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

MEMORANDUM DECISION

Statement of the Case

[1] M.H., a mentally ill person, was hospitalized on an emergency basis after he stopped taking his prescribed medication, became delusional, and stopped cleaning himself and eating sufficiently. While he was hospitalized, he attacked an employee and threatened other people.

[2] M.H. now appeals the trial court's order temporarily committing him to the custody of Community Fairbanks Behavioral Health (“Fairbanks”). M.H. claims the hospital failed to present sufficient evidence to sustain the court's judgment. Concluding that the evidence is sufficient, we affirm.

Issues

[3] M.H. raises two issues, which we consolidate and restate as: whether there is sufficient evidence to sustain the trial court's judgment. In addition, Fairbanks argues this appeal is moot.

Facts and Procedural History

[4] M.H. is a mentally ill forty-seven-year-old man. He lives with his wife, who we refer to as Damita, in Indianapolis. She has arranged for him to be hospitalized on three prior occasions, roughly every two years, due to mental health crises that arose after he stopped taking his medication.

[5] In February 2025, M.H. stopped taking his prescribed medicine again, telling Damita that he did not need it. He became unstable and “hyper religious.” Tr. Vol. II, p. 46. M.H. verbally abused Damita, calling her the devil. He told her he is “immutable [sic] to any harm or danger especially um police or doctors or nurses.” Id. M.H. also became fixated on organization, throwing their food and some of their belongings away.

[6] In mid-February 2025, Damita left the house and made arrangements to have M.H. hospitalized. She returned to the house a few days later, while M.H. was still there. During the visit, Damita saw that he had not changed clothes in days and there was very little food in the house.

[7] On February 20, 2025, Eskenazi Mental Health Center filed a petition to detain M.H. on an emergency basis. The trial court granted the petition, authorizing Eskenazi to detain M.H. for up to fourteen days. Eskenazi transferred M.H. to Fairbanks around the time that the trial court issued the emergency order.

[8] On February 21, Fairbanks employee Dr. Brandon Wilkinson met with M.H. for the first time. M.H. remained in his bed, refusing to talk and holding a graphic novel that he had created. Over the next several days, M.H. communicated through grunts and hand gestures, including using shooing motions to send people away. He was agitated and aggressive. In addition, Dr. Wilkinson saw M.H. wearing underwear on his face, perhaps as a makeshift mask. The doctor asked him to remove the underwear because part of it was wrapped around his neck, posing an asphyxiation risk. M.H. refused and had to be medicated.

[9] M.H. became more verbal in the following days, but not more lucid. He kept a notebook in which he identified other people in his unit, including employees, as “demons or devils.” Id. at 27. M.H. displayed paranoid thoughts and made “vague threats” about having problems with other people who were being loud while he was watching television. Id. at 27-28. He also demonstrated a lack of insight into his medical conditions, repeatedly denying that he needed medicine for mental illness. And when Dr. Wilkinson noted that M.H.’s lab results showed that he had low potassium levels, M.H. refused to take a supplement, saying that he would just eat bananas instead. He also had poor personal hygiene. He refused to change his clothes for several days, and on one occasion he urinated on the floor in his room.

[10] After several days of treatment, Dr. Wilkinson diagnosed M.H. as suffering from “schizo-affective disorder[,] bipolar type.” Id. at 30. His symptoms included delusional and paranoid thoughts, a flattened or blunted affect, and an inability to socialize appropriately. M.H. showed some signs of improvement on different medications, but he relapsed when he stopped complying with the medication schedule. Damita visited him once, but he became so agitated that hospital employees advised her to leave.

[11] On February 24, Fairbanks filed a petition for a temporary commitment hearing, asking the court to determine whether M.H. should be committed to Fairbanks for up to ninety days. The trial court scheduled an evidentiary hearing for February 28.

