IN RE: the Civil Commitment of S.W. (2026)

MEMORANDUM DECISION

Case Summary

[1] S.W. brings this expedited appeal challenging her involuntary temporary commitment to Sandra Eskenazi Mental Health Center (“Eskenazi”). S.W. claims the evidence is insufficient to show that she is gravely disabled or that her commitment is appropriate. Concluding that clear and convincing evidence supports S.W.’s involuntary temporary commitment, we affirm.¹

Issue

[2] S.W. presents one issue, which we restate as whether the evidence is sufficient to support her involuntary temporary commitment.

Facts

[3] S.W. is forty-one years old and has been diagnosed with schizophrenia and post-traumatic stress disorder (“PTSD”). S.W. had temporary commitments in 2013 and 2021. S.W. has resided with her uncle (“Uncle”) for approximately three years. S.W. has four children, and one child resides with her “at times.” Tr. Vol. I p. 7. S.W. has paid Uncle rent, but she does not have a source of income except child support for one of her children.

[4] On June 13, 2026, S.W. told Uncle that she heard gunshots, “ran in the house, [and] ducked and covered.” Id. at 10. Uncle, however, did not hear gunshots and calmed S.W. down. Later that day, Uncle observed S.W. dressed in multiple layers and clutching her purse, a bag of her prescriptions, paperwork, and a packed lunch. S.W. was “ready to head to the streets.” Id. at 11. Uncle again calmed S.W. down, and she put her belongings back.

[5] The next day, S.W. called 911, and she was voluntarily taken to Eskenazi. S.W. told Dr. Jayme Ahmed that “she wanted to be in recovery” and acknowledged that she had paranoid schizophrenia and PTSD. Id. at 29. S.W. said that “she [could not] go out of the house without becoming upset, and she said she was afraid to sleep at night because she was afraid that people would do things to her in her sleep.” Id. Dr. Ahmed noted that S.W. was due to take her long-acting injection, but S.W. did not want to take the injection because she believed that she was pregnant. It was medically impossible, however, for S.W. to be pregnant due to an earlier hysterectomy, but S.W. still refused the injection.

[6] By June 22, 2026, S.W. was “more guarded” and wanted to leave the hospital. Id. Dr. Ahmed did not feel that S.W.’s symptoms were “entirely controlled” but concluded that S.W. was safe to leave the hospital and “there was nothing to hold her against her will.” Id. S.W. was released from Eskenazi and returned to Uncle's home.

[7] Upon her return, Uncle assisted S.W. with getting her prescriptions filled and organizing her medications. S.W., however, was unable to take the correct medications at the correct times on her own. Over the next few days, S.W. was “pretty uncommunicative,” quit going outside, dressed in multiple layers again, and carried her purse and paperwork around the house. Id. at 15. S.W. started misplacing items, taking items out of cabinets, and “leaving bowls of food in closets.” Id. S.W. would “stare out into space, answer a single question with yes, or not even acknowledge that [Uncle] was asking her questions.” Id. S.W. was suspicious of the police and healthcare workers, and S.W. did not eat on June 26 or June 27.

[8] On June 27, 2026, S.W. called 911 again. When the officers arrived, however, S.W. became agitated. A female firefighter was able to calm S.W. down, and the first responders left. They returned, however, the following day, and S.W. went to Eskenazi voluntarily. At that time, S.W. refused to speak with Dr. Ahmed. S.W. would stand in her room and would not make eye contact.

[9] Since that time, S.W. has been willing to speak with Dr. Ahmed on some days, but S.W. has exhibited paranoia and suspiciousness of others. S.W. was suspicious that hospital staff was “trying to give her the incorrect medication.” Id. at 32. S.W. said that she wanted to take a shower but could not do so, and S.W. could not explain to Dr. Ahmed the reason she could not take a shower. S.W. also said that she has been the victim of sexual abuse in the past and was concerned that “she's being touched inappropriately in her sleep” at the hospital. Id. at 33. S.W. thought that Dr. Ahmed was watching her through the cameras in her room.

