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

MEMORANDUM DECISION

Statement of the Case

[1] K.M. brings this expedited appeal challenging her involuntary temporary commitment to Indiana University Health Methodist Hospital (“Hospital”).¹ K.M. claims the evidence is insufficient to show that she is gravely disabled. Concluding that clear and convincing evidence supports K.M.’s involuntary temporary commitment, we affirm.

Facts and Procedural History

[2] On August 12, 2025, thirty-five-year-old K.M., who has a history of mental illness, was voluntarily admitted to the Hospital. K.M.’s mother, L.F., had taken K.M. to the Hospital because she had become concerned by K.M.’s recent behavior. K.M. had removed electrical outlets from the walls and disturbed the wiring in her apartment, burning her finger in the process, and she had “colored” her entire apartment black. Tr. Vol. 1, p. 6. K.M. told L.F. that she was hearing voices and that she wanted to drink bleach water. L.F.’s concern also stemmed from K.M.’s decision to have all of her teeth removed when she was suffering from issues with just a few of her teeth. K.M. admitted to L.F. that she had not been taking her medication and that she needed help.

[3] The day after K.M. was admitted, the Hospital filed an application for emergency detention of K.M., alleging that K.M. suffered from mental illness and was gravely disabled. The trial court granted the Hospital's application, and K.M. was detained. Psychiatrist Dr. Jonathan Withers assumed the care of K.M. and recommended temporary commitment of her to the Hospital. The court then held a hearing on the Hospital's petition for involuntary commitment.

[4] At the hearing, Dr. Withers testified that K.M. suffers from schizoaffective disorder, a chronic mental illness. He examined K.M. on August 14-17 and on August 19-22, with his last examination occurring the morning of the hearing. Id. at 15. Dr. Withers’ diagnosis was based on K.M.’s delusional thought content, specifically Capgras delusion. Id. at 17. Capgras delusion is the idea that family members have been replaced by imposters, and K.M. believed that this had occurred with her children and her mother and that her sisters had been replaced by octopi. Id. Dr. Withers also noted that K.M. was experiencing auditory hallucinations and delusions of “shadow people.” Id.

[5] Dr. Withers indicated that K.M. suffers substantial impairment of judgment that results in her inability to function independently. Id. at 17-18. He testified that K.M.’s concerning behaviors include her electrical work on the outlets without having had any electrical training and which resulted in her sustaining a burn. Id. at 18. Further, although K.M. did have an infection in several teeth that required extraction, she had all her teeth pulled. She suggested that her teeth were infected because people had somehow replaced her healthy teeth with their rotting teeth. Id. Dr. Withers asserted that while K.M. can manage her activities of daily living, due to her mental illness, she engages in risky behavior. Id.

[6] According to Dr. Withers, K.M. has limited insight into her condition, which affects her ability to take her medication, and that she cannot be relied upon to take her medication without supervision. For instance, K.M. claimed that the color of the pill can change its effect on a person and be used to control a person's mind. Id. at 17, 19. In addition, K.M. believes she can manage her symptoms by taking long walks and sitting in a steam room. Id. at 19. When K.M. was admitted to the Hospital, she initially took her medication, and she told Dr. Withers she was doing so in order to advance her discharge. However, when he explained that taking the medication was “100% her choice,” K.M. refused the medication. Id. at 17. In total, K.M. took her medication for three of the nine days she had been in the Hospital. Id.

[7] The treatment plan recommended by Dr. Withers included the administration of a long-acting injectable anti-psychotic drug that had proven to be effective and tolerable for K.M. Id. at 20. Dr. Withers indicated that K.M. would only need to remain in the Hospital for one more week and that this was the least restrictive treatment available to bring about an improvement in K.M.’s condition. Id. Finally, Dr. Withers testified that K.M.’s prognosis with treatment was fair to good, but her prognosis without treatment was poor. Id. at 21.

[8] The court determined that K.M. is suffering from schizoaffective disorder, a mental illness, and that she is gravely disabled as defined by statute. Appellant's App. Vol. II, pp. 37-38 (Order of Temporary Commitment). Accordingly, the court committed K.M. to the Hospital for a period not to exceed ninety days. Id. K.M. now appeals.

Discussion and Decision

[9] A petitioner seeking to have a person involuntarily committed must “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). Clear and convincing evidence is “an intermediate standard of proof greater than a preponderance of the evidence and less than proof beyond a reasonable doubt.” T.D. v. Eskenazi Health Midtown Cmty. Mental Health Ctr., 40 N.E.3d 507, 510 (Ind. Ct. App. 2015).

[10] When reviewing a trial court's order of commitment, we look only to the evidence most favorable to the judgment and all reasonable inferences drawn therefrom. E.F. v. St. Vincent Hosp. & Health Care Ctr., Inc., 194 N.E.3d 1130, 1135 (Ind. Ct. App. 2022). “[W]e will affirm if, after considering the probative evidence and reasonable inferences supporting the decision, a reasonable trier of fact could have found the necessary elements proven by clear and convincing evidence.” Matter of B.N., 137 N.E.3d 330, 336 (Ind. Ct. App. 2019). “The determination of whether an involuntary commitment is appropriate is fact-sensitive.” R.P. v. Optional Behav. MHS, 26 N.E.3d 1032, 1037 (Ind. Ct. App. 2015).

