IN RE: the Civil Commitment of: T.Q. (2025)

MEMORANDUM DECISION

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

Facts and Procedural History

[2] In November 2025, T.Q. was a twenty-eight-year-old woman diagnosed with schizophrenia and alcohol use disorder. On October 16, 2025, she was admitted to Community, and on October 20, 2025, Community filed an Application for Emergency Detention, which stated that T.Q. required involuntary detention to receive care and treatment because she had “[p]sychotic thinking [and thought] something [wa]s causing ‘poop to go to [the] wrong place’ so she [wa]s drinking isopropyl alcohol.” Appellant's App. Vol. II p. 11. The emergency detention was granted the same day. Following T.Q.’s emergency detention, Community physician Dr. Jason Ehret (“Dr. Ehret”) filed a Petition for Commitment Hearing and Physician's Statement (“the Petition”) on October 27, 2025, attesting that, in his professional opinion, T.Q. was suffering from a mental illness, was dangerous to herself, was gravely disabled, and was in need of care, custody, or treatment in an appropriate facility for a period of time not to exceed ninety days.

[3] The trial court conducted a hearing on the Petition on November 3, 2025. At the hearing, testimony was heard from T.Q., her mother, S.D., and Dr. Ehret. Dr. Ehret testified that he had been seeing T.Q. since her admission on October 16 and had examined her eleven times since that date, including the morning of the hearing. He stated that T.Q. has schizophrenia and exhibited symptoms consistent with that illness while in the hospital. Dr. Ehret explained that T.Q. has “significant” psychosis. Tr. Vol. 1 p. 21. He stated he had observed her talking to herself and making unusual, “disjointed” statements. Id. at 22. When Dr. Ehret asked T.Q. a direct question, she would respond with an answer that made no sense and had no connection to the question asked. Dr. Ehret also testified that T.Q. had a persistent belief that something in her stomach needed to be “cleaned out,” which led her to drink isopropyl alcohol. Id. at 22. Specifically, when asked about drinking isopropyl alcohol, T.Q. told Dr. Ehret that “something was wrong with her butt hole and she had to fix it,” and she believed that isopropyl alcohol “will dissolve poop.” Id.

[4] Even when T.Q. was under hospital supervision during her recent admission, there was still concern about her ingesting things she should not as staff had found empty shampoo and mouthwash bottles in T.Q.’s hospital room. Dr. Ehret also testified that T.Q. had been observed squirting hand sanitizer into towels and wrapping those towels around her head and mouth. He stated that T.Q. does not have any insight into her mental illness, which makes her unable to appreciate the need for her care and to stick to her treatment. She does not take her antipsychotic medications regularly and has a history of failing to follow up on medical issues. Dr. Ehret explained T.Q. has never been on antipsychotics long enough for physicians to establish a baseline. He stated he had conversations with her where she agreed to treatment but generally did not think that treatment is needed or that she needs to follow up with the treatment plans.

[5] Dr. Ehret further testified T.Q.’s mental illness prevented her from caring for her basic needs. Specifically, he stated that her sleep pattern was disorganized, and she would often be awake into the early morning hours and then sleep much of the day. When Dr. Ehret first spoke with T.Q. on October 16, she struggled to stay awake, was lethargic, and could not meaningfully participate in her intake interview, which Dr. Ehret attributed to a combination of T.Q.’s lack of sleep prior to admission and substance-use issues. He also described episodes where T.Q. reported showering while fully clothed or wearing her hospital gown.

[6] Dr. Ehret testified that, in his opinion, T.Q. lacked the judgment and reasoning to function independently and that she was unable to perform her “activities of daily living” alone and required assistance from staff throughout her admission. Id. at 27. He further cited T.Q.’s continued psychosis, unusual statements, and ingestion of non-food substances as evidence of her impaired judgment. Dr. Ehret stated that T.Q. would require continuous monitoring, especially with things like household appliances, certain household supplies, or walking through a grocery store.

