Opinion ID: 4358149
Heading Depth: 2
Heading Rank: 2

Heading: Linda M.

Text: Linda M. has a history of mental health issues spanning most of her adult life. By 2016 she had exhibited paranoia and aggressive behavior, such as spitting at people, and kicking and throwing things. The Anchorage Police Department’s crisis intervention team responded several times to calls from Linda’s mother reporting that Linda was threatening her. The police described Linda as “agitated” and “very volatile,” and they eventually arrested Linda for threatening her mother with a shovel and spitting on her. At the time Linda was already facing a criminal charge for reckless driving in connection with a car accident. While in custody for the two criminal cases, Linda was sent to API for an evaluation and restoration of her competency to stand trial. In July 2016 API filed a petition to commit Linda for 30 days. During the commitment hearing, Linda’s testimony seemed paranoid and delusional, including statements that members of a drug cartel had attempted to poison her; a psychiatric nurse practitioner testified that Linda had schizophrenia. The court found that Linda had a mental illness and as a result posed a “substantial risk of harm to others.” It granted API’s petition to commit Linda for up to 30 days. During her commitment, Linda voluntarily participated in therapy, but she also swore, lunged, and swung at various API staff members, raising concerns about her unpredictability and aggressive behavior. The therapy did not lead to improvement, and the efficacy of the drugs administered by API remained unclear. In August 2016 API filed a petition to commit Linda for another 90 days and Linda requested a jury trial. During the trial Linda offered further testimony reflecting paranoid delusions. The jury unanimously found by clear and convincing evidence that Linda was mentally ill and that as a result she was “likely to cause harm to others.” -5- 7328 Approximately one week after the jury verdict, the superior court held an evidentiary hearing on whether there was any less restrictive alternative to hospitalization at API. Various experts testified and several alternatives were explored. An API mental health clinician who was certified as an expert in API discharge planning testified that, because Linda was not taking medication as prescribed, she would not be accepted into a publicly funded assisted living home. The clinician also testified that a halfway house for formerly incarcerated individuals would not be appropriate for Linda, even in conjunction with a community support program, and that privately operated assisted living facilities would likely reject Linda because of her unpredictability and aggressiveness. An API psychiatric nurse practitioner similarly testified that Linda needed to be stabilized using medication at API before her release, that she still needed “24/7 . . . supervision,” and that releasing Linda into the community at that time would set her up for failure. Finally, a clinical psychiatrist testified that Linda could be discharged to an outpatient community support program if safe housing could also be arranged for her, such as an assisted living facility or other location with professional staff that could “retain her” if she became agitated. He also discussed a closed facility, Soteria-Alaska, as a less restrictive alternative to API. He testified that Soteria-Alaska had operated for seven years in Anchorage and had offered an alternative to the psychiatric inpatient hospitalization offered at API, but one that still provided “24/7” supervision. But he testified that Soteria-Alaska was shut down due to funding issues. He opined SoteriaAlaska would have been a good option for Linda if it were still in operation. Linda’s counsel asserted during closing argument that the evidence had not established a high probability that a less restrictive alternative would be unsuccessful. Counsel also argued that Linda “ha[d] the constitutional right to a Soteria-like setting.” -6- 7328 More specifically, counsel argued that “the state cannot de-fund Soteria-Alaska and then say that because we haven’t funded it, there is no less-restrictive alternative.” The superior court determined that, given the jury finding that Linda was likely to cause harm to others, “a less restrictive alternative would have to . . . protect others from physical injury.” The court reasoned that “none of the less restrictive alternatives that have been proposed by [Linda] or would otherwise be available will protect . . . the public from the danger to others that [Linda] currently [poses].” The court explained that when Linda becomes agitated, it happens quickly, and that no less restrictive alternative was sufficient to protect the public “other than a facility like API that is locked and [that] provides 24/7 care.” Finally, with regard to Soteria-Alaska as a proposed alternative, the court stated, “I reject the idea that there’s a constitutional right that would require the state to fund particular kinds of programs. There would be separation of powers issues, I believe.” The superior court found that there was no less restrictive alternative to commitment at API. Linda appeals, arguing that the court erred by rejecting SoteriaAlaska as a feasible less restrictive alternative, and that her commitment order therefore violated her constitutional right not to be hospitalized where a feasible less restrictive alternative exists. She requests that we reverse and vacate the 90-day commitment order.