [29] the plain language of the statute requiring a substantial deterioration of the person's previous ability to function independently [30] appears to respond to O'Connor's direction that the State cannot constitutionally confine without more a nondangerous individual who is capable of surviving safely in freedom. [31] We furthermore agree with the Supreme Court of Washington that [i]t is not enough to show that care and treatment of an individual's mental illness would be preferred or beneficial or even in his best interests. [32] Indeed, AS 47.30.730 does require more than a best interests determination. For example, it requires that the petition for commitment allege that the evaluation staff has considered but has not found that there are any less restrictive alternatives available [33] and allege with respect to a gravely disabled respondent that there is reason to believe that the respondent's mental condition could be improved by the course of treatment sought. [34] As further protection, the statute directs the court to make its findings by clear and convincing evidence. [35] We conclude that in order to be constitutional, AS 47.30.915(7)(B) must be construed so that the distress that justifies commitment refers to a level of incapacity that prevents the person in question from being able to live safely outside of a controlled environment. This construction of the statute is necessary not only to protect persons against the massive curtailment of liberty [36] that involuntary commitment represents, but also to protect against a variety of dangers particular to those subject to civil commitment. For example, there is a danger that the mentally ill may be confined merely because they are physically unattractive or socially eccentric [37] or otherwise exhibit some abnormal behavior which might be perceived by some as symptomatic of a mental or emotional disorder, but which is in fact within a range of conduct that is generally acceptable. [38] A similar concern with the perils of imposing majoritarian values forbids civil commitment to be based on the justification that a person would thereby enjoy a higher standard of living because, as the O'Connor Court explained, mental illness, without more, does not disqualify a person from preferring his home to the comforts of an institution. [39] The level of incapacity represented by AS 47.30.915(7)(B) must be such so as to justify the social stigma that affects the social position and job prospects of persons who have been committed because of mental illness. [40] So construed, AS 47.30.915(7)(B) is constitutional. Wetherhorn additionally argues that AS 47.30.915(7)(B) is unconstitutional because it does not require that the danger be imminent. She relies on Suzuki v. Yuen, in which a Hawaii civil commitment statute was determined to be unconstitutional because it failed to specify that the `danger' to self or others be imminent. [41] But the United States Supreme Court has not made imminence a requirement. [42] We have not yet addressed the question whether the concept of imminence is compatible with the passive nature of harm reflected in the gravely disabled definition or whether the facts and specific behavior of the respondent required by AS 47.30.730(a)(7) must include recent acts. [43] But we need not address those issues here, because the facts alleged in this case were drawn from the recent past. The petition stated that Wetherhorn had shown a manic state, a lack of insight, and non-compliance with her medication for the past three months. And during the hearing, Dr. Kiele testified that Wetherhorn remained confused and agitated and that her difficulties with insight had not changed since she had been at the hospital. He further noted that she had struck people and therefore presented a direct risk of harm to others and more of an indirect risk of harm to herself. Because all these examples of specific behavior were drawn from the recent past, they were sufficient to meet the evidentiary standards established by those states that have addressed the question of imminence. [44]