IN RE: the Commitment of T.B. (2025)

MEMORANDUM DECISION

[1] T.B. appeals his involuntary civil commitment and claims it was not supported by sufficient evidence. We affirm.

Facts and Procedural History

[2] In December 2024, twenty-six-year-old T.B. lived at home with his father, stepmother, and siblings. At that time, T.B. had previously been diagnosed with and treated for Bipolar I Disorder.

[3] On December 27, 2024, T.B. was admitted to Community Fairbanks Behavioral Health (“Community”) on an application for Emergency Detention. The application alleged that T.B. had been “aggressive towards his family and wanted to kill his parents by stabbing them.” Appellant's Appendix Volume II at 14. The application further alleged that T.B. was “[p]aranoid and delusional,” he believed that Eskenazi Health and his family were engaged in a “conspiracy,” he was refusing medications, and he lacked insight into his illness and the need for treatment. Id. Thereafter, Community filed a petition, along with a physician's statement, seeking a temporary mental health commitment. The court held a hearing on January 14, 2025. In support of the temporary commitment, Community presented the testimony of T.B.’s stepmother, A.B., and the expert testimony of Dr. Kanwaldeep Sidhu.¹

[4] A.B. testified that on the evening of December 25, 2024, she, T.B.’s father, and their other children arrived home from a Christmas gathering. T.B. had stayed home and was there when the rest of the family returned. Upon the family's return, T.B. decided to leave “to get some caffeine,” but then he simply remained outside in his truck and began throwing things from his truck into the driveway. Expedited Transcript Volume I at 5. A.B. stated that her son-in-law went out to see if he could convince T.B. to come inside to open gifts, but instead T.B. “decided to drive” his truck into the backyard and “started driving towards the house.” Id. at 5-6. A.B.’s daughters started screaming, and A.B. became “very scared” and “fearful” that T.B “was going to drive into our house,” but “thankfully he stopped just short of that.” Id. at 6. A.B. stated that T.B.’s father and brother-in-law went outside to talk to him and T.B. was “ranting” and demanding dinner. Id. T.B. called the police stating that “he was being threatened” and his family “would not give him his Christmas dinner.” Id. at 7.

[5] A.B. explained that when police arrived and went into T.B.’s bedroom, they discovered that T.B. had “essentially dismantled” both his bedroom and his attached bathroom. Id. at 8. In the bathroom, T.B. had taken all of the lightbulbs out of the sockets and one was left broken on the floor. There was also a toothbrush in the toilet, and the electrical outlet cover had been removed.

[6] A.B. recounted how in the days leading up to Christmas, T.B. was “extremely irritable and combative.” Id. at 9. She stated that on December 20, 2024, she recorded T.B. screaming expletives at his father and threatening to kill him. She stated that T.B. had recently been exhibiting paranoia and delusions. She explained that T.B. was fired from his seasonal job at Target on December 21, 2024, and was claiming that Target, Meijer, Lowe's, and Dick's Sporting Goods were all involved in a drug trafficking conspiracy and that he was going to expose them. T.B. had also accused A.B.’s son-in-law, an Indianapolis Metropolitan Police Department officer, of sabotaging his work at Target as well as his truck. A.B. stated that she believed temporary commitment was in T.B.’s best interests because he “has not been able to ․ see his illness for what it is ․ [a]nd ․ if left to his own devices, he will not get the treatment he needs in order to be able to care for himself.” Id. at 12.

[7] Dr. Sidhu testified that T.B. presented to the hospital with an agitated and elevated mood, pressured speech, was easily distracted, aggressive, and had a decreased need for sleep. Dr. Sidhu diagnosed T.B. with Bipolar I Disorder, manic with psychotic features, for which he noted T.B. had previously been diagnosed. He stated that T.B.’s current symptoms were consistent with “mania” and that it affected T.B.’s “ability to function.” Id. at 16. Dr. Sidhu noted that T.B. had been repeatedly hospitalized for the same symptoms, and he testified that T.B. lacked insight into his illness, rejected the diagnosis, and refused to take any recommended medications.² Dr. Sidhu testified that T.B. had informed him that, on Christmas night, he felt threatened by his brother-in-law so he poured a bottle filled with his own urine on the windshield of his truck. T.B. also revealed to Dr. Sidhu that he carried and slept armed with a knife because he believed he needed it for his safety.

