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

Heading: Least restrictive alternative placement

Text: An important principle of civil commitment in Alaska is to treat persons in the least restrictive alternative environment consistent with their treatment needs. [37] Joan argues the superior court erred in finding commitment to API would be the least restrictive alternative placement. Joan also contends no testimony supported a finding that she refused outpatient treatment or a home placement, particularly in light of Dr. Bell's and Dr. Parker's decisions not to contact her family or prior psychiatrist to ask about Joan's potential success in such alternative settings. Joan's second argument reflects a misunderstanding of the superior court's findingsthe court found outpatient treatment was not a viable option, and therefore the lack of evidence that Joan refused voluntary outpatient treatment is irrelevant. The superior court found there was [n]o less restrictive facility [that] would adequately protect [Joan] and the public. The court explained: API is an appropriate treatment facility, that there is no less restrictive facility that would adequately protect the respondent and the public at this time. The reason for that finding is Dr. Parker's testimony that in order for a family wraparound to work or 24-hour surveillance by a family to work, she would have to agree to it and he has witnessed her changing her mind rapidly about what she will do and what she will not do. So, I can't trust that committing her to her family's care would be a less restrictive alternative that would likely work for her. The record supports the superior court's finding. First, Dr. Bell and Dr. Parker both testified there was no less restrictive facility than API that could meet Joan's needs. Dr. Bell testified Joan needed a very secure mental health unit that would very closely control[] her and provide a lot of emotional support, with careful control of her sleep pattern and regular appetite. Dr. Bell thought Joan need[ed] a long period of treatment, though it could be concluded within 30 days were she to accept medication reliably and begin to understand how drugs and alcohol impact on the exacerbation of her mental illness. Dr. Parker testified Joan needed to come out of her current manic episode and return to her baseline before being released, otherwise she would continue her uncontrolled manic behavior and substance abuse. Second, Dr. Parker testified outpatient psychiatry or psychology require a patient stable enough to have insight into one's behavior and some sort of consistency of behavior. Joan was not stable because she had changeable emotions and could change her mind from one minute to the next. Joan also lacked perspective regarding her bipolar disorder, denying she had any mental illness or needed treatment. Because of Joan's lack of insight, Dr. Parker thought it very unlikely she would follow through with outpatient treatment even if she said she would. The superior court did not err by finding API was the least restrictive placement.