[10] Although S.W. has some insight into her condition, the ongoing paranoia makes it difficult for S.W. to discern between “being appropriately cautious” and being “convinced that somebody's motive is to harm [her].” Id. at 36. Although S.W. requested certain medications, she then refused to take the medications because she did not trust the hospital staff. Dr. Ahmed observed that, “even though [S.W.] recognizes that she has these diagnoses and these medications are helpful to her, she then has ongoing symptoms of paranoia that are preventing her from even taking the medication so she can benefit from it.” Id. at 37. Beginning on July 4, S.W. required almost daily PRN ² injections of medications due to her agitation and imminent risk of harm to either herself or others.

[11] On July 7, 2026, Eskenazi filed a petition for the temporary commitment of S.W. The petition alleged that S.W. was suffering from psychosis and was gravely disabled due to her inability to provide food, clothing, shelter, or other essential human needs. The attached Physician's Statement by Dr. Ahmed alleged that S.W. suffered from schizophrenia. Dr. Ahmed noted that S.W. was “paranoid to the point of not trusting family or healthcare, is not consistently taking medications[, and] [h]as been hospitalized here twice in the last two weeks.” Appellant's App. Vol. II p. 11. Dr. Ahmed further noted that S.W.’s “paranoia and thought processing difficult[ies] are preventing her from being able to make logical decisions” and that S.W. “has barely engaged in interviews while here.” Id. at 12. S.W. had been inconsistent in complying with medications and refused to engage in discussions about medications but then requested discharge.

[12] A hearing was held on July 10, 2026. Uncle testified that S.W. would be incapable of “living out in the world on her own without [his] help right now in her condition.” Tr. Vol. I p. 20. Uncle testified that, “[a]t certain times,” he helps S.W. with her daily activities and daily needs. Id. Sometimes S.W. is “completely independent,” but she has struggled with “compliance with the meds.” Id.

[13] Dr. Ahmed testified that S.W. was currently on a long-acting injectable and an anti-psychotic, Abilify, and she was concerned that, without a temporary commitment, S.W. would not take the injectable consistently. Dr. Ahmed was slowly increasing the dosage of the Abilify. S.W. told Dr. Ahmed that the Abilify was beneficial, but Dr. Ahmed had “not seen objective evidence that it's helping.” Id. at 38. Dr. Ahmed was concerned because “the way [S.W. is] presenting now is not sustainable considering the need for emergent medications every day.” Id.

[14] Dr. Ahmed did not believe that S.W. was able to provide for her basic needs because her paranoia “limit[ed] her ability to navigate the community.” Id. at 39. Dr. Ahmed was unsure whether Uncle was going to be able to assist S.W. S.W. was unable to have a proper conversation with Dr. Ahmed due to the ongoing paranoia, and her judgment continued to be impaired. Dr. Ahmed opined that S.W. was unable to function independently in her current state. Temporary commitment at Eskenazi was recommended. Dr. Ahmed testified that she was hoping to “find the right combination of medications for her so that we can adequately treat the paranoia as well as ongoing PTSD symptoms that she could also be experiencing and that she's also reporting.” Id. at 40.

[15] On July 10, 2026, the trial court entered an order granting Eskenazi's petition for temporary commitment of S.W. The trial court found that S.W. suffered from schizophrenia; S.W. is “gravely disabled”; S.W. is in need of treatment at Eskenazi for a period not expected to exceed ninety days; and the placement is “the least restrictive environment suitable for treatment and stabilization.” Appellant's App. Vol. II p. 6. The trial court further found:

The Court considers the evidence collectively when making a determination of grave disability, including but not limited to, lacks some insight into her mental illness, required PRN medication almost every day during admission, agitated, unable to shower, placed food in closets, patient called police to home multiple times in one month, paranoid, refusal to medicate, refused medication on one occasion because she asserted she was pregnant which is medically impossible due to her previously having a hysterectomy, unable to manage her medication by self or with assistance from family, history of noncompliance with taking medication as prescribed.

Id. at 7. S.W. now appeals.

Discussion and Decision

[16] S.W. appeals her temporary commitment. In Indiana, an adult person may be civilly committed either voluntarily or involuntarily. Commitment of T.K. v. Dep't of Veterans Affs., 27 N.E.3d 271, 273 (Ind. 2015). Here, Eskenazi sought an involuntary temporary commitment of S.W. for a period not to exceed ninety days. See Ind. Code Chapter 12-26-6.

