In The Matter Of The Detention Of R.d.m.

Opinion

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON

In the Matter of the Detention of:

No. 88647-9-I

R.D.M.

DIVISION ONE

UNPUBLISHED OPINION

BUI, J. — R.D.M. appeals a 14-day involuntary commitment order under the “Involuntary Treatment Act” (ITA), ch. 71.05 RCW. R.D.M. challenges the sufficiency of the evidence proving that, as a result of a mental disorder, he posed a substantial risk of harm to himself, and he was gravely disabled under RCW 71.05.020(25)(b). Finding no error, we affirm.

FACTS

On July 17, 2025, R.D.M. was taken to Deaconess Medical Center (Deaconess) after a suicide attempt. R.D.M. stayed at Deaconess for 4 days “for opioid withdrawal symptoms.” Before he was discharged, a social worker at Deaconess contacted a Designated Crisis Responder (DCR) to evaluate R.D.M. for possible involuntary treatment due to concerns of danger to self and grave disability.

On July 30, Fairfax court evaluator Katherine Geisel filed a petition for 14-

day involuntary treatment in superior court. On the same day, the superior court held a probable cause hearing, and the State called R.D.M.’s close friend Gloria Morris and court evaluator Giesel as witnesses. R.D.M. testified on his own

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behalf.

The trial court concluded that as a result of a behavioral health disorder, R.D.M. presented a likelihood of serious harm to himself and was gravely disabled under RCW 71.05.020(25)(b). The court concluded that treatment in a less restrictive alternative setting was not in the best interest of R.D.M. or others. The court entered an order committing R.D.M. for involuntary commitment for 14 days.

R.D.M. timely appealed.

ANALYSIS

R.D.M. argues there was insufficient evidence to show that due to a mental disorder, he posed a substantial risk of harm to self or that he was gravely disabled.

An appellate court reviewing the trial court’s decision on involuntary commitment considers whether the trial court’s findings are supported by substantial evidence and if the trial court’s findings support the court’s conclusions of law and judgment. In re Det. of T.C.,11 Wn. App. 2d 51, 56, 450 P.3d 1230 (2019). “Substantial evidence is the quantum of evidence sufficient to persuade a fair-minded person of the truth of the declared premise.” In re Det. of H.N., 188 Wn. App. 744, 762, 355 P.3d 294 (2015) (citing 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)).

Under RCW 71.05.230(1), a petition for 14 days of involuntary treatment can be filed if the person’s condition is “caused by a behavioral health disorder

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and results in: (a) [a] likelihood of serious harm; or (b) the person being gravely disabled.” “[T]he petitioner must show, by preponderance of the evidence, that the person has not in good faith volunteered for appropriate treatment.” RCW 71.05.240(3).

After a probable cause hearing,

if the court finds by a preponderance of the evidence that a person detained for behavioral health treatment, as the result of a behavioral health disorder, presents a likelihood of serious harm, or is gravely disabled, and after considering less restrictive alternatives to involuntary detention and treatment, finds that no such alternatives are in the best interests of such person or others, the court shall order that such person be detained for involuntary treatment.

RCW 71.05.240(4)(a).

A review of the trial court’s ruling on involuntary commitment is limited to determining whether substantial evidence supports the findings, and if so, whether those findings support the conclusion of law and judgment. T.C., 11 Wn. App. 2d at 56 “ ‘Substantial evidence is evidence that is in sufficient quantum to persuade a fair-minded person of the truth of the declared premise.’ ” T.C., 11 Wn. App. 2d at 56 (internal quotation marks omitted) (quoting A.S., 91 Wn. App. at 162). The “burden is on the challenging party to demonstrate that substantial evidence does not support a finding of fact.” T.C., 11 Wn. App. 2d at 56. Likelihood of Serious Harm We first look to R.D.M.’s argument regarding the sufficiency of the evidence to commit him for 14 days. R.D.M. asserts “the State did not present enough evidence . . . that R.D.M.’s suicide attempt was caused by a mental

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disorder independently from street drugs.”

The court entered findings and identified the evidence upon which it relied in reaching those findings after the hearing. Based on the testimony of Geisel the court found that R.D.M. suffered from a mental disorder as defined in RCW 71.05.020(39). Geisel testified that R.D.M. was diagnosed with a mental health disorder of “unspecified schizophrenia spectrum,” and the symptoms for the mental health disorder include responding to internal stimuli, expressing delusions of persecution and grandeur, being agitated, having difficulty sleeping, being disoriented. Geisel added that R.D.M. “historically . . . has had more than just this one suicide attempt.” For this suicide attempt, R.D.M. “swallowed pills due to delusions that he had been shot in the head and was being sought after by Spokane Police Department.” From the medical notes, R.D.M. was responding to internal stimuli, hallucinating, and having delusions. Geisel testified that with those symptoms continuing to exist, R.D.M. remained at risk of harm to himself. Geisel testified that R.D.M. has “been in the hospital long enough that any [drug] substances would have metabolized.”

