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

MEMORANDUM DECISION

Case Summary

[1] J.F. appeals his regular commitment to Sandra Eskenazi Mental Health Center (“Eskenazi”). The only issue he raises on appeal is whether Eskenazi presented clear and convincing evidence that he is gravely disabled to support the regular commitment order.

[2] We affirm.

Facts and Procedural History

[3] J.F. was taken to Eskenazi on October 13, 2024, after police found him shattering high school windows. J.F.’s speech was disorganized, and he was not making sense. The next day, Eskenazi filed an Application for Emergency Detention of Mentally Ill and Dangerous and/or Gravely Disabled Person. The application's Physician's Attestation explained that J.F. suffered from a psychiatric disorder and that he was dangerous to others and gravely disabled. The Physician's Attestation further explained that J.F. “remains nonsensical in speech and bizarre in behavior,” that J.F. was “undressing inappropriately,” and that J.F. was “charging at staff as if to strike them.” App. at 15. On October 15, the court found probable cause for the detention.

[4] On October 23, Eskenazi filed a petition requesting that the court hold a hearing to determine whether J.F. was in need of commitment. The attached Physician's Statement of Dr. Kenneth Smith, a psychiatrist, explained that J.F. suffered from the mental illness of schizoaffective disorder, bipolar type; J.F. had “hallucinations, disorganized thought processing, and mood lability[;]” J.F. presented a “substantial risk of harm to ․ others” and had been “threatening others during [his] hospital stay[;]” and J.F.’s “[s]ymptoms impair[ed] reliable judgment and reasoning.” Id. at 20-21. Dr. Smith recommended both temporary and regular commitment for J.F.

[5] Following the October 29 hearing on Eskenazi's petition, the court ordered temporary commitment for J.F. The court determined that J.F. suffered from “schizoaffective, bi-polar type” and was “dangerous to others” and “gravely disabled.” Id. at 57.

[6] On December 27, Eskenazi filed a report requesting an extension of J.F.’s temporary commitment, which was to expire on January 27, 2025. The report and attached Physician's Statement by Dr. Smith explained that: J.F. suffered from schizoaffective disorder, bipolar type; J.F. had disorganized thought processing, hallucinations, and mood lability; J.F.’s symptoms prevented him from providing reliable care to himself; J.F. had an inability to provide for food, clothing, shelter, or other essential human needs; and J.F. had “a substantial impairment or obvious deterioration in judgment, reasoning, or behavior that resulted in [his] inability to function independently.” Id. at 65. The report further explained that J.F. did not have “family, friends, or others willing and able to assist in meeting [his] needs[;]” J.F. refused voluntary treatment; and it “[w]ould be harmful [for J.F.] to leave [his] current hospitalization.” Id. at 65-66.

[7] On January 14, 2025, the court held a hearing on Eskenazi's request for extension. Rachel McFadden, an “expert in occupational therapy” at Eskenazi, testified that she began “seeing [J.F.] as a therapist” in November 2024. Tr. at 11-12. McFadden did an individual assessment of J.F. in November, which involved assessing J.F.’s ability to: care for his body; identify “dangerous situations” and the means to address them; manage money; obtain and maintain income; access community services; and plan for “future employment and leisure activity.” Id. at 13-14. McFadden testified that the results of the assessment indicated that J.F. “needed support in every single area on the assessment except for ․ physical appearance.” Id. at 14. McFadden opined that J.F. does not have “the ability to function independently[,]” although she noted that she had had minimal contact with J.F. since administering the November assessment. Id. at 17.