[7] Dr. Ehret described how T.Q.’s mental illness significantly undermined her ability to recognize when she needed medical care, both for psychiatric treatment and for serious physical conditions. Specifically, T.Q. had failed to follow up on her diagnosed Graves’ disease, despite needing medication, and also ignored following up on a 2023 imaging report that suggested potential cancer. During her current admission, Community repeated the imaging, and the MRI revealed demyelinating lesions, which is evidence of a loss of the insulation matter in her brain. This discovery prompted a neurology consult and lumbar puncture, which she repeatedly refused and did not appreciate their necessity. She ultimately completed both but only when her mother intervened. Dr. Ehret explained that the demyelination can result from toxic exposures, including huffing or ingestion of antifreeze, isopropyl alcohol, or methanol alcohol. He further testified that when he had discussed with T.Q. how her MRI findings were related to her substance use and how important it was to follow up with treatment, she either simply stared off or laughed, and he was unsure if she understood.

[8] As to T.Q.’s compliance with treatment, Dr. Ehret testified that she does not regularly take her medications and does not understand the need for ongoing treatment and taking her medications. Dr. Ehret opined that T.Q. cannot reliably manage medications outside of a structured setting. Although T.Q. would accept oral pills from nursing staff, Dr. Ehret explained he could not always confirm she swallowed them, which led him to switch to a long-acting injectable, like Abilify. While T.Q. took this injection willingly and generally agreed to take medication, she would simultaneously insist she did not need it. However, Dr. Ehret noted that after taking Abilify, T.Q. showed significant improvement and had progressed from being unable to engage in conversation to being able to communicate reasonably and spend more time outside her room. He attributed these improvements to “medication consistency” but explained that even with treatment T.Q. would likely continue experiencing psychotic symptoms and would need continued compliance to maintain stability. Id. at 30.

[9] Dr. Ehret testified that T.Q.’s history demonstrated a clear pattern of stabilizing during inpatient stays and decompensating once she left Community's structured setting. Finally, Dr. Ehret testified Community's proposed treatment plan was to continue medications for T.Q.’s mental illness using Abilify, to which she was responding well. He stated he believed that a temporary commitment was the least restrictive means available for T.Q.’s treatment to ensure her stability. Although he acknowledged T.Q. was improving and would be discharged that day, he explained Community sought a temporary commitment to ensure T.Q. would continue with care after discharge. Dr. Ehret testified that it would not be appropriate to discharge T.Q. that day without a commitment order in place because without one, T.Q. would be “likely to have a severe adverse event in the near future.” Id. at 29.

[10] T.Q.’s mother, S.D., also testified at the hearing, and she began by describing T.Q.’s behavior prior to admission, stating that T.Q. was pacing around the house, writing in a notebook, and tried to climb through a window to go back to where she came from, which was the future. S.D. stated that T.Q. believed she could read other people's minds, and when she was not on her medications, she would drink mouthwash, rubbing alcohol, or other alcohol products, and her behavior would range from combative to arguing with herself, staying up all night pacing, drinking alcohol, and other erratic behaviors. S.D. would find empty bottles of alcohol hidden in T.Q.’s belongings, and when confronted with this, T.Q. would claim she drank mouthwash because she had a tooth pulled, but she had finished the whole bottle in a single day. T.Q. told S.D. she drank rubbing alcohol to clean things out of her stomach. S.D. also testified T.Q. lives with S.D. and her husband, has no source of income, and S.D. and her husband provide for T.Q. T.Q. was last employed in 2019, and she does not receive Social Security benefits. S.D. testified that T.Q. sometimes purchases food using public assistance, but she cannot cook for herself. S.D. also testified that T.Q. has poor hygiene and often lies around the house and sleeps all day due to being awake all night. When T.Q. does shower, she sometimes does so fully clothed and wearing shoes.

