IN RE: the Commitment of A.K. (2025)

MEMORANDUM DECISION

[1] A.K. appeals her involuntary civil commitment and claims it was not supported by sufficient evidence. We affirm.

Facts and Procedural History

[2] A.K. is a thirty-four-year old female diagnosed with “[s]chizophrenia paranoid [t]ype.” Appellant's Appendix Volume II at 14. On August 26, 2025, A.K. was admitted to Community Fairbanks Behavioral Health (“Community”) on an application for Emergency Detention. A.K. had visited Community's emergency department after experiencing a “bleeding episode” in her third trimester of pregnancy, Expedited Transcript at 8, and she was subsequently transferred to the behavioral health unit because she was exhibiting signs of “acute psychosis” and was “paranoid and delusional.” Appellant's Appendix Volume II at 8.

[3] On September 9, 2025, Community filed a petition, along with a physician's statement, seeking a temporary mental health commitment for a period of time not to exceed ninety days. The court held a hearing on September 12, 2025. In support of the temporary commitment, Community presented the expert testimony of psychiatrist Dr. Jason Ehret. A.K. also testified.

[4] Dr. Ehret testified that he had examined A.K. eleven times since her admission on August 26, and he had also seen her during a prior admission in June 2025. During the examinations, Dr. Ehret stated that A.K. was quite “guarded” and will “often stand at the doorway and leave [during] an interview” and then “spontaneously come back and make some statements but then walk away again.” Expedited Transcript at 9. Dr. Ehret was concerned because A.K. was thirty-three weeks pregnant, had been experiencing bleeding potentially due to “[s]ome type of placental disconnection,” and was refusing treatment or examination from an obstetrician for that condition. Id. at 9-10. Dr. Ehret noted that A.K. “sporadically takes medication” and that she has “opioid use disorder for which she takes buprenorphine.” Id. at 10. Dr. Ehret expressed concern that A.K. “tried to taper herself off of that medication prior to coming to the hospital” and had been “intermittent in taking that medication” in the hospital despite it being explained to her that there is a “risk of spontaneous abortion with withdrawal and discontinuing that medication.” Id. Dr. Ehret explained that A.K. had been diagnosed with schizophrenia since 2023, had been recommended to take an antipsychotic medication, and oftentimes says “she doesn't have a mental illness and is not going to take it.” Id. He acknowledged that she had “actually” been taking Zyprexa for “three nights now” while hospitalized. Id.

[5] When asked how her schizophrenia symptoms affect her functioning, Dr. Ehret explained that A.K. is “extremely paranoid” which causes her to refuse “almost all interventions or recommendations.” Id. at 12. He stated that he overheard A.K. “on the phone talking about Doug with the CIA is trying to wipe her out.” Id. at 9. A.K. has also told Dr. Ehret that “her mother-in-law is trying to kidnap her children” and that she has talked “to aliens.” Id. Dr. Ehret explained that A.K.’s paranoid “delusions” are preventing her from being discharged from the hospital because she is convinced that she is “not safe and that she can't leave the hospital.” Id. at 12. Dr. Ehret recalled that A.K. had recently barricaded herself in the bathroom “screaming and yelling” because she was “scared she was going to be murdered.” Id. at 14. This required A.K. to be placed in restraints and forcibly injected with medications.

[6] Dr. Ehret stated that A.K. was in dire need of blood draws to monitor her active bleeding but she continued to refuse any “actual intervention.” Id. at 12. He stated that he was concerned about the “stress” A.K.’s delusions caused her pregnancy, but he was also concerned what she might do to her unborn baby because she “has had past concerns that microchips are implanted in her other children's brains.” Id. at 14. He agreed that A.K. has “been in psychosis during this hospitalization the entire time.” Id. at 25. Dr. Ehret opined that A.K. does not currently have the judgment or reasoning to function independently and she “presents a risk to the unborn child.” Id. at 13. He explained that one of the goals with an involuntary commitment would be to allow Community to talk to A.K.’s family, which A.K. was currently refusing, in order to “coordinate some kind of safe supervised [care] setting” with A.K.’s mother. Id. at 14.

[7] A.K. testified that she had never received a diagnosis of schizophrenia but rather had only been diagnosed with “a drug induced type of schizophrenia.” Id. at 30. A.K. denied that any of her behavior was harmful to her unborn child. When asked, “So if you were discharged today, where would you go live,” she responded, “I guess wherever I'm told to live. But I'm not a risk to the community. I want to run around and hug people and love people. I don't want to run around hurting people or yelling stuff that I don't know about. I'm not trying to be weird, but it's like I just want to spread positivity, not this negative stuff.” Id. at 33. When asked why she refused to sign a release so Community could speak to or discharge her to her mother, A.K. stated that she did not think a release was necessary because she was only in the hospital “for something physical, never nothing mental.” Id. at 34. A.K. denied making any delusional statements to Dr. Ehret. She claimed that any delusions were “three and a half years ago” when she “had that drug induced psychosis.” Id. at 37. A.K. admitted that she had only showered “once or twice” while in the hospital but stated that she took “care of [her] hygiene at home.” Id. A.K stated that she believed Dr. Ehret was “misguided” in his belief that she had refused prenatal care while in the hospital. Id. at 38. She surmised that “he can't watch everything” so perhaps he was unaware. Id. When asked if she believed Dr. Ehret was “lying” or “making [things] up” when referencing her delusional statements, A.K. responded, “I don't know what he is doing. I just know I'm not saying this stuff.” Id. at 39. When asked if Dr. Ehret was “lying” when he stated that she had been talking about the CIA and microchips during this hospital admission, A.K. responded, “Yes.” Id. at 40. A.K. stated that she did not agree that she needed antipsychotic medication.

