IN RE: the Civil Commitment of J.W. (2025)

MEMORANDUM DECISION

Statement of the Case

[1] J.W. brings this expedited appeal and challenges his involuntary temporary commitment to Community Fairbanks Behavioral Health (“Community”).¹ J.W. claims the evidence is insufficient to show that he is a danger to himself or gravely disabled. Although this is a close case, we conclude that Community has not shown by clear and convincing evidence that J.W. should be placed under an involuntary temporary commitment. Thus, we reverse and remand.

Issue

[2] J.W. raises two issues, which we consolidate and restate as whether the evidence is sufficient to support J.W.’s involuntary temporary commitment.

Facts and Procedural History

[3] J.W. is thirty-five years old and lives with his wife and four children (two full-time and two half-time). He works full-time as a general manager of a small construction company. He also has suffered from depression for many years and has received differing diagnoses and taken several different medications over the past decade or so with little success. He previously had suicidal ideations and voluntarily sought treatment once before in 2020.

[4] On April 4, 2025, J.W., who was feeling like he was deeply depressed, called Community's crisis center and expressed suicidal thoughts. And he volunteered information to the counselor that he had firearms in the house. After receiving counseling via the hotline, he drove to Community and admitted himself. While there, under Dr. Zainab Shah's care, for the first time he received a diagnosis of Bipolar II disorder and began taking Latuda, a medication that appeared to have a positive effect on his overall mood. And he soon informed staff that he wanted to leave the hospital.

[5] As part of his treatment, J.W. disclosed to Dr. Shah that he continued to have suicidal ideations around April 6 or 7. Community filed a petition on April 7, 2025, requesting J.W.’s involuntary temporary commitment for ninety days. The attached physician's statement alleged that J.W. suffers from Bipolar II depression causing him to be actively suicidal and that J.W. presented a substantial risk of harm to himself. The physician's statement did not fill out the section for grave disability, a requirement of the form if applicable. See Appellant's App. Vol. II, p. 7.

[6] A hearing on Community's petition was held on April 9, 2025. Dr. Shah testified on behalf of Community that she treated J.W. at Community and met with him twice daily. Dr. Shah's diagnosis of Bipolar II disorder meant that J.W. experienced both “hypomanic” and “major depressive episodes[,]” though she “had not observed those hypomanic symptoms.” Tr. Vol. 1, pp. 10-11. Instead, J.W. had volunteered that he experienced symptoms which could be characterized as hypomanic. According to Dr. Shah, studies demonstrate that approximately twenty percent of individuals with bipolar disorder die by suicide and approximately sixty percent attempt suicide. J.W.’s risk factors were elevated, in her opinion, due to his history of prior suicide attempts, chronic depression, childhood trauma, and access to guns.

[7] Dr. Shah further testified in support of the petition that J.W. has been “more isolative, his appetite has been low” though she had “not personally seen how much he eats,” and “he's been struggling with sleep.” Id. at 11, 14. However, she acknowledged that there are routine safety checks of the patients’ rooms every fifteen minutes, “which can be annoying to the patients.” Id. at 16. Nevertheless, Dr. Shah opined that, although J.W. acknowledges that he has a mental illness, she believed that J.W. lacked “awareness into the severity and the associate safety risks” of the mental illness. Id. at 11. She stated that J.W. “consistently dismissed or minimalized therapeutic interventions and alternative treatment options presented to him during admission.” Id. Dr. Shah testified that he told her he would “lie about his suicidal ideation” so that he could “leav[e] the hospital sooner.” Id. at 9. In discussing his suicidal thoughts, J.W. did not believe that an in-patient stay would be helpful and stated that he would “figure out a way to just do it when he's outside of the hospital.” Id. at 14.

[8] Dr. Shah testified that he expressed suicidal ideation two days prior to the hearing. However, she testified that Community's,

plan would be to extend the stay [until] the end of this week [until] Friday April 11, possibly, and we'll be treating him with Latuda or lurasidone, which is an FDA approved medication for the depressive phase of bipolar disorder. And in terms of outpatient, of course, setting him up with therapy, setting him up with a psychiatrist so he can get these medications and possibly consider ECT, which is electroconvulsive therapy given the history of failed medication trials.