[17] Our Supreme Court has held that “[t]he purpose of civil commitment proceedings is dual: to protect the public and to ensure the rights of the person whose liberty is at stake.” Commitment of T.K., 27 N.E.3d at 273. “The liberty interest at stake in a civil commitment proceeding goes beyond a loss of one's physical freedom, and, given the serious stigma and adverse social consequences that accompany such physical confinement, a proceeding for an involuntary civil commitment is subject to due process requirements.” Id. (citing Addington v. Texas, 441 U.S. 418, 425-26 (1979)). “To satisfy the requirements of due process, the facts justifying an involuntary commitment must be shown ‘by clear and convincing evidence ․ [which] not only communicates the relative importance our legal system attaches to a decision ordering an involuntary commitment, but ․ also has the function of reducing the chance of inappropriate commitments.’ ” Id. (quoting Commitment of J.B. v. Midtown Mental Health Ctr., 581 N.E.2d 448, 450 (Ind. Ct. App. 1991), trans. denied).

[18] We will affirm a civil commitment “if, considering only the probative evidence and the reasonable inferences supporting it, without weighing evidence or assessing witness credibility, a reasonable trier of fact could find [the necessary elements] proven by clear and convincing evidence.” J.W. v. Cmty. Fairbanks Behav. Health, 260 N.E.3d 946, 951 (Ind. 2025) (internal quotations omitted). Clear and convincing evidence requires proof that “the existence of a fact [is] highly probable.” Id.

[19] A petitioner for a temporary commitment must prove by clear and convincing evidence that:

(1) an individual is mentally ill and either dangerous or gravely disabled; and

(2) detention or commitment of that individual is appropriate.

Ind. Code § 12-26-2-5(e); see also Ind. Code §§ 12-26-6-1; 12-26-6-8(a). Here, S.W. concedes that she is mentally ill; S.W. challenges the trial court's determination that she is gravely disabled and the appropriateness of the commitment.

A. Gravely Disabled

[20] “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;

(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; or

(3) lacks a fixed, regular, and adequate shelter, resulting in the individual remaining outdoors in places not designed for or ordinarily used for sleeping during weather conditions that are likely to result in death or serious physical injury, if:

(A) the individual has refused transportation to a shelter or mental health service provider; and

(B) a shelter or mental health service provider was reasonably offered and available.

Ind. Code § 12-7-2.1-170.³

[21] S.W. argues that she is able to provide for her essential needs because she pays Uncle rent, cooks, cleans, and cares for her child. S.W. also argues that she is able to function independently. According to S.W., Uncle's testimony that she placed bowls in the closet and failed to eat was speculative. S.W. contends that paranoia and failure to take her medication do not warrant a finding of grave disability.⁴

[22] Eskenazi, however, presented evidence that S.W. was struggling with paranoia in June 2026 and repeatedly agreed to voluntary admissions to address her mental health. Despite her paranoia, S.W. checked herself out of Eskenazi and returned to Uncle's home. Uncle, however, observed that S.W. was unable to properly take her medications despite his significant assistance; dressed in multiple layers and carried her documents around the house with her; was uncommunicative; was placing bowls of food in closets; and failed to eat for two days. On June 28, 2026, S.W. voluntarily returned to Eskenazi.

[23] S.W.’s paranoia has persisted—she is suspicious of being given the wrong medications; she fears that someone is touching her while she is sleeping; she fears taking a shower; she believes that someone is watching the cameras in her room; and she was unable to communicate properly with hospital staff. Dr. Ahmed has prescribed a long-acting injectable in addition to Abilify, an anti-psychotic medication, and she was slowly increasing the dosage of Abilify. Dr. Ahmed was attempting to find the right combination of medication to treat S.W.’s symptoms. Despite the medications, S.W. was routinely requiring emergency PRN injections due to her agitation and imminent risk of harm to herself or others. According to Dr. Ahmed, S.W.’s paranoia prevented her from providing for her basic needs and, thus, she was unable to function independently in her current state.

