IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
In the Matter of the Detention of
No. 84614-1-I
M.M.,
DIVISION ONE
Appellant.
UNPUBLISHED OPINION
MANN, J. — M.M. appeals the trial court’s order involuntarily committing her for 14
days of treatment under the Involuntary Treatment Act (ITA), ch. 71.05 RCW. M.M.
argues that the State presented insufficient evidence to support the trial court’s
conclusion that M.M. was gravely disabled under RCW 71.05.020(24)(a). 1 We affirm.
I.
On September 26, 2022, a designated crisis responder (DCR) responded to
Forks Community Hospital after M.M. was admitted and was reporting “suicidal ideation”
with a plan to “take her pills tonight.” At the hospital, M.M. was seen responding to
internal stimuli.
1 On May 11, 2023, the legislature amended RCW 71.05.020. LAWS OF 2023, ch. 425, § 20.
However, the amendments do not affect our analysis, so we will use the current version of the statute.
No. 84614-1-I/2
In her interview with the DCR, M.M. displayed “hopelessness,” reported that
“nobody loves” her, and that “things get messed up” when she is using
methamphetamines. M.M. reported two recent failed attempts at suicide, including
overdosing on her medications, and explained that she now knows how to “get the right
combination” to succeed. M.M. also described voices in her head telling her they were
going to “kill her.” The DCR contacted M.M.’s sister who reported that M.M. was looking
for a gun to kill herself. The sister stated that M.M. had been unable to do anything for
months due to the “voices in her head.” The sister also reported that M.M. was “super
paranoid” and believed people were trying to kill her.
M.M. was detained under the ITA after the DCR referred M.M. for evaluation and
treatment. M.M. was transported to Telecare North Sound Evaluation and Treatment
Facility in Skagit County. While M.M. was detained, Telecare North Sound staff
petitioned for a 14-day involuntary treatment, alleging that M.M. posed a likelihood of
serious harm to herself.
The involuntary treatment hearing was held on October 4, 2022. Joann Clemo, a
licensed social worker for Telecare North Sound, testified that M.M. had a mental health
disorder with a diagnosis of psychosis unspecified. Clemo identified several symptoms
observed in M.M. including internal preoccupation, responding to internal stimuli, and
delusional thoughts. Clemo also testified that M.M.’s “delusional thought content and
the internal preoccupation strongly suggest that she would not be able to care for her
health and safety at this point.” Clemo explained that while at Telecare North Sound,
M.M. had called 911 claiming someone was trying to kill her, reported believing three
specific women were trying to kill her, and repeatedly stated that she was seeing people
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No. 84614-1-I/3
being murdered under the cars in the parking lot. These thoughts had been occurring
up until two days before the hearing. Clemo also described an incident where M.M.
tried to run out of the facility, she knocked down two people and staff had to intervene.
Clemo also reported that M.M. had been “feeling suicidal due to her voices” the day
before the hearing.
Clemo testified that M.M. had some substance use history, but she tested
negative in the hospital. Clemo added that they did not see withdrawal symptoms at
Telecare North Sound which “speak[s] to something other than substance use issues.”
Clemo testified that M.M.’s discharge plan of attending a specific substance use facility
required more time for fine-tuning M.M.’s medication dosages. Clemo concluded that
M.M. “has made some progress, but she would not be able to manage her health and
safety due to her thought contact right now.”
The court found that M.M. suffered from a mental disorder and was gravely
disabled. The court ordered that M.M. be committed for 14 days for involuntary
treatment.
M.M. appeals.
II.
The State argues that we should dismiss this case as moot because we cannot
provide effective relief and that there is no matter of continuing public interest
warranting review. “An appeal is moot where it presents merely academic questions
and where this court can no longer provide effective relief.” In re Det. of M.K., 168 Wn.
App. 621, 625, 279 P.3d 897 (2012). But an individual’s release will not render the
appeal of their involuntary treatment moot if collateral consequences stem from the
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No. 84614-1-I/4
determination that authorized the involuntary treatment. See Born v. Thompson, 154
Wn.2d 749, 762-63, 117 P.3d 1098 (2005).
When making a civil commitment determination, the court “shall give great
weight” to the individual’s prior civil commitments within the last three years. RCW
71.05.245(3). Thus, “each commitment order has a collateral consequence in
subsequent petitions and hearings.” M.K., 168 Wn. App. at 626; see also In re Det. of
C.K., 108 Wn. App. 65, 71-74, 29 P.3d 69 (2001) (analyzing In re Det. of LaBelle, 107
Wn.2d 196, 204-05, 728 P.2d 138 (1986), and subsequent legislation to hold that C.K.’s
history of decompensation was relevant to his latest involuntary commitment hearing).
Thus, we can “render relief if we hold that the detention under a civil commitment order
was not warranted.” M.K., 168 Wn. App. at 626. Because a court may consider prior
commitment orders, we address M.M.’s appeal even though the commitment order has
expired.
III.
M.M. argues that the State failed to present sufficient evidence to establish that
M.M. was gravely disabled under the definition in RCW 71.05.020(24)(a). We disagree.
The ITA authorizes courts to commit an individual for up to 14 days if, by a
preponderance of the evidence, the petitioning party proves that such person, “as the
result of a behavioral health disorder, presents a likelihood of serious harm, or is gravely
disabled.” RCW 71.05.240(4)(a). The State’s authority to commit people under the ITA
is “strictly limited.” In re Det. of D.W., 181 Wn.2d 201, 207, 332 P.3d 423 (2014). The
court must consider less restrictive alternatives, but if it finds that none are sufficient, the
ITA dictates that the court must order the individual be detained to a licensed treatment
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No. 84614-1-I/5
facility. RCW 71.05.240(4)(a). Involuntary commitment is a “massive curtailment of
liberty,” thus, courts must strictly construe the statutes regulating these proceedings.
