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

MEMORANDUM DECISION

[1] L.H. brings this expedited appeal challenging her temporary involuntary civil commitment to Community Fairbanks Behavioral Health (“Community”), claiming there was insufficient evidence that she was gravely disabled or dangerous.¹ We affirm.

Facts and Procedural History

[2] In August 2025, L.H. was a sixty-year-old woman, living in Ritter Supportive Housing (“Ritter House”² ) and sharing a room with two other women. On August 4, 2025, L.H. was admitted to Community on an Emergency Detention after she got into an altercation with her roommates. L.H. believed that the roommates were jealous of her and putting glasses and bugs in her belongings and stealing things from her. This altercation culminated with L.H. spraying bug spray on one of her roommates. This was L.H.’s third hospitalization related to the treatment of her mental illness in less than thirty days. All of the recent hospitalizations stemmed from L.H. having conflict with others at Ritter House based on her beliefs that people were stalking her, that microchips were placed in her body, and that the staff was trying to harm her.

[3] Following L.H.’s emergency detention, Community filed a Petition for Commitment Hearing and a Physician's Statement, in which Dr. Shilpa Guggali attested that L.H. was suffering from Schizoaffective disorder, Bipolar type, and that she was dangerous and gravely disabled. The petition stated that L.H. presented “with threatening behavior and homicidal ideation towards her roommate” and “continues to endorse psychotic symptoms and manic symptoms[,] ․ has not been compliant with prescribed psychotropic medications[,] ․ [and] lacks insight and judgment.” Appellant's App. Vol. II p. 14.

[4] On August 19, 2025, the trial court conducted a hearing on Community's petition. At that hearing, L.H. testified, along with Dr. Syed Hasan (“Dr. Hasan”), who offered undisputed expert testimony on behalf of Community. Dr. Hasan testified that he had interviewed and examined L.H. four times, including the morning of the hearing. Dr. Hasan testified that L.H. had been diagnosed with Schizoaffective disorder, Bipolar type and stated that L.H. had a “long history of psychotic symptoms including paranoid and grandiose delusions, which apparently get worse when she's not taking medications.” Tr. Vol. 1 p. 6. She also had “mood episodes where she [exhibits] very pressured speech, not sleeping, intrusive, irritable, argumentative, ha[s] racing thoughts, very disinhibited, interrupt[s] others, and [is] almost in a manic state.” Id. Dr. Hasan also stated that L.H. told him she had been hospitalized for her mental illness at least twenty times since 2004.

[5] When Dr. Hasan examined L.H. the morning of the hearing, she was “very upset and angry” and told him that she did not take her medication the previous night because she was worried she would be raped in the hospital and that she was not going to take her medication that day because she did not want to feel “hyped up” for her court hearing. Id. at 8. She then told Dr. Hasan that Community “has been talking about killing her for her organs because she's a very famous person and a rich person and they're going to sell it in the black market.” Id. She also expressed thoughts of not wanting her life to go on, feeling like taking her life, and wanting to go to heaven. She then walked out of the interview, but later came back, “banging on” the door of the room when Dr. Hasan was seeing another patient. Id.

[6] Dr. Hasan stated he believed that L.H. presented a danger to herself because she currently had suicidal ideations that had been expressed as recently as the morning of the hearing, which were based on her belief that people were following her, causing her to feel overwhelmed and distressed. Dr. Hasan testified that, although L.H. did not verbalize a suicide plan, his opinion that L.H. was suicidal remained unchanged, and he believed that her suicidal ideations were a legitimate concern.

[7] At the time of her hospitalization and the commitment hearing, L.H. was unemployed and received social security disability income. When Dr. Hasan asked her about sources of income, L.H. told him that she was involved in multiple businesses, including that she served as an international arms dealer and had dealings with Saddam Hussein. When asked about housing, L.H. indicated to Dr. Hasan that she had concerns about her safety at Ritter House, so she did not want to return there. She later testified that she may possibly go to a different group home.

[8] Dr. Hasan testified that L.H. had no insight into her mental illness and that she did not take her medications consistently. During her hospitalization, she was aggressive and argumentative with staff. L.H. exhibited “disintegrated behaviors in ․ social settings,” such as not wearing enough clothing to the point that the staff had to tell her to cover her body and stating that the TV instructed her to take clothing from another patient. Id. at 12. These behaviors, coupled with L.H.’s repeated conflict with other residents at Ritter House and her inconsistency in taking medications, supported Dr. Hasan's belief that L.H. was unable to function independently.