Id. at 16. Dr. Shah additionally testified that Latuda “takes four to five days for the initial benefits to be observed.” Id. at 31. J.W. has been compliant with taking his medications while hospitalized. And Dr. Shah noticed a mild improvement in J.W. socializing with others since starting the medication.

[9] When asked if J.W.’s judgment and reasoning is so impaired that he cannot function on his own outside the hospital, Dr. Shah said,

I do believe there's impairment in judgment, given these ongoing suicidal thoughts and the chronic depression, but I do think he can function and go to work. If that's your question.

Id. at 28. When further questioned, Dr. Shah agreed that her “main concern ․ is just whether or not he's having suicidal thoughts or the concern that he's a danger to himself today[.]” Id. She testified, however, that when she examined him today, he did not express any suicidal thoughts.

[10] J.W. testified on his own behalf. He denied experiencing any suicidal thoughts. Instead, he testified that he was “excited” about receiving treatment due to his new diagnosis and new medication. Id. at 35. He discussed his admitted ownership of “hunting firearms ․ no handguns” Id. at 39. He planned to have his wife transfer the guns to his brother, who was a state trooper, for safekeeping. And J.W. testified that he was an active outdoorsman and he has had those guns while suffering from his mental health condition for over a decade.

[11] As for his appetite, J.W. testified that he had “been eating three meals a day for at least the past three days” as much as he could. Id. at 39. He said that “for more than 10 years now[,]” he did “not eat breakfast and [he] rarely [ate] lunch.” Id. As for isolation, J.W. testified that Dr. Shah saw him at around eight in the morning when he was still in bed. He said that otherwise, he was out of his room, in group sessions, and spent many hours out in the public meeting area with other patients.

[12] In response to Dr. Shah's concerns that J.W. would say anything or lie in order to be discharged from the hospital, J.W. testified in response that,

we were having a conversation about the overall scope of the way that that outlines things, not necessarily me committing to saying that I was going to lie to her for the remainder of my stay. Just simply noting that this type of setup does encourage dishonesty ․because I have potential ramifications for the things that I say that could either land me in great financial despair or social despair or potentially losing my individual freedoms such as I've been experiencing these last few days.

Id. at 40.

[13] J.W. testified that the care provided by Community was “very minimal.” Id. at 35. He said that he would “spend roughly 10 to maybe 15 minutes with this doctor a day.” Id. at 36. He wanted to be released from the hospital to “pursue active treatment that might be more beneficial to [him]” and was concerned about the impact of continued hospitalization upon his career. Id.

[14] The trial court granted Community's petition for involuntary temporary commitment of J.W. The trial court found that J.W. suffers from bipolar II depression; is a danger to himself and is gravely disabled; and is in need of custody, care, and treatment for a period of time not expected to exceed ninety days. The trial court found:

[J.W.] remains a danger to himself and gravely disabled in his judgment and reasoning, as his psychiatrist opines he accepts his diagnosis but does not adequately appreciate the grave danger of bipolar depression. He spoke about suicidal intentions just 2 days ago, and his doctor believes he will benefit sufficiently from medication to discharge safely in 2 more days. The court shares the concerns [J.W.] voiced to his doctor that he would return to the hospital or commit suicide without effective intervention.

Appellant's App. Vol. II, p. 22. J.W. now appeals.

Discussion and Decision

[15] J.W. appeals his involuntary temporary commitment. “ ‘[T]he purpose of civil commitment proceedings is dual: to protect the public and to ensure the rights of the person whose liberty is at stake.’ ” Civ. Commitment of T.K. v. Dep't of Veterans Affs., 27 N.E.3d 271, 273 (Ind. 2015) (quoting In re Commitment of Roberts, 723 N.E.2d 474, 476 (Ind. Ct. App. 2000)). “To satisfy the requirements of due process, the facts justifying an involuntary commitment must be shown ‘by clear and convincing evidence ․ [which] not only communicates the relative importance our legal system attaches to a decision ordering an involuntary commitment, but ․ also has the function of reducing the chance of inappropriate commitments.’ ” Id. (quoting Commitment of J.B. v. Midtown Mental Health Ctr., 581 N.E.2d 448, 450 (Ind. Ct. App. 1991), trans. denied).