[12] In the days leading up to the hearing, M.H. continued to deny that he needed medication. In one troubling incident, he grabbed a Fairbanks employee and later said he was “ready to break [the employee's] neck[.]” Id. at 32. On other occasions, M.H. acted aggressively, they attempted to redirect him orally. When that failed, they offered him oral medication. On February 27, M.H. could not be redirected, refused oral medication, and continued to act aggressively, which resulted in employees placing him in seclusion for several hours. On a different occasion, Fairbanks employees had to restrain him by tying him to his bed.

[13] At the evidentiary hearing, Dr. Wilkinson stated that, due to M.H.’s mental illness, he cannot function independently and endangers others. M.H. also testified, asserting that he did not need any medication because he is not mentally ill.

[14] The court determined M.H. is suffering from schizoaffective disorder, bi-polar type. The court also determined he was dangerous to others and gravely disabled. Finally, the court committed M.H. to Fairbanks’ custody for up to ninety days. This appeal followed.

Discussion and Decision

I. Mootness

[15] Before we address the merits of M.H.’s claims, Fairbanks argues the appeal is moot because the period of M.H.’s temporary commitment has expired and the Court cannot grant him any relief. Fairbanks relies upon J.F. v. St. Vincent Hospital & Health Care Center, 256 N.E.3d 1260 (Ind. 2025), but that reliance is misplaced.

[16] In J.F., the trial court committed a patient to a hospital for treatment on a temporary basis. The patient appealed, and the hospital claimed her appeal was moot because her temporary commitment had expired. The Indiana Supreme Court disagreed, noting that temporary involuntary civil commitments “implicate a great public interest in both liberty and public safety.” Id. at 1263. The Court added that temporary commitment orders “generally deserve appellate review on the merits.” Id. at 1267. The necessity of appellate review stems in part from the collateral consequences that may ensue after a temporary involuntary civil commitment. See id. at 1268 (describing consequences including ban on carrying firearms and a greater likelihood of future involuntary commitments based on evidence of prior commitments). As a result, the Court concluded that “timely appeals of temporary commitment orders generally do not become moot when the orders expire,” except when an appellee makes an “extraordinary showing” that a commitment order does not “carry the potential for any collateral consequences.” Id. at 1269.

[17] In the current case, Fairbanks notes that M.H. has been the subject of prior orders of temporary commitment and claims the Court cannot provide any meaningful relief here because reversal would not “eliminate any collateral consequences” he already faces from prior cases. Appellee's Br. p. 15. We disagree. The J.F. court cited as a collateral consequence that a potentially invalid commitment order, if not reversed on appeal, could form the basis for a later order of commitment. 256 N.E.3d at 1268. And the court also stated “that individuals whose commitment issues are capable of repetition in their own future cases” should have access to meaningful appellate review. Id. at 1269. The current commitment order, if invalid, could have negative consequences in any subsequent proceedings involving M.H. Fairbanks has failed to make the extraordinary showing described in J.F., and we reject Fairbanks’ claim of mootness.

II. M.H.’s Involuntary Commitment

[18] When reviewing the sufficiency of the evidence supporting an order of civil commitment, we will affirm if, “considering only the probative evidence and reasonable inferences favorable to the judgment[,] a reasonable factfinder could have found the necessary statutory elements proven by clear and convincing evidence.” Id. at 1270. The clear and convincing evidence standard “is defined as an intermediate standard of proof greater than a preponderance of the evidence and less than proof beyond a reasonable doubt.” Commitment of B.J. v. Eskenazi Hosp./Midtown CMHC, 67 N.E.3d 1034, 1038 (Ind. Ct. App. 2016).

[19] A petitioner in a temporary involuntary commitment proceeding “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) (2007). On appeal, M.H. does not dispute that he is mentally ill, but he argues that he is neither dangerous nor gravely disabled. The statute is written in the disjunctive, meaning that a petitioner need only prove dangerousness or grave disability, but we will address both elements.