Humphrey v. Cady, 405 U.S. 504, 509, 92 S. Ct. 1048, 31 L. Ed. 2d 394 (1972); D.W.,
181 Wn.2d at 207.
On review, we determine whether substantial evidence supports the trial court’s
findings and, if so, whether those findings support its conclusions of law and judgment.
In re Det. of A.S., 91 Wn. App. 146, 162, 955 P.2d 836 (1998), aff’d, 138 Wn.2d 898,
982 P.2d 1156 (1999). “Substantial evidence is said to exist if it is sufficient to persuade
a fair-minded, rational person of the truth of the declared premise.” Brown v. Superior
Underwriters, 30 Wn. App. 303, 306, 632 P.2d 887 (1980).
RCW 71.05.020(24) defines “gravely disabled” as:
a condition in which a person, as a result of a behavioral health disorder:
(a) Is in danger of serious physical harm resulting from a failure to provide
for his or her essential human needs of health or safety; or (b) manifests
severe deterioration in routine functioning evidenced by repeated and
escalating loss of cognitive or volitional control over his or her actions and
is not receiving such care as is essential for his or her health or safety.
The court here issued the civil commitment order under prong (a) of the gravely
disabled definition. 2 Prong (a) requires “a showing of a substantial risk of danger of
serious physical harm resulting from failure to provide for essential health and safety
needs.” LaBelle, 107 Wn.2d at 204. But the substantial risk of harm need not “be
evidenced by recent, overt acts.” LaBelle, 107 Wn.2d at 204. Rather, “the State must
present recent, tangible evidence of failure or inability to provide for such essential
2 While the petition checked the box indicating M.M. presents a likelihood of serious harm to
herself not the box for grave disability, M.M. has not assigned error to this and in a footnote concedes that
the factual contentions in the petition were sufficient to provide notice: “Finally, unlike in the case of the ‘a’
criterion, the 14-day petition itself contained no related allegations.”
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No. 84614-1-I/6
human needs as food, clothing, shelter, and medical treatment which presents a high
probability of serious physical harm within the near future unless adequate treatment is
afforded.” LaBelle, 107 Wn.2d at 204-05. The State must show that the person’s
mental condition “render[s] [her] unable to make a rational choice with respect to [her]
ability to care for [her] essential needs.” LaBelle, 107 Wn.2d at 210.
According to the court’s written order:
[M.M.] is improving but unable to engage in treatment. Diagnosis is
psychosis unspecified. Responds to internal stimuli and shows delusional
thought content. Has been tangential & labile. Has expressed suicidal
ideation. ADLs[3] are fairly good and is taking meds but needs further
stabilization [for] discharge. [M.M.] has responded to internal stimuli and
delusional thoughts as recently as yesterday.
There was sufficient evidence to support the trial court’s finding that M.M. was in danger
of serious physical harm resulting from failure to provide for her essential needs. RCW
71.05.020(24)(a). Clemo testified that M.M.’s current diagnosis was psychosis
unspecified and described M.M. as internally preoccupied, responding to things unseen
and unheard by others, and having delusional thought content. M.M. was “tangential
and nonsensical with most of her responses and very labile.”
M.M. asserts that neither the court, nor Clemo, explained how M.M.’s psychotic
symptoms prevented her from meeting essential health or safety needs. Proving an
individual is gravely disabled under prong (a) does not necessarily require prior
knowledge of the individual’s lifestyle, but instead recent tangible evidence of failure to
provide for essential human needs. LaBelle, 107 Wn.2d at 204-05. The risk of harm
“usually arises from passive behavior.” LaBelle, 107 Wn.2d at 204. Here, the State
3 Activities of daily living.
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No. 84614-1-I/7
properly focused on the recent evidence that during M.M.’s commitment, many mental
health symptoms persisted despite her general compliance with some aspects of
treatment.
The court’s findings are supported by substantial evidence that while at Telecare
North Sound, M.M. continued to experience delusional thought content and internal
preoccupation. From the facility, M.M. called 911 claiming someone was trying to kill
her and repeatedly told providers she was seeing people being murdered under their
cars in the parking lot. M.M. was initially detained because of an imminent risk of
suicide and while she was no longer expressing plans, the day before the hearing she
was feeling suicidal and hearing voices.
Clemo admitted that M.M.’s activities of daily living had been improving while at
Telecare North Sound. But M.M. showed impaired insight into her prescribed
medications. M.M. did not understand what medications she was taking, was maxing
out her use of “as needed” medications, and did not understand that her prior
medications did not seem to work which is why Telecare North Sound was trying to
switch and modify them. Even during the hearing, M.M. interrupted the proceedings
twice showing that she did not understand the medications that were being given. 4
Clemo also testified that M.M. was unable to engage and continue in
conversations with her. This prevented M.M. from engaging in discharge planning to
take care of her essential needs. And while M.M. told Clemo that she wanted to be
discharged to a specific chemical dependency program, the program was unlikely to
4 Clemo testified that Telecare North Sound had just started M.M. on Depakote and was giving
her Zyprexa. M.M. interrupted to say she had never had Zyprexa. A few minutes later, she interrupted
again and said that she had never taken Depakote before.
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No. 84614-1-I/8
take someone until they were showing no psychotic symptoms and were stable on
medication. These facts all show a failure and inability to provide for her ongoing
medical treatment.
Reviewing the record as a whole, the trial court’s findings for M.M.’s 14-day
involuntary commitment are supported by substantial evidence.
Affirmed.
WE CONCUR:
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In Re The Detention Of M.m.
Combined Opinion