[8] Dr. Smith also testified at the January hearing. Dr. Smith had been J.F.’s attending physician since J.F. was admitted to Eskenazi in October 2024 and had seen J.F. on sixty-one “separate days” in that time period. Id. at 20-21. He stated that J.F. has “schizoaffective disorder, bipolar type,” id. at 21, including “disorganized thought processing” in his speech and behavior; intermittent “auditory hallucinations[;]” and “substantial mood instability[,]” id. at 22. Dr. Smith noted that J.F. initially had no improvement with medication. However, when J.F.’s medication was switched to Loxapine in late November, J.F.’s symptoms began to improve. Specifically, J.F.’s hallucinations “decreased,” his overall mood and stability improved, and his thought organization improved but was “still causing [J.F.] substantial difficulty.” Id. at 23. Throughout December, J.F. “struggled to be able to give ․ what seemed to be reality[-]based plans for what he would do to care for himself in the community if discharged.” Id. J.F.’s “plan” for himself following his hospitalization was to live in homeless shelters or a restroom at the city library, neither of which would “have the level of support that he needs.” Id. at 27.

[9] Eskenazi conducted another assessment of J.F. on December 20, 2024. Dr. Smith did not do the assessment himself, but he reviewed it and testified that the “overall result was exactly the same” as the assessment done in November 2024. Id. at 24. The December 20 assessment recommended that J.F. “live in a supported living environment with total oversight of his health and financial management for the reason of overall safety.” Id. at 25. Dr. Smith testified that J.F.’s disorganized thinking had led to threats against Dr. Smith and significantly impaired J.F.’s judgment and reasoning. He further testified that J.F. lacked insight into his mental health condition and needs, could not identify any significant social support for himself in the community, and was not “currently able to function independently.” Id. at 26. Dr. Smith reached the latter conclusion based, in part, on the results of the safety portion of the assessments of J.F.; specifically, J.F.’s inability “to adequately recognize several environmental safety hazards ․ and make adequate executive planning decisions for himself.” Id. at 27.

[10] Dr. Smith testified that he was still in the process of slowly increasing J.F.’s current medication doses. He further noted that “good medication compliance” is “essential” for J.F., and missing even “one dose of medication in a given week could have a significant worsening [effect on] his condition.” Id. at 31-32. Yet, Dr. Smith believed that J.F. had been “cheeking the medication or not actually taking it when it was administered” until Dr. Smith had begun a protocol in which the administering nurse watched J.F. “for several minutes after giving the medication doses,” which seemed to help. Id. at 32. Dr. Smith stated that J.F. needs such supervision in order to stay medication-compliant, but that level of support would not be available in a homeless shelter. Dr. Smith concluded that J.F.’s

exacerbation of psychosis and mood instability over the recent months has been more treatment refractory than I believe episodes that he has experienced in the past[,] um and despite um a fairly aggressive medication management, although his symptoms have improved[,] his symptoms linger[,] and at this point I believe a longer term hospitalization is most appropriate to ․ treat his residual symptoms.

Id. at 31.

[11] The court took judicial notice of J.F.’s “five prior mental health cases from 2000, 2016, 2020[,] and in 2024 filings from February and from March.” Id. at 35. The court concluded that

[J.F.] does not appear to have regained the faculties necessary for him to keep himself safe and to direct his own treatment․ [J.F.] remains incapable of directing his own medical care, of complying with the medications necessary to manage and maybe even abate the psychiatric symptoms that continue to debilitate him including especially psychosis which makes it impossible for him to relate normally to the world around him․ [J.F.] remains an incapacitated adult and particularly is gravely disabled in his judgment and reasoning as well as incapable of caring for himself outside the carefully and [sic] controlled environment of the hospital.

Id. at 35-36. The court ordered J.F.’s regular commitment, and this appeal ensued.

Discussion and Decision

[12] J.F. appeals his regular commitment ¹ on the ground that Eskenazi failed to present sufficient evidence that J.F. is gravely disabled.

When reviewing the sufficiency of the evidence supporting a civil commitment, we consider only the probative evidence and reasonable inferences supporting it, without weighing evidence or assessing witness credibility. Civ. Commitment of T.K. v. Dep't of Veterans Affairs, 27 N.E.3d 271, 273 (Ind. 2015). We will affirm if clear and convincing evidence supports the trial court's judgment. Id. Clear and convincing evidence requires proof that the existence of a fact is “highly probable.” Matter of Commitment of C.N., 116 N.E.3d 544, 547 (Ind. Ct. App. 2019).

