IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
In the Matter of the Detention of No. 82065-6-I
M.M. DIVISION ONE
UNPUBLISHED OPINION
CHUN, J. — A Pierce County Superior Court commissioner entered an
order involuntarily committing M.M. for up to 180 days of mental health treatment
on grounds of her grave disability. M.M. moved to revise the order, which motion
the trial court denied. M.M. appeals. We affirm.
I. BACKGROUND
M.M. is 72 years old and suffers from an unspecified delusional disorder.
She first began to exhibit related mental health symptoms at the age of 41. In
May 2019, M.M. was evicted from her apartment. She returned to the apartment
multiple times after the eviction, claiming she had not been evicted. On one such
instance, law enforcement brought her to Recovery Resource Center,1 where a
designated crisis responder evaluated her for detention.
Following petitions by care providers, a Pierce County Superior Court
commissioner involuntarily committed M.M. for a 14-day stay, and then a 90-day
stay, at Telecare, an evaluation and treatment center.
1 Recovery Resource Center is apparently a mental health treatment center.
Citations and pin cites are based on the Westlaw online version of the cited material. No. 82065-6-I/2
Care providers then petitioned for 180 days of involuntary treatment. A
Pierce County Superior Court commissioner held a hearing on the 180-day
petition at which a Telecare mental health clinician and M.M.’s daughter testified.
The clinician testified that she examined M.M. five days before the
hearing, and that during the examination, M.M. was appropriately dressed and
groomed, her memory was intact, and she denied hallucinations and suicidal and
homicidal ideation. But the clinician also stated that M.M. was delusional. The
clinician testified that M.M. stated it was illegal to evict her from her apartment
since she had paid an electricity bill there, and that lead in the water at the
apartment building was poisoning the residents. The clinician also stated that
M.M. had delusions about someone impersonating her daughter. The clinician
testified that M.M.’s judgment and insight were impaired, since they had
presented her with 40 to 50 housing options, but M.M. had rejected all of them
because she was afraid a roommate would get her in trouble with law
enforcement. The clinician testified that M.M. preferred to live in her car, which
she had done before in her daughter’s backyard. But the clinician learned from
the daughter that M.M. had done so in temperatures exceeding 80 degrees
Fahrenheit, and could not tell that it was too hot for her to sleep in the car. The
clinician also stated that M.M.’s plans to live in her car were not safe because of
her age. The clinician testified that M.M. stated she would refuse medication
once discharged and had no plans to participate in outpatient therapy, and that
M.M. had not responded to medication given to her while detained. She testified
that a less restrictive alternative than a 180-day commitment would not serve
2 No. 82065-6-I/3
M.M.’s best interest, since M.M. would not be able to care for herself and
planned to refuse medication.
The daughter testified that M.M. had slept in her car in the daughter’s
backyard for a period during summer of 2017 and described M.M. as “frail.” She
also testified that M.M. believed she could still live in her apartment since she
had paid an electricity bill, and that M.M. “has got split realities.”
Following the hearing, the commissioner entered findings of fact and
conclusions of law, and an order involuntarily committing M.M. for a 180-day
stay. The order found that M.M. is delusional, has impaired judgment and
insight, lacks cognitive and volitional control, and that her discharge plan would
not be safe. Based on the foregoing testimony, the commissioner found that
because of a mental disorder, M.M. manifests severe deterioration in routine
functioning evidenced by repeated and escalating loss of cognitive or volitional
control over her actions and is not receiving such care as is essential for her
health or safety. It ultimately found by clear, cogent, and convincing evidence
that M.M. is gravely disabled.
M.M. moved to revise the order, which motion the trial court denied after a
hearing.
II. ANALYSIS
M.M. says that insufficient evidence supports the trial court’s finding that
she is gravely disabled. We conclude the trial court’s grave disability finding is
supported by substantial evidence, which the trial court could have reasonably
found to be clear, cogent, and convincing.
3 No. 82065-6-I/4
Under chapter 71.05 RCW, a court may involuntarily commit a person for
the treatment of a mental disorder if, because of the disorder, they are gravely
disabled. In re Det. of LaBelle, 107 Wn.2d 196, 201–02, 728 P.2d 138 (1986).
“Gravely disabled” means: 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 [their] essential 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 [their] actions and is not receiving such care as is essential for [their] health or safety.