[11] As to T.Q.’s compliance with taking medications, S.D. stated that, when T.Q. is at home, S.D. must personally administer medication to her because if T.Q. is given medication to take on her own, she will not take it. S.D. stated that T.Q. would discard pills, and she would find loose pills around the house after thinking T.Q. took them. Therefore, S.D. stated she favors injectable medication over pills because T.Q. cannot be trusted to take medication on her own. She further stated that T.Q. does not believe she needs medication and insists nothing is wrong with her. S.D. testified that T.Q.’s symptoms improve significantly when she is on her medication. She further explained that T.Q. could continue to live with her as long as she continues to take her prescribed medication.

[12] T.Q. also testified at the hearing, and her testimony was consistent with that of both Dr. Ehret and S.D., though it was confusing at times. When questioned about her medication, T.Q. stated she wished to switch back to pills, but then stated that she had been placed on injectable medication because she did not like taking medication every day. Although T.Q. admitted she did not like taking daily pills, she denied ever hiding or discarding pills. T.Q. admitted to showering with her clothes on but stated she did so in the summertime so she could clean them off and dry in the sun. She then admitted that she had showered the day before the hearing in her hospital gown while at Community.

[13] When questioned about attending follow-up appointments concerning her physical health issues, T.Q. first acted confused before agreeing she would see a neurologist. T.Q. stated that the last time she drank isopropyl alcohol was two weeks before the hearing and said she drank it to clean her system out. When asked about Dr. Ehret's testimony about her wrapping towels with hand sanitizer around her mouth, she asserted Community was an alcohol-free environment. She also interjected statements during portions of Dr. Ehret's and S.D.’s testimonies, attempting to clarify or contradict their statements. Specifically, she attempted to dispute the significance of empty shampoo bottles being found in her hospital room by stating the shampoo was alcohol-free, and when her mother testified that she showered with shoes on, T.Q. interrupted to clarify she was only wearing flip-flops. T.Q. further testified that she did not understand why she needed to take medication and denied having any mental illness. She became frustrated during the questioning about taking her medications and asserted she needed power of attorney over herself so she could “talk and explain what [she was] doing because nobody can read [her] mind[.]” Id. at 49.

[14] Following argument by counsel, the trial court granted Community's request for a temporary commitment, finding Community had proven “by clear and convincing evidence” that T.Q. was suffering from schizophrenia, which was a mental illness; that she was gravely disabled; and was “in need of custody, care, and treatment in an outpatient setting ․ for a period of time not expected to exceed ninety (90) days” (“the Order”). Appellant's App. Vol. II pp. 7–8. In the Order, the trial court specifically found that T.Q. “is gravely disabled in her judgment and reasoning by delusions of schizophrenia” and that she “wrongly believes she does not have a mental illness and likely will only take medications with a court order and her mother's supervision.” Id. at 8. The trial court also found that T.Q. “told her doctor today it's fine to shower while fully clothed in summertime when she can air dry in the sun.” Id. Further, the trial court found that she “talks to herself and believes drinking isopropyl alcohol—which can be deadly and contributes to her neurological symptoms—will clear her digestive system.” Id. T.Q. now appeals.

Discussion and Decision

[15] T.Q. challenges the sufficiency of the evidence supporting the trial court's finding that she was 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).

[16] 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, T.Q. does not dispute that she suffers from mental illness. Rather, she argues the evidence was insufficient to establish that she was gravely disabled.

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

We note that this statute is also written in the disjunctive, and therefore, for the trial court to find a person to be gravely disabled, it must only find either (1) or (2) above. See W.S. v. Eskenazi Health, Midtown Cmty. Mental Health, 23 N.E.3d 29, 34 (Ind. Ct. App. 2014), trans denied. T.Q. argues that the evidence presented was insufficient to support that she was gravely disabled and specifically contends that Community did not “prove a substantial impairment or obvious deterioration of T.Q.’s judgment, reasoning, or behavior that resulted in her inability to function independently.” Appellant's Br. p. 7.

[18] The evidence at the hearing revealed that T.Q. had been diagnosed with schizophrenia and had significant psychoses. T.Q. had no insight into her mental illness, did not appreciate the need for her care and sticking to her treatment, and denied that she even had a mental illness. T.Q. talked to herself, made unusual, “disjointed” statements, and when Dr. Ehret asked her direct questions, she would respond with an answer that made no sense and had no connection to the question asked. Tr. Vol. 1 p. 22. Prior to being given an injectable medication while hospitalized, T.Q. did not take her pill medications consistently, if she took them at all. T.Q. required supervision to ensure that she took her medications, and Dr. Ehret believed that T.Q. was not able to function independently. T.Q. lived with her mother with no income except for public assistance for food and was unemployed. T.Q.’s mother testified that T.Q. was not able to cook her own meals and that she did not believe that T.Q. could be trusted to independently take her medications. Evidence was presented that T.Q. had poor hygiene and would often not shower, but when she did, she would sometimes shower fully clothed. She explained that she did this in the summertime so that she could air dry in the sun, but there was testimony that she had done this while hospitalized, which was in October.

[19] There was also evidence that T.Q. had erratic sleeping patterns and would stay up into the early morning hours and then sleep all day. When she was admitted into the hospital, Dr. Ehret stated that she was lethargic, falling asleep, and not able to engage in the interview. The behaviors that precipitated her admission into the hospital included pacing around the house, writing in a notebook, and trying to climb through a window to go back to the future, which was where she stated she came from. The most concerning evidence was that T.Q. had a persistent belief that something in her stomach needed to be “cleaned out,” which led her to drink isopropyl alcohol. Id. at 22. She told Dr. Ehret that “something was wrong with her butt hole and she had to fix it,” and she believed that isopropyl alcohol “will dissolve poop.” Id. T.Q. testified that she last consumed isopropyl alcohol about two weeks before the hearing. Although there was no direct evidence that she had consumed any alcohol since being hospitalized, empty bottles of shampoo and mouthwash were found in her room, and she was observed squirting hand sanitizer into towels and wrapping those towels around her head and mouth. There was evidence that this consumption of isopropyl alcohol and other non-food substances may have contributed to serious physical medical issues as a recent MRI had revealed demyelinating lesions, which can be caused by exposure to toxins. As a result of these medical findings, T.Q. needed to follow up with a neurologist, and there was evidence presented that she historically does not follow up with medical care as she did in the past with her diagnosed Graves’ disease. Dr. Ehret testified that he had concerns that if a commitment order was not in place, T.Q. would not follow up with the neurologist and would continue to consume isopropyl alcohol and that she “is more likely to have a severe adverse event in the near future.” Id. at 29. Looking to all of the evidence presented, we conclude that there was clear and convincing evidence to prove that T.Q. had a substantial impairment or an obvious deterioration of her judgment, reasoning, or behavior that resulted in her inability to function independently.

[20] T.Q. argues that denial of illness and refusal to medicate, standing alone, are not sufficient to establish grave disability. She also contends that mere symptoms of an individual's mental illness cannot support a finding of grave disability. However, as stated above, that was not the only evidence presented to support the trial court's order. In addition to T.Q.’s denial of having a mental illness, her refusal to consistently take medications, and the symptoms of her mental illness, evidence was presented that T.Q. believed that something in her digestive system needed cleaning out and that drinking isopropyl alcohol would accomplish this cleansing. She testified that she drank the isopropyl alcohol as recently as two weeks before her hospitalization, and her mother testified that she also had consumed mouthwash in the past. While in the hospital, empty shampoo and mouthwash bottles were found in her room. This consumption of non-food substances was dangerous, and there was evidence that T.Q.’s actions had caused serious medical issues, which necessitated her seeing a neurologist. Dr. Ehret testified that without the commitment order, he was concerned about her “life-threatening conditions” and her ability to follow up. Id. Thus, in light of the evidence most favorable to the judgment, we conclude that sufficient evidence supported the trial court's findings that T.Q. was mentally ill and 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).

Foley, Judge.

Tavitas, J. and Robb, Sr. J., concur.