Military Law Issues
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Mental Health Commitment
Due Process Requirements.
A civil commitment for any purpose constitutes a significant deprivation of liberty that requires due process protection. Addington v. Texas, 441 U.S. 418, 425 (1979). In re R.P., 606 N.W.2d 15, 17 (Iowa 2000). Commitment must be “justified on the basis of a legitimate state interest, and the reasons for committing a particular individual must be established in an appropriate proceeding. O’Connor v. Donaldson, 422 U.S. 563, 580 (1975). Involuntary commitment deprives an individual of his liberty through coercive state action. In re Oseing, 296 N.W.2d 797, 798 (Iowa 1980).
Therefore, it is imperative that the statutory requirements and procedures be followed. Cf. Suzuki v. Quisenberry, 411 F. Supp.1113, 1129-30 (D. Haw. 1976) (detailing various circumstances under which committee may be excluded from hearing and requiring court inquiry and approval, as well as exploration of alternatives to total exclusion); Doremus v. Farrell, 407 F. Supp. 509, 515 (D. Neb. 1975) (“The subject has a constitutional right to be present at the hearing unless he voluntarily, intelligently and knowingly waives it or his counsel waives it for him after a showing that he is incompetent, or the subject’s conduct is so disruptive as to require his exclusion.”); In re Watson, 154 Cal. Rptr. 151, 155 (Ct. App. 1979) (holding denial of committee’s right to be present at hearing “absent an on-the-record showing that she waived that right or was incapable of doing so by reason of either physical or mental incapacity, deprived her of her fundamental constitutional right to due process of law”); Green v. State, 537 S.W.2d 100, 102 (Tex. Civ. App. 1976) (“Due process requires the presence of the person proposed to be involuntarily committed at all judicial proceedings conducted for that purpose, unless the right has been knowingly and intelligently waived by such person or by adversary counsel acting in her behalf and for good cause shown.” In the Matter of M.T., Alleged to be Seriously Mentally Impaired, 56/00-0886 (Iowa 2001).
Requirements for Involuntary Hospitalization and Treatment.
Iowa Code section 229 governs involuntary hospitalization and treatment… After an “interested person” commences commitment proceedings under section 229.6, the district court must decide whether the respondent is “seriously mentally impaired,” a condition that is defined in section 229.1[(17)]. B.A.A. v. Chief Medical Officer, University of Iowa Hospitals, 421 N.W.2d 118, 121 (Iowa 1988) (updated with code section (2009)).
A person found to have a serious mental impairment may be committed involuntarily. Iowa Code § 229.13 (2009). Definition of “serious mental impairment” in Iowa Code section 229.1(17) (2009) has three elements: the person committed must be found to be
“(1) afflicted with 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 self-injury or injury to others, or to inflict emotional injury on the designated class of persons. Oseing, 296 N.W.2d at 799. Accord Mohr, 383 N.W.2d at 541. B.A.A 421 N.W.2d at 124.
Mental Illness: 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). A finding of “mental illness” alone cannot justify a state’s locking a person up against his will and keeping him indefinitely in simple custodial confinement…there is still no constitutional basis for confining such persons involuntarily if they are dangerous to no one and can live safely in freedom. O’Connor at 575. This danger must be evidenced by a “ ‘recent overt act, attempt, or threat.” “ In re Mohr, 383 N.W.2d 539, 542 (Iowa 1986).
Lack Sufficient Judgment to make Responsible Decisions in Regard to his/her hospitalization or treatment: 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. In re J.P., 574 N.W.2d 340, 343 (Iowa 1998). A decision, although medically inadvisable, may be rationally reached, and if so, it is not the court’s place to second guess the decision. Id.
Likely to Inflict Physical Injury to One’s Self or Others or Infliction of Serious Emotional Injury on Specified Persons: 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 endangerment element consists of three alternative criteria: (a) the person is likely to physically injure the person’s self or others if allowed to remain at liberty without treatment; (b) the person is likely to inflict serious emotional injury on members of the person’s family or others; or (c) the person is unable to satisfy the person’s need for nourishment, clothing, essential medical care or shelter so that it is likely that the person will suffer physical injury, physical debilitation, or death. Iowa Code § 229.1(17)(a)-(c) (2009). “Likely” is construed to mean “probable or reasonably to be expected.” Oseing, 296 N.W.2d at 801.
The danger the person poses to himself/herself or others must be evidenced by a “recent overt act, attempt, or threat.” Id. Emotional trauma is insufficient for involuntary hospitalization. In re J.P., 574 N.W.2d 340, 343 (Iowa 1998). The Code requires “serious emotional injury.” Iowa Code § 229.1(16)(2009). “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.
“Overt act” connotes past aggressive behavior or threats by the respondent manifesting the probable commission of a dangerous act upon himself or others that is likely to result in physical injury. In re Foster, 426 N.W.2d 374 (Iowa 1988). Socially unacceptable, even repugnant, behavior does not satisfy the overt act requirement. In re Mohr, 383 N.W.2d 539,542 (Iowa 1986). Verbalized delusions, even though bizarre, do not constitute the type of overt act necessary to establish dangerousness. In re Foster, 426 N.W.2d 374, 378 (Iowa 1988). “Overt acts include behavior such as a threat to take one’s life,…a threat to kill, …and verbal abuse coupled with aggressive physical action such as being ‘armed’ with a baseball bat…”Id. (quoting In re M.C., 716 P.2d 203, 207 (Mont. 1986)).