RCW 71.05.020(23). The trial court found that M.M. is gravely disabled under
subsection (b) of the definition. When determining whether a person is gravely
disabled under this subsection, a court should consider “(1) whether the person
is showing severe deterioration of routine functioning, evidenced by recent proof
of loss of cognitive or volitional control, and (2) whether they would receive the
care they need to maintain their health and safety if released.” In re Det. of D.W.,
6 Wn. App. 2d 751, 759, 431 P.3d 1035 (2018). The evidence supporting a
grave disability finding “must show that the person is unable to make a rational
choice about [their] need for treatment, creating a ‘causal nexus’ between the
person’s severe deterioration in routine functioning and evidence that [they]
would not receive essential care if [they] were released.” Id. (quoting LaBelle,
107 Wn.2d at 208). Subsection (b) enables the State to provide the kind of
continuous care and treatment that can break “‘revolving door’ syndrome, in
which patients often move from the hospital to dilapidated hotels or residences or
even alleys, parks, vacant lots, and abandoned buildings, relapse, and are then
4 No. 82065-6-I/5
rehospitalized, only to begin the cycle over again.” LaBelle, 107 Wn.2d at 206
(quoting Rhoden, The Limits of Liberty: Deinstitutionalization, Homelessness,
and Libertarian Theory, 31 Emory L.J. 375, 391 (1982)).2
The State bears the burden of proving that a person is gravely disabled by
clear, cogent, and convincing evidence. In re Det. of R.H., 178 Wn. App. 941,
945–46, 316 P.3d 535
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IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
In the Matter of the Detention of No. 82065-6-I
M.M. DIVISION ONE
UNPUBLISHED OPINION
CHUN, J. — A Pierce County Superior Court commissioner entered an
order involuntarily committing M.M. for up to 180 days of mental health treatment
on grounds of her grave disability. M.M. moved to revise the order, which motion
the trial court denied. M.M. appeals. We affirm.
I. BACKGROUND
M.M. is 72 years old and suffers from an unspecified delusional disorder.
She first began to exhibit related mental health symptoms at the age of 41. In
May 2019, M.M. was evicted from her apartment. She returned to the apartment
multiple times after the eviction, claiming she had not been evicted. On one such
instance, law enforcement brought her to Recovery Resource Center,1 where a
designated crisis responder evaluated her for detention.
Following petitions by care providers, a Pierce County Superior Court
commissioner involuntarily committed M.M. for a 14-day stay, and then a 90-day
stay, at Telecare, an evaluation and treatment center.
1 Recovery Resource Center is apparently a mental health treatment center.
Citations and pin cites are based on the Westlaw online version of the cited material. No. 82065-6-I/2
Care providers then petitioned for 180 days of involuntary treatment. A
Pierce County Superior Court commissioner held a hearing on the 180-day
petition at which a Telecare mental health clinician and M.M.’s daughter testified.
The clinician testified that she examined M.M. five days before the
hearing, and that during the examination, M.M. was appropriately dressed and
groomed, her memory was intact, and she denied hallucinations and suicidal and
homicidal ideation. But the clinician also stated that M.M. was delusional. The
clinician testified that M.M. stated it was illegal to evict her from her apartment
since she had paid an electricity bill there, and that lead in the water at the
apartment building was poisoning the residents. The clinician also stated that
M.M. had delusions about someone impersonating her daughter. The clinician
testified that M.M.’s judgment and insight were impaired, since they had
presented her with 40 to 50 housing options, but M.M. had rejected all of them
because she was afraid a roommate would get her in trouble with law
enforcement. The clinician testified that M.M. preferred to live in her car, which
she had done before in her daughter’s backyard. But the clinician learned from
the daughter that M.M. had done so in temperatures exceeding 80 degrees
Fahrenheit, and could not tell that it was too hot for her to sleep in the car. The
clinician also stated that M.M.’s plans to live in her car were not safe because of
her age. The clinician testified that M.M. stated she would refuse medication
once discharged and had no plans to participate in outpatient therapy, and that
M.M. had not responded to medication given to her while detained. She testified
that a less restrictive alternative than a 180-day commitment would not serve
2 No. 82065-6-I/3
M.M.’s best interest, since M.M. would not be able to care for herself and
planned to refuse medication.
The daughter testified that M.M. had slept in her car in the daughter’s
backyard for a period during summer of 2017 and described M.M. as “frail.” She
also testified that M.M. believed she could still live in her apartment since she
had paid an electricity bill, and that M.M. “has got split realities.”
Following the hearing, the commissioner entered findings of fact and
conclusions of law, and an order involuntarily committing M.M. for a 180-day
stay. The order found that M.M. is delusional, has impaired judgment and
insight, lacks cognitive and volitional control, and that her discharge plan would
not be safe. Based on the foregoing testimony, the commissioner found that
because of a mental disorder, M.M. manifests severe deterioration in routine
functioning evidenced by repeated and escalating loss of cognitive or volitional
control over her actions and is not receiving such care as is essential for her
health or safety. It ultimately found by clear, cogent, and convincing evidence
that M.M. is gravely disabled.
