In re S.L., 377 Mont. 223

Background

S.L., a 42-year-old woman with a history of traumatic brain injury and diagnosed mood and personality disorders, had multiple prior psychiatric hospitalizations and several suicide attempts/overdoses in Maine and Montana during 2013.
On September 27, 2013, after ingesting a large quantity of medication and reporting suicidal intent to her case manager, S.L. was taken to the ER, medically stabilized, and the State filed a petition for involuntary commitment.
At the October 7, 2013 adjudicatory hearing the State presented two mental-health witnesses (a psychiatrist and a counselor) who testified S.L. posed an imminent risk of self-harm and that the Montana State Hospital (MSH) was the least restrictive appropriate placement; S.L. presented one physician and testified on her own behalf.
The district court found S.L. suffered from a mental disorder, concluded she posed an imminent threat of self-harm and that her condition would deteriorate if untreated, ordered commitment to MSH for up to 90 days, and did not hold a separate posttrial disposition hearing.
S.L. was unconditionally discharged 11 days later and appealed, challenging the constitutionality of the statutory “deterioration” standard, the sufficiency of the evidence for commitment (including least-restrictive placement), and whether a separate dispositional hearing was required.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
1. Constitutionality of the § 53-21-126(1)(d) “deterioration” standard	S.L. argued the deterioration standard is unconstitutional	State invoked alternative statutory grounds for commitment and urged avoidance of constitutional ruling	Court declined to decide constitutionality because commitment was supported on independent grounds (avoid constitutional question)
2. Sufficiency of evidence for involuntary commitment (mental disorder; imminent threat; least restrictive placement)	S.L. argued mental disorder not proven to reasonable medical certainty, no imminent threat, and MSH was not least restrictive (alternate outpatient/non-pharmacological options exist)	State relied on testimony of treating psychiatrist and counselor about recent overdoses, prior hospitalizations, rapid decompensation, and lack of local placement options; recommended MSH as least restrictive	Court affirmed: substantial evidence supported finding of mental disorder and imminent risk of self-harm; MSH was least restrictive given unavailable community resources and vague out-of-state plan
3. Whether § 53-21-127(2) requires a separate dispositional hearing upon request	S.L. argued statute required a separate posttrial disposition hearing and that immediate disposition deprived her of due process	State argued statute permits the posttrial disposition hearing to be held immediately and that no separate hearing was necessary given record	Court held statute does not preclude immediate disposition; no due process violation shown because subsequent hearing would have been pointless given established findings

Key Cases Cited

In re R.W.K., 2013 MT 54, 369 Mont. 193, 297 P.3d 318 (standard of review for civil commitment appeals)
In re Mental Health of A.S.B., 2008 MT 82, 342 Mont. 169, 180 P.3d 625 (definition and proof of imminent threat for commitment)
In re C.R., 2012 MT 258, 367 Mont. 1, 289 P.3d 125 (deference to district court credibility findings; strict adherence to commitment statutes)
In the Matter of F.B., 189 Mont. 229, 615 P.2d 867 (imminent threat requires present indication of probable injury likely to occur imminently)
In re G.M., 2008 MT 200, 344 Mont. 87, 186 P.3d 229 (deference to district court on evidentiary weight)