[16] When reviewing the sufficiency of the evidence in civil commitment cases, we “will affirm if, ‘considering only the probative evidence and the 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.’ ” T.K., 27 N.E.3d at 273 (quoting Bud Wolf Chevrolet, Inc. v. Robertson, 519 N.E.2d 135, 137 (Ind. 1988)). Clear and convincing evidence requires proof that “the existence of a fact ․ [is] highly probable.” T.D. v. Eskenazi Health Midtown Cmty. Mental Health Ctr., 40 N.E.3d 507, 510 (Ind. Ct. App. 2015). Here, the court, in entering its order of temporary involuntary commitment, found that J.W. was both dangerous and gravely disabled.

[17] For involuntary temporary commitments lasting not more than ninety days, the petitioner must prove that the individual is “mentally ill and either dangerous or gravely disabled.” Ind. Code § 12-26-6-1 (1992), -8(a) (2020). The trial court can only order an involuntary temporary commitment if it finds by clear and convincing evidence that the person is mentally ill and either dangerous or gravely disabled and that committing the person is appropriate. Ind. Code § 12-26-2-5(e) (2007), -6-8(a). J.W. does not challenge the trial court's determination that he is mentally ill or the appropriateness of his commitment. Rather, J.W. challenges the trial court's determination that J.W. was a danger to himself and was gravely disabled.

[18] But as respects foretelling future dangerousness, “ ‘the court must exercise extreme caution that it not utterly strip a person suffering from mental illness of the power to make an informed decision concerning risk-taking.’ ” Commitment of M.E. v. Dep't of Veterans Affairs, 64 N.E.3d 855, 861 (Ind. Ct. App. 2016) (discussing dangerousness in involuntary medical treatment case) (quoting Commitment of J.B. v. Midtown Mental Health Ctr, 581 N.E.2d 448, 451 (Ind. Ct. App. 1991), trans. denied), disapproved on other grounds by AA. v. Eskenazi Health/Midtown CMHC, 97 N.E.3d 606, 612 (Ind. 2018). Courts should look “to the patient's behavior at the time of the hearing, not to his history.” Id. at 863. We acknowledge that history may help explain an individual's behavior and aid in diagnosis, but it is the individual's current status that is determinative as far as the legal conclusions we reach. At the time of the hearing, J.W. exhibited behavior consistent with reducing risks, a mindset we should encourage others with mental health issues to achieve.

[19] We first look to the trial court's comments from the bench deciding this case on the issue of “dangerousness.” In finding the ninety-day commitment was warranted, the court said, “This matter is placed in front of me today because of the danger, not that you've posed to yourself, but that bipolar disorder has posed to you.” Tr. Vol. 1, p. 47 (emphasis added). But the critical inquiry here is whether the individual is both mentally ill, which is conceded, and dangerous to himself or others. I.C. § 12-26-6-1 (emphasis added). An individual is “dangerous” when, “as a result of mental illness,” the individual “presents a substantial risk that the individual will harm the individual or others.” Ind. Code § 12-7-2-53(a) (2023). The court's statement appears to conflate the two distinct requirements.

[20] Thus, we are called to examine the evidence Community presented to show J.W. was dangerous. The parties and the court discussed J.W.’s admitted ownership of “hunting firearms ․ no handguns.” Tr. Vol. 1, p. 39. The testimony showed that J.W. had a gun with him when he called the crisis hotline. But J.W. testified that he received counseling on the hotline, drove to the hospital, and admitted himself. Furthermore, he had a plan to have his wife transfer the guns to his brother, who was a state trooper, for safekeeping. J.W. possessed those same guns while suffering from mental illness for over a decade. Because J.W. sought help, he received a diagnosis of Bipolar II disorder for the first time while at Community and began taking a medication that appeared to have a positive effect on his overall mood.

[21] J.W. did express suicidal ideation two days prior to the hearing. However, we find it hard to reconcile that J.W. is “dangerous” if Community's plan was to release him to outpatient treatment in just two more days’ time. And we are concerned with why Community is now taking the position of committing him to inpatient treatment. In other words, had J.W. not objected to their determination, would Community have released him two days later? The plan to release him suggests that Community did not consider him to be “dangerous” until he disagreed with how long he should remain in inpatient care. Furthermore, J.W. had a plan in place for his hunting firearms. J.W. also expressed that he was “excited” about receiving treatment due to his new diagnosis and new medication. Tr. Vol. 1, p. 35. And J.W. expressed his understanding of the tension between honesty for purposes of receiving treatment in a system that seems to encourage dishonesty. But the court found J.W. was dangerous even though he had no plan in place nor did he express one for carrying out his own demise.

