In re S.M., 377 Mont. 133

S.M., with bipolar disorder, was discharged from Montana State Hospital on Sept 12, 2013, stopped taking meds, and displayed manic/psychotic behavior leading to emergency detention on Sept 27.
State filed a petition for involuntary commitment; hearings were held Oct 4 and Oct 8 in Eleventh Judicial District Court.
Mental-health witnesses (Dr. Dennis Gee, Camalla Larson, Blake Passmore) testified S.M. was manic, delusional, noncompliant with medication, and needed hospitalization to stabilize; community options (including Pathways and a rural cabin with her mother) were deemed inadequate.
District Court found by clear and convincing evidence that S.M. had a mental disorder, was substantially unable to provide for her basic needs (health/safety), and would predictably deteriorate; it ordered commitment to Montana State Hospital for up to 30 days as the least restrictive appropriate placement.
S.M. appealed, arguing insufficient factual findings to support inability to care for basic needs, that commitment to the state hospital was not the least restrictive alternative, and that commitment based solely on predictability of deterioration cannot justify state-hospital placement.
Supreme Court majority affirmed the commitment; a dissent argued medication noncompliance alone cannot justify commitment under § 53-21-126(1)(a) and, if only subsection (d) is met, commitment must be to a community program, not the state hospital.

Issue	Plaintiff's Argument (S.M.)	Defendant's Argument (State)	Held
1. Whether S.M.’s condition required involuntary commitment	Evidence insufficient that S.M. was currently substantially unable to care for basic needs; findings lacked required detail; at most predictability of deterioration applies (which cannot alone justify state-hospital commitment)	Medical testimony and conduct (med noncompliance, delusions, wandering, disinhibition) show she could not provide for health/safety and would deteriorate if untreated	Affirmed: sufficient evidence supports findings under § 53-21-126(1)(a) and (d); court’s factual findings adequate
2. Whether Montana State Hospital was the least restrictive placement	Less restrictive alternatives (Pathways or mother’s cabin) were available; written order failed to address Pathways specifically	Testimony showed Pathways and community options were inadequate to provide required treatment/follow-up; state hospital was necessary to permit effective treatment	Affirmed: record and oral findings support that state hospital was the least restrictive alternative in these circumstances

In re Mental Health of L.K-S., 247 P.3d 1100 (Mont. 2011) (standard of review for commitment orders)
In re L.LA., 267 P.3d 1 (Mont. 2011) (requirements for written findings in commitment orders)
In re Mental Health of O.R.B., 191 P.3d 482 (Mont. 2008) (oral findings may supplement written findings)
In re Mental Health of S.C., 15 P.3d 861 (Mont. 2000) (doctrine of implied findings; consulting transcripts)
O’Connor v. Donaldson, 422 U.S. 563 (1975) (state cannot confine a nondangerous person who can survive safely in freedom)
Addington v. Texas, 441 U.S. 418 (1979) (constitutional standards for civil commitment proof)