E.p. v. Alaska Psychiatric Institute: the Evolution of Involuntary Civil Commitments from Treatment to Punishment

• Publication year: 2011

§ 28 Alaska L. Rev. 189. E.P. V. ALASKA PSYCHIATRIC INSTITUTE: THE EVOLUTION OF INVOLUNTARY CIVIL COMMITMENTS FROM TREATMENT TO PUNISHMENT

Alaska Law Review
Volume 28
Cited: 28 Alaska L. Rev. 189

E.P. V. ALASKA PSYCHIATRIC INSTITUTE: THE EVOLUTION OF INVOLUNTARY CIVIL COMMITMENTS FROM TREATMENT TO PUNISHMENT

Proud Usahacharoenporn ^[*]

Abstract

The Alaska Statutes require the State to prove by clear and convincing evidence that an individual is either gravely disabled or a danger to himself or others before that person can be involuntarily civilly committed. If a person is gravely disabled, the State must also prove that his condition will improve with treatment during the commitment. There is no such requirement for those who are a danger to others, but there is controversy over whether a showing of improvement is required for those who are a danger to themselves. In E.P. v. Alaska Psychiatric Institute, E.P. was involuntarily committed because he was addicted to huffing gasoline, and the courts found that this condition made him a danger to himself. E.P. was wrongfully committed for three reasons. First, he was more likely gravely disabled than a danger to himself; however, he could not be committed for being gravely disabled because the State could not show that his condition would improve with treatment. Second, the State did not meet its burden of proving that E.P. was a danger to himself. Third, even if E.P. was a danger to himself, the Alaska Statutes require the State to show that he would improve with treatment.

Introduction

Terry Foucha was charged with aggravated battery inside of an inhabited dwelling and illegal discharge of a .357 revolver. ^[1] Foucha was found not guilty by reason of insanity and was admitted to a hospital because he was found to be a menace to himself and others. ^[2] While at the hospital, he remained "combative, agitated, and psychotic" and continued to be a "menace to society." ^[3] Foucha frequently fought with other patients and consequently was sent to the maximum security section of the hospital. ^[4] Nevertheless, the Supreme Court of the United States found his commitment unconstitutional because the State of Louisiana failed to meet its burden of proving by clear and convincing evidence that Foucha was a danger. ^[5]

In stark contrast, E.P. was involuntarily committed to the Alaska Psychiatric Institute (API) for ten months on the grounds that he was mentally ill and was considered a danger to himself. ^[6] Unlike Foucha, E.P. was never charged with a crime and did not get into altercations at the hospital. ^[7] E.P. was involuntarily committed because he was addicted to huffing (or inhaling) substances like gasoline fumes. ^[8] Although E.P.'s addiction was cited as the reason for his commitment, E.P. did not receive any treatment for his addiction while he was locked in API because API is not a substance abuse treatment facility. ^[9] Nevertheless, the Alaska Supreme Court upheld the commitment and agreed with the superior court's finding that E.P. was a danger to himself. ^[10]

Mental hospitals provide treatment and medication for thousands of mentally ill individuals across the nation and are effective for many patients. However, the denial of liberty that results from an involuntary commitment to a mental hospital has substantial negative effects on a person's physical, social, and mental well-being. ^[11] People who are committed to psychiatric hospitals also face social consequences, which makes it harder for them to fit in amongst peers and to find jobs post-commitment. ^[12] Despite the negative aspects of involuntary hospitalization, mental hospitals are useful to society when they provide treatment for the mentally ill. However, when an individual confined in a mental hospital does not receive treatment for his illness, the hospital no longer serves its purpose and becomes merely a prison.