There was substantial evidence to support the finding that R.D.M.

presented a likelihood of serious harm to himself and its order of commitment. Gravely Disabled Next, we turn to R.D.M.’s argument regarding the sufficiency of the evidence to commit him for 14 days based on the court’s finding that he presented as gravely disabled.

RCW 71.05.020(25), defines “gravely disabled” as “a condition in which a

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person, as a result of a behavioral health disorder . . . (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 statute requires that “the individual is unable, because of severe deterioration of mental functioning, to make a rational decision with respect to [their] need for treatment.” In re Det. of LaBelle, 107 Wn.2d 196, 208, 728 P.2d 138 (1986). A “causal nexus” must exist between “ ‘severe deterioration in routine functioning’ and proof that the person so affected ‘is not receiving such care as is essential for [their] health or safety.’ ” LaBelle, 107 Wn.2d at 208 (quoting former RCW 71.05.020(1)(b) (1979) now codified at 71.05.020(25)(b)).

a. Manifests severe deterioration from routine functioning To support a finding of severe deterioration, the State must provide “recent proof of significant loss of cognitive or volitional control.” LaBelle, 107 Wn.2d at 208. Here, Morris testified that R.D.M.’s behavior at the hospital was unlike that before his commitment. Morris testified that before R.D.M.’s hospitalization, he was doing well, had a good sense of humor, and was employed as a truck driver. Morris further testified that R.D.M. understood that his wife had passed away. Geisel testified that R.D.M.’s working diagnosis of unspecified schizophrenia spectrum disorder was based on observations by herself and the medical team, that R.D.M. was responding to internal stimuli, expressing delusions of persecution that people were “out to get me,” that his deceased wife Emily was walking around the hospital, paranoia, being assaultive

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toward staff, and needing prompting to maintain boundaries. Geisel further stated that R.D.M. had psychomotor agitation, difficulty sleeping, and was disorganized and disoriented. Geisel opined that R.D.M.’s impairment had a substantial and adverse effect on his cognitive and volitional functioning.

The testimony from Morris and Geisel support the court’s finding that R.D.M.’s behavior had deteriorated. Substantial evidence supports that R.D.M. manifested severe deterioration from routine functioning.

b. Ability to make a rational decision about need for treatment The rational decision requirement ensures that “a causal nexus exists between proof of ‘severe deterioration in routine functioning’ and proof that the person so affected ‘is not receiving such care as is essential for his or her health or safety.’ “ LaBelle, 107 Wn.2d at 208 (quoting former RCW 71.05.020(1)(b)).

The court found that R.D.M., outside of the hospital setting, would not receive care that is essential to his health and safety. Geisel testified that R.D.M.’s insight and judgment were impaired, and that he lacked the insight of reasons for and circumstances leading to his hospitalization. R.D.M. told treatment staff that “I’m pretty good.” R.D.M. was compliant with medication while hospitalized, but his attendance in group treatment sessions was inconsistent. Additionally, R.D.M. told Geisel he only had “mild depression and PTSD”, and that he did not require mental health treatment and insisted “I don’t need to be here.” Based on the record, substantial evidence supports the court’s finding that R.D.M. is unable to make a rational decision about his need for treatment.

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c. Repeated and escalating loss of control over his actions R.D.M. asserts the trial court erred by finding repeated and escalating loss because he had no history of mental episodes or prior hospitalizations for mental health. The State contends that prior episodes or hospitalizations are not required. We agree with the State.

Our Supreme Court has held that “[e]vidence must include recent proof of significant loss of cognitive or volitional control.” LaBelle, 107 Wn.2d at 208. Under RCW 71.05.285, evidence of prior history or a pattern of decompensation is given great weight. While prior mental episodes or hospitalizations may be strong evidence, it is not the only way to show that an individual experienced repeated and escalating loss of cognitive or volitional control. In re Det. of H.T., 2026 WL 1948396 *6 (July 6, 2026); In re Det. of D.W., 6 Wn. App. 2d 751, 758- 59, 431 P.3d 1035 (2018); A.S., 91 Wn. App. at 153.

Here, R.D.M.’s behavior during his hospitalization showed mental illness episodes with moments of improvement. When R.D.M. was admitted, he told the nurse practitioner the reason he [R.D.M.] was in the hospital was because “they don’t like me there, Carlos’s boyfriend, and a lot of people don’t like me here or there.” When asked about the suicide by medication, R.D.M. stated “I don’t know. I don’t know. Somebody tried to take my house.” But days later, R.D.M. told Geisel that his admission to the hospital was because “he had swallowed pills.” During his stay, R.D.M. would insist that he did not need treatment for mental health, but he took all of his prescribed medications and sporadically attended group treatment session. Geisel testified that R.D.M. showed improvement in his

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mood instability, but later, his “[b]ehavior was agitated,” he was irritable and angry.

There is sufficient evidence to support the trial court’s finding that R.D.M.

experienced repeated loss of cognitive and volitional control over his actions, and the trial court did not err when it found that R.D.M. was gravely disabled.

We affirm.

WE CONCUR: