IN RE: the Civil Commitment of C.M. (2025)

MEMORANDUM DECISION

Case Summary

[1] C.M. appeals an involuntary temporary commitment order that expired in January 2025, contending that it was not supported by sufficient evidence and that the trial court erred in imposing a special condition. Indiana University Health Methodist (“IU Health”) contends that the appeal should be dismissed as moot. Because C.M. makes no argument to the contrary, we agree with IU Health that the appeal is moot, but we exercise our discretion to address the merits of C.M.’s challenge to the special condition, which had no evidentiary foundation. Therefore, we affirm in part, reverse in part, and remand with instructions.

Facts and Procedural History

[2] On October 8, 2024, IU Health filed an application for the emergency detention of thirty-two-year-old C.M., who had been admitted to its facility the previous evening. The attesting physician stated that he had probable cause to believe that C.M. was mentally ill due to a psychiatric disorder, was a danger to himself, and required involuntary detention to receive care and treatment because he was “stating that his body parts have experienced sin and therefore he needs to cut off body parts[.]” Appellant's App. Vol. 2 at 13. The trial court granted the application on October 9, and IU Health filed a petition for involuntary commitment that same day. The trial court set a hearing for October 16.

[3] At the hearing, IU Health psychiatrist Dr. Jonathan Withers testified that C.M. had been “brought in on a law enforcement initiated emergency detention” on the evening of October 7 after being “picked up by police” at his church, which he had entered “while nude.” Tr. Vol. 2 at 6. C.M. told Dr. Withers that “he had received a directive from God to strip naked and go for a walk and that this time he broke a record cause he made it three blocks[.]” Id. C.M. told the doctor that “the last time he did that on October 1st he had only made it a couple blocks before he was picked up by law enforcement.” Id. C.M. was admitted to IU Health at that time, but because he was “meeting his basic needs” and “did not endorse any thoughts of self-harm or impulses from God to harm himself at that time[,]” he was released on October 3. Id. at 7.

[4] This time, however, C.M. reported that he had received “various impulses from God to harm himself[,]” including “to potentially remove his eyes or engage in auto castration[.]” Id. at 8. According to Dr. Withers, C.M. stated

that he's been experiencing residual numbness in his ․ right fifth digit on his hand from a time when he attempted to remove that hand with a table saw after a directive from God that occurred in January and he said that hand was causing him to sin so better to cut it off and go to heaven with one hand [than] to ․ go to hell with two ․.

Id. The doctor further testified that the day before the hearing, C.M.

actually did bite his finger after telling us that he was having some thoughts that he could maintain his safety. He bit his finger, drew blood, did not require any sutures but we have him on a one-to-one sitter now. He told me today that he bit his finger because God told him to quote go for it and when I asked for further specification, he said chew it off.

Id. Before C.M. bit his finger, he told the doctor “that God was telling him to be silent, be still and die and so he was upset with himself because he was speaking with [hospital staff].” Id. at 9.

[5] Dr. Withers testified that C.M. had “a historical diagnosis of schizoaffective disorder” and that his current symptoms were “consistent with that as well.” Id. 7. C.M. had told the doctor that he “was on several or three” mental health commitments in the past. Id. at 11. Dr. Withers opined that C.M. has “limited insight” into his mental illness, that “a majority of” his “current condition and behaviors [are] a result of” that illness, and that C.M. is resistant to taking medications because it would be “sinful[.]” Id. at 9, 10, 14. The doctor stated that C.M.’s prognosis with treatment, including a “long-acting injectable anti-psychotic[,]” was “fair to good[,]” and that his prognosis without treatment was “[p]oor.” Id. at 11, 12.

[6] C.M. also testified. He stated that God had told him to walk in the nude and that “I am God, I do hear God.” Id. at 19. He further stated that he was told to bite his finger, that he stopped biting it because it hurt, and that he intended “to actually bite [his] finger off[.]” Id. at 20. C.M. told the court, “I believe if God tells me to inflict any kind of suffering on my body that I have that right.” Id. at 22.

[7] After the hearing, the trial court issued a temporary commitment order. The court found by clear and convincing evidence that C.M. was suffering from the mental illness of schizoaffective disorder, was a danger to himself and gravely disabled, and was “in need of custody, care, and treatment at IU Health for a period of time not expected to exceed ninety (90) days.” Appealed Order at 1. The court ordered C.M. committed to IU Health “until January 14, 2025, unless discharged prior.” Id. at 2. The court further ordered that, “upon attaining outpatient status,” C.M. was to abide by several “special conditions[,]” including that he “shall not use alcohol, or drugs, other than those prescribed by a certified medical doctor.” Id. Finally, the court granted IU Health “an Order to Treat unless [C.M.] does not substantially benefit from the medications. The Order to Treat shall terminate with the Commitment.” Id.

[8] On November 14, C.M. “filed a Notice of Expedited Appeal indicating the appeal was part of the Marion County Expedited Mental Health Appeals Project.” Appellant's App. Vol. 2 at 39. Shortly thereafter, C.M. filed a motion for leave to opt out of the expedited process on the basis that his notice of appeal was untimely under the project's guidelines but was not untimely under Indiana Appellate Rule 9. This Court granted C.M.’s motion, and the appeal was fully briefed in due course.