[22] The record shows that J.W. became deeply depressed, recognized his state of mind, called a helpline, received counseling, and made the decision to drive to a hospital where he admitted himself for treatment. Once there, he was properly diagnosed and began willingly taking the medication that, for the first time, seemed to help. He was open and honest about his suicidal ideations to the detriment of his physical liberty, but to the benefit of his own mental health. He also expressed a desire to do more research about an additional treatment option so he could make an informed and independent decision about his care. At the time of the hearing, J.W. seemed to have turned a corner for the better of his mental health. Yet, had he been dishonest about his suicidal ideations two days prior to the hearing, he likely would not be facing a ninety-day commitment.

[23] Because we conclude that the court erred by finding that Community met its burden of proving by clear and convincing evidence that J.W. was dangerous, we turn to the issue of whether Community presented clear and convincing evidence that J.W. was gravely disabled. Once again, we observe that the physician's statement, which was attached to the request for involuntary commitment, based the request solely on danger to self, and did not complete the section for grave disability, a requirement if applicable. See Appellant's App. Vol. II, p. 7.

[24] An individual is “gravely disabled” when, as a result of mental illness, the individual is in danger of coming to harm because he: 1) is unable to provide for his food, clothing, shelter, or other essential needs; or 2) has a substantial impairment or an obvious deterioration of his judgment, reasoning, or behavior that results in his inability to function independently. Ind. Code § 12-7-2-96 (1992).

[25] Turning to the court's notations in its written order, the court found J.W. to be “gravely disabled in his judgment and reasoning, as his psychiatrist opines he accepts his diagnosis but does not adequately appreciate the grave danger of bipolar depression.” Appellant's App. Vol. II, pp. 22.

[26] When asked if J.W.’s judgment and reasoning is so impaired that he cannot function on his own outside the hospital, Dr. Shah's concern was whether he was having suicidal thoughts today. She testified that he had impairment in judgment relative to his suicidal thoughts and chronic depression. Otherwise she thought he could function and go to work.

[27] J.W. testified that he earns income for his family through his job as a general manager of a small construction company, he has a support system, and a place to live. And he testified that he was willing to seek help again if he is feeling depressed, and that he was open to additional forms of treatment. And he expressed a desire to do more research about an additional treatment option so he could make an informed and independent decision about his care. Community's closing argument and the comments from the court in reaching its determination focused almost entirely on whether J.W. was a danger to himself. Nevertheless, the court also found a grave disability.

[28] Once again, we turn to Community's plan for J.W. Dr. Shah testified that she would probably keep J.W. in inpatient treatment for two more days before releasing him to outpatient treatment. And she shared the outline of her outpatient treatment plan. We question whether there is clear and convincing evidence of how gravely disabled J.W. was on Wednesday, the date of the hearing, if Community's plan was to release him on Friday, two days later. The plausible inference which is evident from the record is that J.W. disagreed that he needed to receive inpatient treatment for two more days. And that disagreement resulted in Community seeking a ninety-day commitment.

[29] Our Supreme Court has held that the “denial of illness and refusal to medicate, standing alone, are insufficient to establish grave disability because they do not establish, by clear and convincing evidence, that such behavior ‘results in the individual's inability to function independently.’ ” Commitment of T.K., 27 N.E.3d at 276. Here, to the contrary, J.W. is taking his new medication and acknowledges his new diagnosis. He simply did not want to continue to do so in inpatient treatment. And Community had an outpatient plan it shared at the hearing. We conclude that the court erred when it found Community had presented clear and convincing evidence that J.W. was gravely disabled.

[30] It bears repeating that this admittedly is a close case. J.W.’s battle to achieve better and more stable mental health remains ongoing. Although we reverse, we echo the trial court's comments urging J.W. to continue to follow the instructions of the professionals assigned to treat him and to actively participate in his care so he can achieve the goal of good mental health.

Conclusion

[31] We conclude that Community did not meet its burden of clear and convincing evidence to support J.W.’s involuntary temporary commitment, and we reverse and remand the trial court's involuntary temporary commitment order.

[32] Reversed and remanded.