[9] Dr. Hasan stated that a temporary commitment would be the least restrictive means to provide care for L.H. and get her stabilized. He explained that the current treatment plan for L.H. would be to switch her to a long-acting injectable version of her medication to ensure compliance, continue with the injectable form of another medication, and take lithium as recommended by her treating physicians. The goals for L.H.’s treatment were to establish consistency and compliance with her medication, help her to understand her illness and symptoms, rather than blaming others, and work on a plan for her to return to Ritter House where she can live without supervision.

[10] L.H. also testified at the commitment hearing. Before her testimony, she interrupted the proceedings several times. The trial court had to mute her line after three verbal warnings, and the court also noted that, at various times, L.H. gave the court “the finger,” lifted up her shirt, and referred to the court as a prude. Id. at 32. L.H. testified that she did not want to take lithium anymore because it made her face swollen and that Michelle Obama even told her that her face looked different and explained that the Obamas were related to her. She explained she was willing to take other prescribed medications, just at lower doses or as needed. L.H. exhibited disorganized thoughts throughout her testimony. For example, when asked about taking care of her finances, she asserted that, “these hospitals and the system or whoever's behind this, my mother, I don't know” were trying to ruin her credit. Id. at 43. L.H. also admitted that she was suicidal but then digressed into a story about her prior experience as a welder for Caterpillar.

[11] At the conclusion of the hearing, the trial court granted Community's request for a temporary commitment, finding that Community had proven by clear and convincing evidence that L.H. was suffering from Schizoaffective Disorder (Bipolar Type), which was a mental illness; was dangerous to herself; was gravely disabled; and was in need of custody, care, and treatment at Community for a period of time not expected to exceed ninety days. In the Commitment Order, the trial court specifically noted:

The court considers the evidence collectively when making a determination of danger to self and grave disability, including but not limited to, psychosis-Paranoid and grandiose delusions—thinks she is an arms dealer, that Barack Obama is her blood relative[,] that the hospital wants her organs, Michelle Obama said her face was different and is related to her daughter, when she goes to sleep she is raped by hospital staff. She is suicidal, has disorganized thoughts, agitated, disruptive to proceeding, concerns of people following her, third admission to the hospital since July 21, not consistently taking her medication.

Appellant's App. Vol. II p. 21. L.H. now appeals.

Discussion and Decision

[12] L.H. challenges the sufficiency of the evidence supporting the trial court's finding that she was dangerous and gravely disabled. Pursuant to Indiana Code section 12-26-2-5(e), there must be clear and convincing evidence supporting the trial court's findings. 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 [the statutory findings], without weighing evidence or assessing witness credibility, a reasonable trier of fact could find [the necessary elements] proven by clear and convincing evidence.’ ” Civil Commitment of T.K. v. Dep't of Veterans Affs., 27 N.E.3d 271, 273 (Ind. 2015) (second alteration in original) (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).

[13] To enter a civil commitment order, the trial court must find that “the individual is mentally ill and either dangerous or gravely disabled[.]” Ind. Code § 12-26-2-5(e). Here, L.H. does not dispute that she suffers from mental illness. Rather, she argues the evidence was insufficient to establish that she was dangerous or gravely disabled.

[14] Indiana Code Section 12-7-2-53 defines dangerous for purposes of civil commitments 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.” “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.” Commitment of M.M. v. Clarian Health Partners, 826 N.E.2d 90, 97 (Ind. Ct. App. 2005) (citing Commitment of C.A. v. Ctr. for Mental Health, 776 N.E.2d 1216, 1218 (Ind. Ct. App. 2002)), trans. denied. L.H. argues that there was insufficient evidence to support that she was dangerous because the evidence did not establish that she was at risk of harming herself. Specifically, she asserts that her expressions of hopelessness were merely a product of her hospitalization and there was no showing that she had an actionable plan to carry out her suicidal ideations.

[15] L.H.’s assertions are merely requests to reweigh the evidence, which we will not do. T.K., 27 N.E.3d at 273. The evidence presented at the commitment hearing revealed that, as recently as that morning, L.H. expressed suicidal thoughts, and articulated thoughts of not wanting her life to go on, feeling like taking her life, and wanting to go to heaven. Even though L.H. did not verbalize a specific plan for how she was going to commit suicide, she specifically told Dr. Hasan, “I just want to end my life and go to heaven.” Tr. Vol. 1 p. 23. In her own testimony, L.H. corroborated Dr. Hasan and her suicidal ideations, stating “I feel like if I can't work and if I got to be in these hospitals and if I can't live with my dream, what's the use of living? What's the use of being here?” Id. at 44. We conclude that clear and convincing evidence was presented to establish that, as a result of mental illness, L.H. presented a substantial risk that she would harm herself or others and to support the trial court's finding that L.H. was dangerous.