[8] Dr. Sidhu opined that temporary commitment was necessary because T.B. was still exhibiting an agitated mood with paranoia and that providing him with the necessary medication and therapy services would keep T.B. and others safe. Dr. Sidhu explained that medications, specifically an antipsychotic and a mood stabilizer, would be of substantial benefit in treating T.B.’s mental illness, and the probable benefits from the proposed treatment outweighed the risk of harm. Dr. Sidhu anticipated that T.B. would only need to remain inpatient at Community for another week or so before his condition would likely greatly improve with court-ordered treatment.

[9] T.B. testified and admitted that he did not wish to take any of the recommended medications because of the side effects. He claimed that when he had previously taken similar medications, he “felt kind of psychopathic.” Id. at 25. He recalled spending time in “rehab” in the past and also being homeless before his parents took him in “as a last ditch effort so [he] had a place to stay[.]” Id. at 26. He admitted that he unscrewed the lightbulbs in his bathroom but he could not articulate why he had done so. He admitted to urinating in an empty protein powder bottle and to later pouring it on the windshield of his truck to keep his brother-in-law away from him. When the trial court asked him specifically why he had engaged in that strange behavior, T.B. stated that pouring the urine on his windshield was “instinctual for [his] safety.” Id. at 29. When asked where he would go if released, T.B. stated that his parents had indicated that he was no longer welcome in their home but that he did not want to be “forced to choose a certain medical care ․ based on having a safe place to live.” Id. at 26.

[10] At the conclusion of the hearing, the court explained on the record:

Today, the evidence is clear and uncontroverted that [T.B.] does suffer from a mental illness. In Dr. Sidhu's expert opinion, it's bipolar disorder, and under these circumstances, with bipolar [I] with a manic episode and psychotic features. [T]oday I've heard an account which is alarming of conflict among family members in Christmas time at their house and [T.B.] and his family are all entitled to live in peace and safety․ Under these circumstances, I find that he does suffer from a chronic mental illness and is gravely disabled in his judgment and reasoning as a result, not just because of the conflict that he and his family have described, but because of the danger it poses to both of them, his bizarre behavior in dismantling rooms in his house. And his bizarre description of using urine as a defense mechanism, which required him to fill a bottle and then to discharge it on his vehicle. His account of conspiracies makes it impossible [to] relate properly to the people and places around him. And for his safety, I'll find that the least restrictive option at this moment is temporary commitment to [Community].

Id. at 30-31.

[11] Accordingly, the trial court entered its order granting the petition for involuntary commitment finding that: T.B. suffers from Bipolar I Disorder which is a mental illness as defined in Ind. Code § 12-7-2-130; T.B. is gravely disabled as defined by Ind. Code § 12-7-2-96; T.B. is in need of custody, care and treatment at Community for a period of time not expected to exceed ninety days; such placement is the least restrictive environment suitable for treatment and stabilization as well as protecting T.B.; and the benefits of the treatment plan outweigh any risks of harm. The order further provided that T.B. is gravely disabled because his “judgment and reasoning are grossly impaired by his psychosis which prevents him from interacting correctly with the world.” Appellant's Appendix Volume II at 10. The court ordered T.B. involuntarily committed to Community until April 14, 2025, unless discharged prior.

Discussion

[12] In Indiana, an individual who is alleged to be mentally ill and either dangerous or gravely disabled may be committed to a facility for not more than ninety days under Ind. Code Chapter 12-26-6. The petitioner is required to prove by clear and convincing evidence that the individual is mentally ill and either dangerous or gravely disabled and detention or commitment of that individual is appropriate. Ind. Code § 12-26-2-5(e). The clear and convincing evidence standard is an intermediate standard of proof greater than a preponderance of the evidence and less than proof beyond a reasonable doubt. T.D. v. Eskenazi Health Midtown Cmty. Mental Health Ctr., 40 N.E.3d 507, 510 (Ind. Ct. App. 2015). We consider only the evidence favorable to the judgment and all reasonable inferences drawn therefrom and do not reweigh the evidence or judge the credibility of witnesses. Id.

[13] “Gravely disabled” means “a condition in which an individual, as a result of mental illness, is in danger of coming to harm because the individual:”

(1) is unable to provide for that individual's food, clothing, shelter, or other essential human needs; or

(2) has a substantial impairment or an obvious deterioration of that individual's judgment, reasoning, or behavior that results in the individual's inability to function independently.