[8] At the conclusion of the hearing, the court explained on the record:

The court considers the evidence collectively when making a determination of grave disability including but not limited to paranoia, delusional behavior, disorganized thoughts, agitated that the CIA is bullying her in the hospital, putting invisible chips into her[,] denial of illness, refusal for evaluation and treatment of her pregnancy even though she's been bleeding. The court finds that Dr. Ehret was more credible than [A.K.] regarding her delusions and refusal of prenatal care.

Id. at 46.

[9] Accordingly, the trial court entered its order granting the petition for involuntary commitment finding that: A.K. suffers from schizophrenia which is a mental illness as defined in Ind. Code § 12-7-2-130; A.K. is gravely disabled as defined by Ind. Code § 12-7-2-96; A.K. is in need of custody, care and treatment at Community for a period of time not expected to exceed ninety days; such placement is the least restrictive environment suitable for treatment and stabilization as well as protecting A.K.; and that the benefits of the treatment plan outweigh any risks of harm. The court ordered A.K. involuntarily committed to Community until December 11, 2025, unless discharged prior.

Discussion

[10] In Indiana, an individual who is alleged to be mentally ill and either dangerous or gravely disabled may be committed to a facility for not more than ninety days under Ind. Code Chapter 12-26-6. The petitioner 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). The clear and convincing evidence standard 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). We consider only the evidence favorable to the judgment and all reasonable inferences drawn therefrom and do not reweigh the evidence or judge the credibility of witnesses. Id.

[11] “Gravely disabled” means “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. “Because the definition of grave disability is written in the disjunctive, the evidence needs to support only one of those two prongs 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).

[12] A.K. does not challenge the trial court's finding that she is mentally ill. Rather, she argues the trial court's finding that she is gravely disabled is not supported by clear and convincing evidence. Specifically, the court found that A.K. is gravely disabled pursuant to the second prong of the definition. A.K. maintains that although she “may have exhibited signs of delusion and paranoia at the beginning of her admission, she was not exhibiting those signs at the time of the commitment hearing.” Appellant's Brief at 10.

[13] Our review of the record reveals that the court heard considerable evidence to support its finding that A.K. is gravely disabled as a result of her mental illness. Dr. Ehret provided detailed testimony regarding the substantial impairment in A.K.’s judgement, reasoning, and behavior which causes her to be unable to function independently. Dr. Ehret stated that A.K. had been in active psychosis during her entire hospital admission, was refusing much-needed prenatal treatment, and was recently so delusional and agitated that she had to be restrained and forcibly medicated. He opined that A.K. does not currently have the judgment or reasoning to function independently and she “presents a risk to the unborn child.” Expedited Transcript at 13. The court further heard A.K.’s testimony, during which she displayed a lack of insight and/or acceptance into the seriousness of both her mental and physical condition and the benefits of treatment, as well as a complete denial of her recent delusions and troubling behavior which placed herself and her unborn baby at risk. Based upon this evidence, the trial court found that A.K.’s impairment in judgment has caused A.K.’s “refusal for evaluation and treatment of her pregnancy even though she's been bleeding.” Expedited Transcript at 46.

[14] Although A.K. claims that she was not delusional at the time of the hearing and “was not refusing treatment and care, in general, for her pregnancy and mental health,” Appellant's Brief at 10, this amounts to a request for us to reweigh the evidence and reassess witness credibility, which we may not do. Indeed, when asked about A.K.’s state of mind at the time of the hearing, Dr. Ehret agreed that A.K. has “been in psychosis during this hospitalization the entire time.” Expedited Transcript at 25. The court specifically found that “Dr. Ehret was more credible than [A.K.] regarding her delusions and refusal of prenatal care.” Id. at 46.

[15] Based upon our thorough review of the record, we conclude that clear and convincing evidence supports the trial court's conclusion that A.K. is in danger of coming to harm because she has a substantial impairment or an obvious deterioration of judgment, reasoning, or behavior that results in her inability to function independently and therefore that she is gravely disabled. See A.O. v. Cmty. Health Network, Inc., 206 N.E.3d 1191, 1194 (Ind. Ct. App. 2023) (finding sufficient evidence of grave disability based on lack of insight into patient's condition and that her delusional thoughts had compromised her treatment, judgment, and ability to function independently).

[16] Regarding A.K.’s claim that outpatient treatment, rather than involuntary commitment “was better suited for [her] needs and condition,” Appellant's Brief at 10, we observe that “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). Dr. Ehret testified extensively regarding his attempts at seeking less restrictive alternatives for A.K.’s treatment but found such alternatives impossible to implement because A.K. was afraid to leave the hospital and she further refused to sign a release so that outpatient care and a safety plan could be coordinated with her family. Accordingly, Dr. Ehret unequivocally opined that “anything less than a temporary commitment” would not be appropriate for A.K. as of the date of the hearing. Expedited Transcript at 13. Sufficient evidence supports the trial court's conclusion that temporary commitment at Community is appropriate.

[17] For the foregoing reasons, we affirm the trial court's Order of Temporary Commitment.

[18] Affirmed.

Brown, Judge.

Judges Tavitas and Foley concur. Tavitas, J., and Foley, J., concur.