[33] I agree with the majority's determination that Community did not prove J.W. is gravely disabled. I dissent, however, from the majority's conclusion that Community failed to prove J.W. was a danger to himself. The trial court's finding that J.W. remains a danger to himself is supported by clear and convincing evidence. I conclude that the majority is reweighing the evidence, which we cannot do. T.K., 27 N.E.3d at 273. Accordingly, I would affirm the trial court's temporary commitment decision.

[34] Community presented evidence that J.W. has a long-standing history of depression that has been resistant to treatment. He had a prior mental health case in 2015, and Community treated him in October 2020. J.W. has tried multiple antidepressants in the past with minimal or no response. Although J.W. has agreed to outpatient treatment in the past, he has not been compliant. In early April 2025, J.W. expressed suicidal thoughts, contacted Community's crisis hotline, and drove himself to the hospital, where he was admitted. Dr. Shah diagnosed J.W. with bipolar II disorder, which has a high risk for suicide and suicide attempts. J.W.’s particularized risk factors for suicide were elevated.

[35] Dr. Shah testified that, while hospitalized, J.W. has been “more isolative, his appetite has been low, [and] he's been struggling with sleep.” Tr. Vol. I p. 11. Although J.W. acknowledges that he has a mental illness, Dr. Shah believed that J.W. lacked “awareness into the severity and the associated safety risks” of the mental illness. Id. J.W. “consistently dismissed or minimalized therapeutic interventions and alternative treatment options presented to him during admission.” Id. Even two days before the hearing, J.W. expressed suicidal thoughts to Dr. Shah. Although J.W. claims that he had no plan to commit suicide, he also told Dr. Shah that he would “lie about his suicidal ideation” so that he could “leav[e] the hospital sooner.” Id. at 9. In discussing his suicidal thoughts, J.W. did not believe that an in-patient stay would be helpful and stated that he would “figure out a way to just do it when he's outside of the hospital.” Id. at 14.

[36] Dr. Shah testified that J.W. was being treated with Latuda, which is an approved medication for the depressive phase of bipolar disorder. J.W. has been compliant with taking his medications while hospitalized. Latuda generally takes “four to five days for the initial benefits to be observed,” but the amount of time necessary for Latuda to stabilize a patient is “on a very individual basis.” Id. at 31. Dr. Shah noticed a mild improvement in J.W. socializing with others since starting the medication, but she recommended that J.W. stay in the hospital for a few more days.² Dr. Shah also recommended that J.W. participate in outpatient therapy and consider electroconvulsive therapy “given the history of failed medication trials.” Id. at 16.

[37] J.W.’s argument is merely a request that we reweigh the evidence and judge the credibility of the witnesses, which we cannot do. T.K., 27 N.E.3d at 273. Community presented evidence of a substantial risk that J.W. will harm himself, and the majority merely weighs J.W.’s testimony more heavily than his doctor's testimony. Accordingly, I conclude that clear and convincing evidence supports J.W.’s involuntary temporary commitment based upon J.W.’s dangerousness to himself, and I would affirm the trial court's involuntary temporary commitment order. See, e.g., B.D. v. Ind. Univ. Health Bloomington Hosp., 121 N.E.3d 1044, 1050 (Ind. Ct. App. 2019) (affirming a temporary commitment order where the person expressed suicidal ideation among other factors). I commend J.W. for acknowledging his mental illness and admitting himself into the hospital. I encourage J.W. to put his trust in the doctors and take advantage of the new treatments available to him based upon his new diagnosis.

FOOTNOTES

1.   This expedited appeal is part of the two-year Marion County Expedited Mental Health Appeals Pilot Project, which the Indiana Supreme Court established to address the challenge that “[t]he typical duration of temporary mental health commitments often exceeds the standard appellate timeline.” In re Marion Cnty. Expedited Mental Health Appeals Pilot Project, No. 24S-MS-190, Order p. 1 (Ind. July 16, 2024).

2.   A ninety-day commitment does not mean that the individual is necessarily committed to the facility for ninety days. A committed individual may be placed on outpatient status and required to follow a therapy program. See Ind. Code Chapter 12-26-14.

Robb, Senior Judge.

Judge Brown concurs. Judge Tavitas dissents with separate opinion. Brown, J., concurs. Tavitas, J., dissents with separate opinion.