Discussion and Decision

[9] A civil commitment is warranted when the petitioner proves, by clear and convincing evidence, that (1) the individual is mentally ill and either dangerous or gravely disabled; and (2) detention or commitment of that individual is appropriate. G.H. v. Richard L. Roudebush Veterans Affs. Med. Ctr., 216 N.E.3d 485, 489 (Ind. Ct. App. 2023) (citing Ind. Code § 12-26-2-5 and T.K. v. Dep't of Veterans Affs., 27 N.E.3d 271, 273 (Ind. 2015)). “An appellate court should affirm a civil commitment if based on the ‘probative evidence and reasonable inferences supporting it, without weighing evidence or assessing witness credibility, a reasonable trier of fact could find the necessary elements proven by clear and convincing evidence.’ ” Id. (quoting T.K., 27 N.E.3d at 273).

[10] C.M. asserts that IU Health did not present clear and convincing evidence that he was dangerous to himself or gravely disabled and did not present sufficient evidence to support the special condition regarding alcohol and drug use. In response, IU Health asserts that C.M.’s appeal is moot because the commitment order expired in January 2025. C.M. does not contest the mootness of his appeal. As such, we will not make an argument for him. “A case is moot when the controversy at issue has been ended, settled, or otherwise disposed of so that the court can give the parties no effective relief.” E.F. v. St. Vincent Hosp. & Health Care Ctr., Inc., 188 N.E.3d 464, 466 (Ind. 2022). However, under Indiana common law, appellate courts have discretion to decide moot cases that present issues of great public importance that are likely to recur. Id.

[11] In the context of temporary mental health commitments, this Court “routinely consider[s] the merits” of moot cases where the appeal addresses a novel issue, presents a “close case,” or presents an opportunity to develop case law on a complicated topic. Id. at 467. We do so because a “[c]ivil commitment for any purpose has a very significant impact on the individual and constitutes a significant deprivation of liberty that requires due process protection.” Id. (quotations and citation omitted). But “because one of the hallmarks of a moot case is the court's inability to provide effective relief, appellate courts are not required to issue an opinion in every moot case.” Id. (citations omitted). Rather, we apply the mootness exception “on a case-by-case basis[,]” and we need not address all the issues raised by the parties. Id. at 465, 467.

[12] C.M.’s challenge to the trial court's findings that he was dangerous to himself and gravely disabled does not present a novel issue, a close case, or an opportunity to develop case law on a complicated topic.¹ Accordingly, we decline to exercise our discretion to address this issue.

[13] But C.M.’s challenge to the special condition is another matter. In G.H., we exercised our discretion to address a challenge to an expired commitment order “to develop case law on a topic that is relatively undeveloped but likely to recur in this case and others: the proof necessary to impose special conditions upon attaining outpatient status.” 216 N.E.3d at 489. We explained that “Indiana law allows a court to impose special conditions when ordering an individual to enter outpatient therapy.” Id. at 490 (citing I.C. § 12-26-14-3). “However, there must be sufficient evidence in the record for the trial court to conclude that such a ‘special condition’ bears a reasonable relationship to the treatment of the individual and the protection of the individual and the public.” Id. (citing M.L. v. Eskenazi Health/Midtown Mental Health CMHC, 80 N.E.3d 219, 223 (Ind. Ct. App. 2017)). We noted that “we have struck down a special condition prohibiting the use of alcohol and drugs where a doctor requested that condition without any evidence that the individual had ever used or abused such substances.” Id. (citing M.L., 80 N.E.3d at 224, and M.M. v. Clarian Health Partners, 826 N.E.2d 90, 99 (Ind. Ct. App. 2005), trans. denied).

[14] In G.H., there was no evidence that the appellant “had ever abused alcohol or drugs in the past or that he was likely to do so in the future[,]” and although his doctor opined that he would encourage anyone taking the antipsychotic medications prescribed for G.H. to avoid taking illegal drugs or consuming too much alcohol, he “never stated that G.H. should refrain from all alcohol and drug use, such as use of over-the-counter drugs.” Id. Accordingly, we concluded that “there was insufficient evidence in the record showing a reasonable relationship between the prohibition on the use of alcohol and drugs and G.H.’s treatment and safety or that of the general public,” and we ordered the condition stricken from his commitment order. Id.

[15] In this case, Dr. Withers did not request a special condition prohibiting C.M.’s use of alcohol and drugs, and no evidence was presented regarding C.M.’s past, present, or projected use or abuse of alcohol or drugs, or any potential negative interactions of those substances with his prescribed medication. As in G.H., we must conclude that there was insufficient evidence in the record showing a reasonable relationship between the prohibition on the use of alcohol and drugs and C.M.‘s treatment and safety or that of the general public. Indeed, IU Health candidly “concedes the Record could be more developed on this point.” Appellee's Br. at 27. Therefore, we affirm the commitment order in part but reverse in part and remand with instructions to strike the special condition associated with his outpatient treatment.

[16] Affirmed in part, reversed in part, and remanded with instructions.

FOOTNOTES

1.   Notably, C.M. does not invoke the Free Exercise Clause of the First Amendment to the United States Constitution.

Bailey, Judge.

Judges Vaidik and DeBoer concur. Vaidik, J., and DeBoer, J., concur.