F.L. v. Cmty. Fairbanks Behav. Health, 245 N.E.3d 1033, 1035 (Ind. Ct. App. 2024), trans. denied.

[13] To prove that an individual should be involuntarily committed for a period of more than ninety days, a petitioner must prove by clear and convincing evidence that the individual is (1) mentally ill, (2) either dangerous or gravely disabled, and (3) needs continuing care and treatment in a facility for a period of more than ninety days. I.C. § 12-26-6-11. An individual is “gravely disabled” when he has

a condition in which [the] 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.

I.C. § 12-7-2-96.

[14] J.F. does not dispute that he is mentally ill. However, he contends that Eskenazi did not provide clear and convincing evidence that he is gravely disabled. Specifically, he alleges that there was only evidence that he was gravely disabled at the time of his November 2024 assessment, but no evidence to show he was gravely disabled at the time of the January 2025 hearing.

[15] We disagree. At the January 14 hearing, Eskenazi provided probative evidence—including the testimony of McFadden and Dr. Smith—that:

• J.F. continued to experience the mental illness symptoms of disorganized thoughts, hallucinations, and mood instability.

• J.F. had a significant history of mental health cases related to his mental illness. See, e.g., M.T. v. Cmty. Health Network, 219 N.E.3d 151, 155 (Ind. Ct. App. 2023) (noting we have “long recognized” that a history of mental illness requiring hospitalizations is probative of a grave disability).

• J.F. had a lack of insight into his mental illness. See, e.g., Civ. Commitment of W.S. v. Eskenazi Health, 23 N.E.3d 29, 34 (Ind. Ct. App. 2014) (recognizing an individual's lack of insight into his mental illness as probative of a grave disability), trans. denied.

• J.F. required daily and consistent medication for his mental illness but had a history of medication noncompliance if not supervised. See E.F. v. St. Vincent Hosp. and Health Care Ctr., Inc., 194 N.E.3d 1130, 1137 (Ind. Ct. App. 2022) (finding a history of medication noncompliance as probative of a grave disability).

• J.F. was unable to provide a plan to support himself, keep himself safe, and provide for his own needs if discharged. See, e.g., Civ. Commitment of J.B. v. Cmty. Hosp. N., 88 N.E.3d 792, 797-98 (Ind. Ct. App. 2017) (citing evidence of an inability to provide for own basic needs to be probative of a grave disability).

That evidence supports the probate's court's findings that J.F. was gravely disabled and should be committed. J.F.’s contentions to the contrary are merely requests that we reweigh the evidence, which we may not do. See F.L., 245 N.E.3d at 1035.

[16] J.F. contends that all the above evidence of his grave disability came only from the November 2024 assessment of him, but that is demonstrably false; Dr. Smith specifically testified that the result of the recent December 20, 2024, evaluation of J.F. “was exactly the same” as the assessment done in November 2024. Tr. at 24. That result was a conclusion that J.F. needs support “in every single area on the assessment” other than maintaining his physical appearance, id. at 14, and a recommendation that J.F. live in an “environment with total oversight of his health and financial management for the reason of overall safety,” id. at 25.

Conclusion

[17] Based on the foregoing, we conclude that Eskenazi provided clear and convincing evidence that J.F. is gravely disabled; therefore, we affirm the court's order of J.F.’s regular commitment.

[18] Affirmed.

FOOTNOTES

1.   The regular commitment proceeding was conducted pursuant to Indiana Code Section 12-26-6-11, under which a regular commitment may be sought at least twenty days before the expiration of a previously-obtained temporary commitment.

Bailey, Judge.

Brown, J., and Weissmann, J., concur.