[16] Although Indiana Code section 12-26-2-5(e) is written in the disjunctive, such that if we affirm on dangerousness, we do not need to address the alternate element of grave disability, we will proceed to also determine whether sufficient evidence supported the trial court's finding that L.H. was gravely disabled. See A.P. v. Cmty. Health Network, Inc., 238 N.E.3d 704, 710 n.1 (Ind. Ct. App. 2024). Indiana Code section 12-7-2-96 defines “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.

[17] L.H. argues that the evidence presented was insufficient to support that she was gravely disabled, pointing out that, prior to her hospitalization, she had a source of income and housing, had planned to start working again so she would not be dependent on her disability income, handled her own finances, bought her own groceries, and was able to obtain transportation when needed. L.H. also pointed out she was eating and bathing while in Community. Based on all of this, she asserts that she could obtain food, clothing, shelter, or other essential human needs and that she was able to function independently.

[18] L.H.’s contentions are again a request that we reweigh the evidence. Although L.H. highlights tasks she was able to perform prior to her most recent hospitalization, the evidence at the hearing revealed that L.H. had no insight into her mental illness and did not take her medications consistently, if she took them at all. Dr. Hasan stated that L.H. required supervision to ensure that she took her medications and that he believed that L.H. was not able to function independently. The evidence established that L.H. had been hospitalized three times in the prior thirty days alone, and multiple times over the course of twenty years. Dr. Hasan testified that he attributed her frequent hospitalizations to L.H.’s lack of medication compliance and her inability to understand and participate in treating her illness. It was Dr. Hasan's belief that, even with treatment, L.H.’s “prognosis [wa]s guarded”; and without treatment, Dr. Hasan was concerned that L.H. would “end up killing herself.” Tr. Vol. 1 p. 14.

[19] Evidence was also presented that during her current hospitalization, L.H. was aggressive and argumentative with staff, which Dr. Hasan attributed to her delusions because when she experienced delusions, she did not understand that she was experiencing them. Then, she would act according to those delusions, which led to paranoid behavior and escalated to aggression or self-harm. Additionally, L.H. exhibited “disintegrated behaviors in ․ social settings,” such as wearing inadequate amounts of clothing and believing that the TV instructed her to take clothing from another patient. Id. at 12. There was also evidence presented of L.H.’s grandiose delusions regarding her beliefs of being related to famous people, that she was an arms dealer, and that the hospital staff wanted to kill her for her organs to sell on the black market. Further, during the hearing, the trial court was able to witness L.H.’s disorganized thoughts and inability to control herself in a formal social setting when she constantly interrupted the court verbally and with physical motions, gave the trial court the finger, and lifted her shirt during the doctor's testimony. We, therefore, conclude that clear and convincing evidence was presented to establish that L.H.’s mental illness created actual risks of harm and resulted in her inability to function independently so as to satisfy the statutory criteria for grave disability.

[20] In light of the evidence most favorable to the judgment, we conclude that sufficient evidence supported the trial court's findings that L.H. was mentally ill and either dangerous or gravely disabled under Indiana Code section 12-26-2-5(e).

[21] Affirmed.

FOOTNOTES

1.   This expedited appeal is part of the two-year Marion County Expedited Mental Health Appeals Pilot Project (“the 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, slip op. at 1 (Ind. July 16, 2024). On September 2, 2025, the Supreme Court issued an order modifying the Pilot Project, which amended several of the parameters under which the Pilot Project is to proceed. See In re Marion Cnty. Expedited Mental Health Appeals Pilot Project, No. 25S-MS-204 (Ind. Sept. 2, 2025). However, such amendments do not become effective until October 1, 2025, and are therefore, not pertinent to this appeal.

2.   “Ritter Supportive Housing is a 45-bed, short-term/acute care transitional housing program that works with clients ages 18 and over with a diagnosis of mental illness ․ who require skills training and care coordination to reach the next step of recovery, which is independent community living.” Sandra Eskenazi Mental Health Center Residential Services, available at: https://www.eskenazihealth.edu/mental-health/sandra-eskenazi-mental-health-center/residential-services [https://perma.cc/3N4S-L4Y4].

Foley, Judge.

Judges Mathias and Brown concur. Mathias, J. and Brown, J., concur.