The statute requires a respondent’s serious mental impairment be established as of the time of the decision to commit rather than at some earlier point. This is true not only with respect to the initial treatment decision, but also for each of the subsequent re-determinations which must be made at a number of identified stages throughout the commitment, evaluation, and treatment process. The standards applicable at each step are the same; at each point the question relates to the respondent’s present, not past, condition. Bezanson, 61 Iowa L.Rev. at 270.
Least restrictive placement. It is not only the customary procedure, but the constitutionally and statutorily mandated requirement, to treat even seriously mentally impaired persons in the least restrictive environment medically possible. Leonard v. State, 491 N.W.2d 508, 512 (Iowa 1992) (citing B.A.A., 421 N.W.2d at 124). Iowa Admin. Code 441-28.2 (2009). In the Matter of E.H., 3-419/ 02-1786 (Iowa App. 2003).
The allegations made in the application for involuntary commitment must be supported by clear and convincing evidence. Iowa Code § 229.13 (2009). Clear and convincing evidence is more than a preponderance of the evidence but less than evidence beyond a reasonable doubt. In Interest of N.C., 551 N.W.2d 872,873 (Iowa 1996). “It means that there must be no serious or substantial doubt about the correctness of a particular conclusion drawn from the evidence.” In Interest of L.G., 532 N.W.2d 478, 481 (Iowa App. 1995).
Outplacement treatment. To be ordered to outpatient treatment, a person cannot be involuntarily committed unless all the elements of serious mental impairment are proven by clear and convincing evidence. In the Interest of R.I., 5-149/04-1203 (Iowa App. 2005).
Challenge to Involuntary Commitment and Appeals
A respondent may appeal the decision to order placement, but shall remain in placement until the Iowa Supreme Court orders otherwise. Iowa Code 229.17 (2009). A respondent may appeal within 10 days of the date of the order. Iowa Code section 229.21 (2009). Notice must be given to the Clerk of Court and signed by the respondent, respondent’s next friend, guardian, or attorney.
A patient, see Iowa Code § 229.1(10) (2009), may challenge the continued involuntary commitment under section 229.37 (2009). This section provides that “[a]ll persons confined as seriously mentally impaired shall be entitled to the benefit of the writ of habeas corpus, and the question of serious mental impairment shall be decided at the hearing.” Id. A person civilly committed to the Security Hospital can always raise the question of his mental illness by habeas corpus proceedings. Hiatt v. Soucek, 36 N.W.2d 432, 434 (Iowa 1949).
Termination of Involuntary Commitment.
O’Connor mandates that once a justification or legitimate state interest no longer exists, confinement must cease. O’Connor 422 U.S. at 580. The Iowa involuntary commitment statute was crafted to comply with O’Connor by (1) assuring continual monitoring of the committed person, (2) requiring the least restraint medically possible, and (3) providing for the person’s immediate release once it is determined that the person requires no further treatment for serious medical impairment. B.A.A. 421 N.W.2d at 124.
Presence of the Respondent at the Hearing.
Iowa Code section 229.12 (2009) provides that “[t]he respondent has the right to be present at the hearing.” Nonetheless, under the Supreme Court’s Rules for Involuntary Hospitalization of Mentally Ill, the judge or mental health referee may determine that the respondent’s presence is not in his or her best interests. Rule 20 provides in pertinent part:
The respondent must be present at the hearing unless prior to the hearing the respondent’s attorney stipulates in writing to respondent’s absence, such stipulation to state (1) that the attorney has conversed with the respondent, (2) that in the attorney’s judgment the respondent can make no meaningful contribution to the hearing, and (3) the basis for such conclusions. A stipulation to the respondent’s absence shall be reviewed by the judge or referee before the hearing, and may be rejected if it appears that insufficient grounds are stated or that the respondent’s interests would not be served by the respondent’s absence. Iowa Sup. Ct. R. for Involuntary Hospitalization of Mentally Ill 20.
If the respondent has been medicated within 12 hours or longer period if the court designates, prior to the hearing, the judge shall be notified of that fact and the probable effects of the medication. Iowa Code section 229.12 (2009).
Incompetence not the same as Commitment.
Iowa Code 229.27 (2009) provides the procedure for finding incompetency which is not the same as involuntary commitment. Voluntary or involuntary commitment does not constitute a finding of or a presumption of incompetency, nor deemed to not be of sound mind, nor legal disability. This requires a petition to the court that the person is incompetent by reason of mental illness. The test for competence is whether the person possesses sufficient mind to understand in a reasonable manner the nature and effect of the act in which the person is engaged. A hearing prescribed in Iowa Code sections 633.552-633.556 (2009) is required for incompetency.
Mental Health Advocates.
Mental health advocates are appointed in the respondent’s county and are provided copies of the application and order. Iowa Code section 229.9A.
Mental health proceedings and reports are confidential as per Iowa Code section 229.24-229.25 (2009).
Juvenile health procedures are contained on a separate page.