[11] K.M. does not contest the determination that she is mentally ill, but she challenges the trial court's finding that she is gravely disabled. 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). Because this definition is written in the disjunctive, the evidence need only support one of the two factors for a person to be found gravely disabled. A.S. v. Ind. Univ. Health Bloomington Hosp., 148 N.E.3d 1135, 1140 (Ind. Ct. App. 2020). At the hearing, the Hospital focused on subsection (2), arguing that K.M.’s judgment is substantially impaired resulting in her inability to function independently.

[12] First, K.M. contends that the Hospital's evidence was insufficient to establish grave disability because it demonstrated her past, rather than current, behavior as well as speculative harm. Evidence of a patient's prior conduct may establish the requisite nexus to her current condition so as to be considered by the trial court in ordering a temporary commitment. J.F. v. St. Vincent Hosp. & Health Care Ctr., Inc., 256 N.E.3d 1260, 1271 (Ind. 2025). The evidence here established such a nexus.

[13] K.M.’s mother testified that three months prior to the hearing K.M. had attempted to perform electrical work and had painted her entire apartment black. L.F. asked K.M. to get help, but K.M. refused. Tr. Vol. 1, p. 6. Approximately one month later, K.M. stayed with L.F. for two weeks, and during that time, K.M. told her mother she knew something was going on, that she did not feel right, and that she wanted to drink bleach water. Id. at 9. The testimony also showed that within two months of the hearing K.M.’s delusional thoughts about how she came to have rotten teeth caused her to have all her teeth extracted. Id. at 10.

[14] Although these events occurred in the couple months leading up to the hearing, they had a nexus to K.M.’s current hospitalization and her condition at the time of the hearing. The electrical wiring incident was the warning sign to L.F. that K.M. needed help. Indeed, K.M. admitted to L.F. that she needed help and that she was not taking her medication. Rather than one isolated incident, additional behavior demonstrated K.M.’s deterioration over the next several months while her mother continued to plead with her to seek help.

[15] Furthermore, K.M.’s behavior continued after she was admitted to the Hospital. She reported to Dr. Withers that her children had been replaced by adults who were reincarnated, that her sisters had been replaced by octopi, and that her mother was replaced by an imposter. Id. at 17. This evidence also demonstrates the pattern of delusions and behavior that Dr. Withers anticipated would continue if K.M. were not temporarily committed. Moreover, K.M.’s counsel acknowledged at the hearing that evidence of K.M.’s behavior “in the last couple months” was appropriate evidence for the court to consider. Id. at 12.

[16] In addition, the Hospital's evidence demonstrated that K.M.’s behavior resulted in actual harm. The Hospital produced evidence that K.M. suffered a burn as a result of her electrical tinkering. In its order, the court merely noted that her injury, while not insignificant, was minor compared to the damage had she burned down her apartment. See id. at 25.

[17] Next, K.M. argues that the court's decision was based only on her refusal to medicate, which is insufficient to establish grave disability. As is clear from our prior discussion, the Hospital's evidence supporting the court's order temporarily committing K.M. was not based solely on her refusal to take her medication. See id. at 25-26.

[18] Finally, K.M. asserts that Dr. Withers’ testimony that she can manage her activities of daily living and that she does not present a substantial risk that she will harm herself or others undercuts any showing by the Hospital that she is gravely disabled.

[19] Managing one's own activities of daily living is but one piece of the puzzle. The evidence demonstrates that K.M. lacks insight into her medical condition such that she refuses medication and thinks she can treat her illness with long walks and visits to a steam room. Further, it is clear from the context of Dr. Withers’ testimony that he was referring to his belief that K.M. would not intentionally harm herself. This is distinct from coming to harm as a result of substantially impaired judgment. As to this type of harm, Dr. Withers testified that K.M. did in fact come to harm when her impaired judgment led to her decision to perform dangerous electrical work for which she had no training.

[20] Additionally, Dr. Withers testified that K.M.’s mental illness, categorized as schizoaffective disorder, causes delusional thoughts. Most recently she has experienced Capgras delusion, which has caused her to believe family members were being replaced by imposters or even animals.

[21] Other delusional thoughts include her belief that individuals replaced her healthy teeth with their rotten teeth. Her impaired judgment as a result of this delusion led to her decision to have all her teeth extracted, some of which were healthy. K.M. argues that this choice does not show that she is gravely disabled but rather that she simply made a medical decision with which others may not agree. However, it is not the choice itself but the process by which she decided that establishes that she is gravely disabled. In sum, Dr. Withers testified that K.M. engages in risky behavior due to her delusional thoughts and the “serious deterioration in her judgment that puts her at risk for harm.” Id. at 18.

[22] K.M.’s arguments amount to requests that we reweigh the evidence, which we cannot do. The evidence is sufficient to support the trial court's determination that K.M. is gravely disabled.

Conclusion

[23] Based on the foregoing, we conclude the Hospital presented sufficient evidence to support K.M.’s involuntary temporary commitment.

[24] Affirmed.

FOOTNOTES

1.   This expedited appeal is part of the two-year Marion County Expedited Mental Health Appeals Pilot Project established by the Indiana Supreme Court to examine the dilemma that the standard appellate timeline typically exceeds the duration of a temporary mental health commitment. In re Marion Cnty. Expedited Mental Health Appeals Pilot Project, No. 24S-MS-190, slip op. at 1 (Ind. July 16, 2024).

Robb, Senior Judge.

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