For these reasons, the Supreme Court of the United States "repeatedly has recognized that civil commitment for any purpose constitutes a significant deprivation of liberty that requires due process protection." ^[13] When deciding whether a commitment is necessary, courts must weigh the potential harms to the individual, including the denial of constitutional rights, against the state's interest in providing treatment to the individual and preventing future harm to the individual and to society. ^[14] Because such important individual rights are at stake, the Supreme Court has held that the state bears the burden of proving by clear and convincing evidence that the commitment is necessary. ^[15]

In the Alaska Statute sections that governed E.P.'s case, the Alaska Legislature codified the Supreme Court's recognition that involuntary commitments should be used primarily for treatment. ^[16] In Alaska, there are three groups of mentally ill individuals who can be committed: those who are gravely disabled, those who are a danger to themselves, and those who are a danger to others. ^[17] The statute clearly mandates that the State can commit a gravely disabled person only when he will improve with treatment. ^[18] But, this requirement is not present when a person is a danger to others ^[19] because other citizens' safety concerns are at stake. However, an important issue in this case, which will be discussed at length in Part Iv.C, is whether the State is required to show that an individual will improve with treatment when that individual is committed for being a danger to himself.

In E.P, v, Alaska Psychiatric Institute, ^[20] the Alaska Supreme Court wrongly upheld E.P.'s commitment because the State failed to prove by clear and convincing evidence that E.P.'s commitment was necessary. First, E.P. was more likely gravely disabled than a danger to himself, so the State should have been required to show that he would improve with treatment. The State itself admitted that it could not commit E.P. for being gravely disabled because he would not improve with treatment. ^[21] The State therefore attempted to commit E.P. on the basis that he was a danger to himself. ^[22] Second, because the evidence more clearly supported the assertion that E.P. was gravely disabled, the State did not meet its burden of showing that E.P. was a danger to himself with clear and convincing evidence. Third, even if E.P. was a danger to himself, the statute required that the State show that E.P. would improve with treatment, ^[23] and the State failed to do so. For these reasons, E.P.'s involuntary commitment was an unconstitutional deprivation of his rights and served more as a punishment than as a form of treatment.

Part I more thoroughly examines the facts of E,P, v, Alaska Psychiatric Institute ^[24] ("E,P, v, API") and the sections of the Alaska Statutes that apply to involuntary civil commitments. Part II describes the Alaska Supreme Court's holdings in E,P, v, API, Part III explores the legal background of involuntary civil commitments with a focus on the standard of proof and the difficulties of defining the dangerousness standard. Part Iv is a critique of the State's failure to meet its burden in E.P.'s case and of the Alaska Supreme Court's interpretation of the civil commitment statutes. It explains why the court should not have found E.P. to be a danger to himself and why this error resulted in a commitment that was more of a punishment for E.P.'s lifestyle choices than an effort to treat his mental illness. This section discusses the need for statutory revisions, including a more concrete definition of "dangerousness" and a clarification of the elements that must be proved in civil commitment cases. Finally, the Note proposes alternatives to civil commitments that would prevent individuals from being wrongfully committed in the future.

I. E.P.: TOCommit or Not to Commit?

A. Involuntary Commitment Statutes

Sections 47.30.655 through 47.30.770 of the Alaska Statutes govern the involuntary civil commitments of mentally ill individuals. ^[25] Section47.30.655 of the Alaska Statutes states the Legislature's purpose in writing these statutes - to "more adequately protect the legal rights of persons suffering from mental illness." ^[26] Other principles that guide these provisions are "that persons be treated in the least restrictive alternative environment consistent with their treatment needs" and "that persons who are mentally ill but not dangerous to others be committed only if there is reasonable expectation of improving their mental condition." ^[27]

The other sections describe the elements that must be met in order to commit an individual involuntarily to a mental facility for thirty, ninety, or 180 days. ^[28] A person must first be committed for thirty days before he can be re-committed for ninety days, ^[29] and for ninety days before he can be re-committed for 180 days. ^[30] The individual may then be committed for successive 180-day terms with no limit to the number of commitments. ^[31] Generally, to commit an individual for any length of time, a court must find by clear and convincing evidence that the individual is mentally ill, and as a result is likely to cause harm to himself or others, or that he is gravely disabled. ^[32]

"Gravely disabled" is "a condition in which a person as a result of mental illness is in danger of physical harm arising from . . . complete neglect of basic needs for food, clothing, shelter, or personal safety" or the person will suffer "abnormal...