[20] We start with the issue of dangerousness. For purposes of involuntary civil commitments, the General Assembly has defined “dangerous” as “a condition in which an individual as a result of mental illness, presents a substantial risk that the individual will harm the individual or others.” Ind. Code § 12-7-2-53(a) (2023). ‘ “Dangerousness must be shown by clear and convincing evidence indicating that the behavior used as an index of a person's dangerousness would not occur but for the person's mental illness.” ’ B.M. v. Ind. Univ. Health, 24 N.E.3d 969, 972 (Ind. Ct. App. 2015) (quoting Commitment of C.A. v. Ctr. for Mental Health, 776 N.E.2d 1216, 1218 (Ind. Ct. App. 2002)), trans. denied.

[21] Here, Damita testified that M.H. was a supportive husband and a productive person when he took his medication as prescribed, but the current case arose when M.H. stopped taking his medication and displayed paranoid behavior. After he was hospitalized, he continued to display paranoia, expressing a belief that other patients and Fairbanks employees were demons or devils. M.H. physically attacked a Fairbanks employee and indicated he was willing to break the person's neck. On one occasion, Fairbanks employees restrained him in his bed because he would not comply with their directives and lesser methods to redirect him did not work. M.H. also made vague threats against people being too loud while he was watching television. This is clear and convincing evidence that, due to M.H.’s untreated mental illness, he poses a threat to others. See B.M., 24 N.E.3d at 972 (evidence sufficient to sustain trial court's determination of dangerousness; patient displayed psychotic behaviors, refused medication, attacked hospital staff, and needed to be restrained).

[22] M.H. argues that he was not violent toward his wife and reasonably rejected the medication out of a concern for its side effects. His arguments amount to a request to reweigh the evidence, which our standard of review forbids.

[23] We next turn to the element of grave disability. The General Assembly has defined “gravely disabled” as:

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 (1992). A trial court's finding of grave disability under this statute will be affirmed “if we find that there was sufficient evidence to prove either that the individual was unable to provide for his basic needs or that his judgment, reasoning, or behavior was so impaired or deteriorated that it resulted in his inability to function independently.” Commitment of B.J., 67 N.E.3d at 1039.

[24] Dr. Wilkinson diagnosed M.H. with “schizo-affective disorder[,] bipolar type.” Appellant's App. Vol. II, p. 30. Both before and after his hospitalization, M.H.’s behavior matched the symptoms of schizo-affective disorder as identified by Dr. Wilkinson. He displayed delusional or paranoid thoughts and problems socializing. In addition, he has repeatedly denied being mentally ill and needing medication. M.H. was verbally abusive to Damita and threw out their food and some of their property. She left the house to arrange for his hospitalization, and when she returned a few days later, he had stopped attending to his personal hygiene and there was very little food. Even after M.H. was hospitalized, he wore the same clothes for several days and once urinated on the floor. He also wore underwear on his face, perhaps as a type of mask. And M.H.’s symptoms of paranoia and delusion continued in the hospital. This is clear and convincing evidence that M.H. has a substantial impairment or an obvious deterioration in his judgment, reasoning, or behavior which caused him to be unable to function independently. See F.L. v. Cmty. Fairbanks Behav. Health, 245 N.E.3d 1033, 1035-36 (Ind. Ct. App. 2024) (hospital presented clear and convincing evidence of grave disability; patient was diagnosed with mental illness but denied that diagnosis and need for medication; her sleep and appetite had declined before hospitalization and she had delusional thinking), trans. denied.

[25] M.H. points out that he held several jobs before his hospitalization, that he knows how to cook, and has published a graphic novel. But we are required to view the evidence in the light most favorable to the judgment, and his ability to function declined after he stopped taking his medication. There is sufficient evidence to support the trial court's determination that M.H. is gravely disabled.

Conclusion

[26] For the reasons stated above, we affirm the judgment of the trial court.

[27] Affirmed.

Baker, Senior Judge.

Judges Bradford and Scheele concur. Bradford, J., and Scheele, J., concur.