[24] Eskenazi presented evidence that S.W. is unable to provide for her essential human needs and/or that S.W. has a substantial impairment or an obvious deterioration of judgment, reasoning, or behavior that results in her inability to function independently. S.W.’s arguments are merely a request to reweigh the evidence, which we cannot do. Under these circumstances, sufficient evidence was presented to demonstrate that S.W. is gravely disabled.

B. Appropriateness of Commitment

[25] Next, S.W. claims that her commitment is inappropriate. “ ‘The determination of whether an involuntary commitment is appropriate is fact-sensitive.’ ” J.S. v. Neuropsychiatric Hosp. of Indianapolis, 263 N.E.3d 165, 169 (Ind. Ct. App. 2025) (quoting R.P. v. Optional Behav. MHS, 26 N.E.3d 1032, 1037 (Ind. Ct. App. 2015)).

[26] S.W. argues that her paranoia could be the result of her PTSD rather than her schizophrenia and that cognitive behavioral therapy might be more helpful. Given her PTSD, S.W. suggests that hospitalization might exacerbate her symptoms. S.W. contends that no alternative treatments were evaluated and that commitment is not the least restrictive treatment plan.

[27] Dr. Ahmed testified that she was trying to:

find the right combination of medications for [S.W.] so that we can adequately treat the paranoia as well as ongoing PTSD symptoms that she could also be experiencing and that she's also reporting. Although, as I mentioned, it's hard to tell what if [sic] this is schizophrenia versus PTSD, and I hope that because those symptoms improve that she then, when outpatient, will continue attending appointments and continue to take the medications as prescribed.

Tr. Vol. I p. 40. Dr. Ahmed further testified that a temporary commitment at Eskenazi was appropriate to treat S.W.

[28] When living at Uncle's residence, S.W. was unable to manage her medications, despite Uncle's significant assistance. S.W.’s severe paranoia persisted, resulting in her hospitalization. During the hospitalization, Dr. Ahmed has been attempting to find a combination of medications that treat S.W.’s paranoia. Despite these attempts, S.W. has required regular PRN injections to reduce her agitation. Given this evidence, S.W.’s argument that other treatments should have been ordered is merely a request that we reweigh the evidence, which we cannot do. Regardless of whether S.W.’s paranoia is caused by schizophrenia or PTSD, the evidence supports the conclusion that S.W.’s temporary commitment is appropriate.

Conclusion

[29] Eskenazi presented clear and convincing evidence to prove that, as a result of S.W.’s mental illness, she is gravely disabled and that temporary commitment is appropriate. Accordingly, we affirm the trial court's judgment.

[30] Affirmed.

FOOTNOTES

1.   This expedited appeal is part of the Marion County Expedited Mental Health Appeals Pilot Project established by the Indiana Supreme Court. In re Marion Cnty. Expedited Mental Health Appeals Pilot Project, No. 24S-MS-190, slip op. at 1 (Ind. July 16, 2024).

2.   PRN means “as needed.” https://www.nurse.com/nursing-resources/how-to-guides/prn-in-medical-care/ [https://perma.cc/9MEE-QGA2] (last visited Aug. 17, 2026).

3.   “Gravely disabled” was previously defined by Indiana Code Section 12-7-2-96. This statute, however, was repealed and replaced with Indiana Code Section 12-7-2.1-170 effective July 1, 2026, only nine days before the hearing in this matter. The statute previously provided that “gravely disabled” meant: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 (repealed). The trial court erroneously cited to the former statute in its order. S.W. argues that “remand is necessary to correct the order if this Court does not vacate the order based on insufficient evidence.” Appellant's Br. p. 15 n.5. The new version of the statute merely added subsection (3), which is inapplicable to S.W. Accordingly, we conclude that the error was harmless and remand is unnecessary.

4.   S.W. relies upon Commitment of T.K., 27 N.E.3d at 276-77, in which our Supreme Court found insufficient evidence to support a finding of grave disability. T.K., however, is distinguishable. There, the Court noted that T.K. “rents his own home, lives by himself, holds full-time employment, and owns two vehicles while making payments on a third. No evidence was presented to dispute his ability to provide food, clothing, or shelter for himself.” Id. at 276. Here, however, S.W. lived with Uncle, had no source of income except child support, and was, according to Uncle, incapable of living on her own.

Tavitas, Chief Judge.

Mathias, J., and Robb, Sr.J., concur.