M.M. moved to revise the order, which motion the trial court denied after a
hearing.
II. ANALYSIS
M.M. says that insufficient evidence supports the trial court’s finding that
she is gravely disabled. We conclude the trial court’s grave disability finding is
supported by substantial evidence, which the trial court could have reasonably
found to be clear, cogent, and convincing.
3 No. 82065-6-I/4
Under chapter 71.05 RCW, a court may involuntarily commit a person for
the treatment of a mental disorder if, because of the disorder, they are gravely
disabled. In re Det. of LaBelle, 107 Wn.2d 196, 201–02, 728 P.2d 138 (1986).
“Gravely disabled” means: 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 [their] essential 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 [their] actions and is not receiving such care as is essential for [their] health or safety.
RCW 71.05.020(23). The trial court found that M.M. is gravely disabled under
subsection (b) of the definition. When determining whether a person is gravely
disabled under this subsection, a court should consider “(1) whether the person
is showing severe deterioration of routine functioning, evidenced by recent proof
of loss of cognitive or volitional control, and (2) whether they would receive the
care they need to maintain their health and safety if released.” In re Det. of D.W.,
6 Wn. App. 2d 751, 759, 431 P.3d 1035 (2018). The evidence supporting a
grave disability finding “must show that the person is unable to make a rational
choice about [their] need for treatment, creating a ‘causal nexus’ between the
person’s severe deterioration in routine functioning and evidence that [they]
would not receive essential care if [they] were released.” Id. (quoting LaBelle,
107 Wn.2d at 208). Subsection (b) enables the State to provide the kind of
continuous care and treatment that can break “‘revolving door’ syndrome, in
which patients often move from the hospital to dilapidated hotels or residences or
even alleys, parks, vacant lots, and abandoned buildings, relapse, and are then
4 No. 82065-6-I/5
rehospitalized, only to begin the cycle over again.” LaBelle, 107 Wn.2d at 206
(quoting Rhoden, The Limits of Liberty: Deinstitutionalization, Homelessness,
and Libertarian Theory, 31 Emory L.J. 375, 391 (1982)).2
The State bears the burden of proving that a person is gravely disabled by
clear, cogent, and convincing evidence. In re Det. of R.H., 178 Wn. App. 941,
945–46, 316 P.3d 535 (2014); RCW 71.05.310. “[W]e will not disturb the trial
court’s findings of ‘grave disability’ if supported by substantial evidence which the
lower court could reasonably have found to be clear, cogent, and convincing.”
LaBelle, 107 Wn.2d at 209.
We conclude the State has borne its burden of proof. The clinician’s
evaluation of M.M. came just five days before the involuntary commitment
hearing. Her testimony established that M.M. suffers from delusional thinking
about her living situation and daughter, and that she planned to reject medication
and more reliable housing in favor of living in her car. The daughter testified that
M.M. “has got split realities.” This constituted recent evidence of M.M.’s loss of
cognitive and volitional control.
M.M. says that it is not the place of a court to “[impose] majoritarian values
on a person’s chosen lifestyle which, although not sufficiently harmful to justify
commitment, may be perceived by most of society as eccentric, substandard, or
otherwise offensive,” so it was inappropriate to override her decision to live in her
2 M.M. says that a pattern of repeated hospitalizations or law enforcement intervention is necessary to establish a nexus between a person’s mental health deterioration and a court’s determination that the person would not receive essential care if released, and that she has no such history. But Division Two of this court rejected this argument in D.W. 6 Wn. App. 2d at 759.
5 No. 82065-6-I/6
car. Id. at 204. But as noted by the revision court, a younger person may be
able to endure more physical hardship than a frail person in their seventies. The
hearing testimony also established that M.M. had previously lived in her car but
had not been able to tell when it was too hot to be in the car. And M.M. stated
she would decline medication once released and had no plans to participate in
outpatient therapy. This constituted evidence that M.M. would not receive the
care she needed to maintain her health and safety if released.
We conclude the trial court’s grave disability finding is supported by
substantial evidence, which the trial court could have reasonably found to be
clear, cogent, and convincing.3
We affirm.
WE CONCUR:
3 M.M. says the trial court’s findings of fact are not sufficiently specific to permit review of its finding that she is gravely disabled. Such findings must indicate that the court considered the applicable criteria and the factual basis underlying the conclusion that the person is gravely disabled. LaBelle, 107 Wn.2d at 220. Since the findings support the conclusion that M.M. is showing severe deterioration of routine functioning, evidenced by recent proof of loss of cognitive or volitional control, and that she would not receive the care she needs to maintain her health and safety if released, they are adequate.