Ind. Code § 12-7-2-96. “Because the definition of grave disability is written in the disjunctive, the evidence needs to support only one of those two prongs for a person to be found gravely disabled.” A.S. v. Ind. Univ. Health Bloomington Hosp., 148 N.E.3d 1135, 1140 (Ind. Ct. App. 2020).

[14] T.B. does not challenge the trial court's finding that he is mentally ill. Rather, he argues the trial court's finding that he is gravely disabled is not supported by clear and convincing evidence. Specifically, the court found that T.B. is gravely disabled pursuant to the second prong of the definition. T.B. claims that the court's finding was “based on the respondent pouring urine on his vehicle,” and while “grotesque and strange,” the behavior did not “pose a danger of T.B. coming to harm or show an inability to function independently.” Appellant's Brief at 2, 6.

[15] We note that T.B. begins his argument by citing generally to Civil Commitment of T.K. v. Dep't of Veterans Affairs, 27 N.E.3d 271 (Ind. 2015), in which the Indiana Supreme Court made clear that “denial of illness and refusal to medicate, standing alone, are insufficient to establish grave disability ․” 27 N.E.2d at 276. Although Community presented evidence that T.B. denied his illness and refused to take recommended medications, T.B. makes no suggestion, and the record does not indicate, that this was the only evidence presented or that the trial court found him to be gravely disabled solely on these bases.

[16] Rather, the court heard considerable additional evidence to support its finding that T.B. is gravely disabled as a result of his mental illness. A.B. provided detailed testimony regarding the recent and severe deterioration in T.B.’s judgment, reasoning, and behavior. T.B. threatened to kill his father, dismantled his room and bathroom, and drove his truck in the backyard and toward the family home. T.B. was fired from his job and was exhibiting paranoia and delusions and espousing bizarre conspiracy theories. Dr. Sidhu opined that T.B. was unable to function independently because he lacked insight into his disorder to understand the necessity of the recommended medications and the dangerousness of repeated episodes. Dr. Sidhu stated that without the medications, T.B.’s prognosis was “very poor.” Expedited Transcript Volume I at 14. Indeed, Dr. Sidhu testified that, while hospitalized, T.B. refused the recommended medications and thus he remained agitated and paranoid as of the morning of the hearing. Significantly, the court heard T.B.’s testimony, during which he clearly displayed a lack of insight and/or acceptance of the seriousness of his condition and the benefits of treatment, a complete denial of his recent dangerous and bizarre behavior which included threats against his family, and his continued paranoid thinking. Based upon this evidence, the trial court found that T.B.’s impairment in judgment “makes it impossible he could relate properly to the people and places around him.” Id. at 31.

[17] Although T.B. attempts to downplay the evidence presented, this amounts to a request for us to reweigh the evidence and reassess witness credibility, which we may not do. Further, unlike the authority relied upon by T.B., this is not a case in which a decision ordering an involuntary commitment was made on the basis of mere idiosyncratic behavior, a few isolated instances of unusual conduct, or the hypothetical future deterioration of the individual's mental state without the requisite showing that the individual is presently in danger of coming to harm. See A.B. v. St. Vincent Hosp. & Health Care Ctr., Inc., 240 N.E.3d 166, 171 (Ind. Ct. App. 2024) (finding insufficient evidence to support commitment because establishment of grave disability “requires more than paranoid beliefs and bizarre behavior” and hospital failed to show respondent was in danger of coming to harm as a result of impaired judgment).

[18] Based upon our thorough review of the record, which includes the videorecording of the commitment hearing, we conclude that clear and convincing evidence supports the trial court's conclusion that T.B. is in danger of coming to harm because he has a substantial impairment or an obvious deterioration of judgment, reasoning, or behavior that results in his inability to function independently, and therefore that he is gravely disabled. See A.O. v. Cmty. Health Network, Inc., 206 N.E.3d 1191, 1194 (Ind. Ct. App. 2023) (finding sufficient evidence of grave disability based on lack of insight into patient's condition and that her delusional thoughts had compromised her treatment, judgment, and ability to function independently).

[19] For the foregoing reasons, we affirm the trial court's Order of Temporary Commitment.

[20] Affirmed.

FOOTNOTES

1.   The record reveals that T.B.’s father, B.B., also appeared at the hearing and was prepared to testify in favor of his son's commitment; however, due to time constraints, Community did not present his testimony.

2.   The record indicates that T.B. would agree to take only Adderall that had been prescribed by his treating nurse practitioner prior to this episode.

Brown, Judge.

Foley, J., and Robb, Sr.J., concur.