*1 In the Matter of J.W.J: of the Mental Commitment Petitioner-Respondent,
Waukesha County,
v. Respondent-Appellant-Petitioner. J.W.J.,
Supreme Court
argument
No. 2016AP46-FT
January
Oral
2017.
Decided June
¶ 1. KELLY, J.W.J., DANIEL J. The suffering paranoid schizophrenia. an adult from He is currently subject involuntary to an commitment order undergo requiring and an order him to treatment and prescribed take medication for his condition. Wauke- County sha seeks to extend those an orders for addi- year; says involuntary tional Mr. J. further commit- ment and treatment him, will not rehabilitate so he is subject proper meaning not a for treatment within the 51.20(1) (2015-16).1 § of Wis. Stat. We review the unpublished appeals2 affirming decision of the court of County the Waukesha circuit court's extension those orders.3
I. BACKGROUND 55-year-old ¶ 2. is a Mr. J. man who has suffered from mental health or substance abuse issues for most life. He has been to commitment orders subsequent All references the Wisconsin Statutes are to the 2015-16 version unless otherwise indicated. 2In re 2016AP46, Mental Commitment No. (Wis. 2016). unpublished slip op., App. May Ct. 3 The presiding. Honorable William Domina *5 continuously 2008, at which time from 1990 almost prison Upon in term. release he started an 18-month adjudged threatening psychotic he so 2009 was immediately subjected to a he was new set others that place have since commitment orders that been of then. County 16, filed a 2015, June Waukesha On involuntary
petition to commitment extend Mr. J.'s petition, time Mr. J. treatment orders. At the of the appointments, receiving attending medication, his was living community. independently in the The Coun- ty's represents petition of the sixth extension current and treatment orders. Mr. J.'s commitment provide a of 4. Mr. J.'s medical records sense youth longstanding, struggles continual from his through up 2014: history drug and alcohol lengthy J[4]
Mr. has a Marijuana, LSD and barbiturates abuse abuse. age of if not In at the started at the 15 earlier. experienced which age of he an LSD overdose required at the .. . Child and Adolescent treatment diagnosed Drug Induced Schizo- Center. He was with phrenia. from
[I]n-patient periods extend ; through psychiatric ad- approximately 2014 .. . Additionally, Center]. [Mental to the Health missions . Center dur- psychiatric treatment at the .. Resource ing his incarceration. history over the
Mr. J. a of criminal behaviors has DWI, theft, robberies, burning years including car two court, records redact all to the the medical As submitted name, convention we follow J.'s last a but first letter engage in such noting every in which we without instance elision. a selling
down field as as a well 2008 conviction for marijuana [store] out he ran [a ... certain *6 municipality]. prison His sentence was 18 months. During period of quite upset time he became threatening a letter [a] wrote to his mother as well as sexually explicit to letter the female warden. Mr. J was . . committed . has been [and] under commit- consistently ment almost since 1990. the
Over course of mental health treatment Mr. J. has significant a insight shown lack of into his mental lengthy history illness and a not cooperating of with taking psychiatric Many hospital- medications. of his period izations occurred after a of refusing medica- with expected tions the that results Mr. J. became increasingly paranoid, rambling/pressured more speech, sleep problems, experiencing often times auditory command-type hallucinations to kill himself depression along others with agitated and/or behav- Significant usage iors. alcohol has also continued over years. the Mr. J. continues insist to that it is the psychotropic medications which causes all his men- symptoms. tal health hospitalization
The last ... to 3/1/14 3/27/14 occurred by after he was taken the Department get Sheriffs to his IM injection previ- [intramuscular] which he had ously refused get. to J. was noted attending MD be rambling to complained bizarre. Patient throwing glass 'the apartment. beast' around his He police get wanted the him a tank and so bombs he could kill the beast. He was then admitted [Mental Center].5 Health (dated This material from of Examination Report comes a 2015)
July 1, prepared by Dr. Richard J. Koch. Doctor Koch is a psychologist licensed and has seen Mr. J. on five occasions between 1990 and 2004. He Mr. J.'s condition in performed also an assessment of although rely he had to on medical generally records and other available information because Mr. along Report filed with The Recommitment County's petition extend Mr. J.'s commitment Mr. J.'s status 2015:6 described receiving and is his making appointments his Mr. J. is [sic] maintained He has been IM medication. community. [in] the housing and remains current hospitalizations this inpatient [have] been no There of medical experiencing number past year. Mr. J. medica- may to his current which be due problems Schizophrenia, I Alco- diagnoses are Axis . His tion. . . History Cannabis Use Disor- hol Use Disorder allergic to all he is continues to state der. He appoint- last shot He at the medication. psychotropic like he is him feel medication makes ment said the medication *7 every night. Given the being murdered insight into his Mr. J's lack of changes being made and is prescriber] nurse practice [the illness advanced commitment. the current an extension of requesting personally Mr. examine Koch tried to 6. Doctor involuntary commit- with his in in connection J. allow J. would not Mr. could not because ment but by telephone this examiner "Mr. J. contacted it: cooperate in a quickly not that he would stated he questions personal not answer and he would interview prior telephone. the call Mr. J. disconnected over the rights." being him his to read able examiner this Report Mr. J.'s Consequently, on Dr. Koch based he was existing information and other records medical personal examination. without to assemble able Dr. Koch submitted personal examination. J. refused a Report Mr. J.'s County's petition to extend of the support in involuntary commitment. Walker, C. Mr. Robert was submitted report This Community Human County LCSW, of the Waukesha on behalf Department. Services
¶ 7. Dr. Koch's evaluation resulted in this assess- ment: year past
This hospital- Mr. J. has not been He ized. has maintained housing his current community. remains J. compliant has been psychotropic with medications he but has stated that "allergic" psychotropic he all is medications. He continues lack insight to show of into his illness. Report Dr. Koch checked the boxes in the that indicate opinion, degree profes- it was his to a reasonable of certainty, mentally danger- sional that Mr. J. ill,7 is appropriate subject outpatient ous,8 an treat- psychotropic ment, and that medication would be therapeutically valuable to him. Dr. Koch also wrote "substantially that Mr. J.'s mental illness makes him incapable applying understanding an advan- tages, disadvantages and alternatives in order make accept an informed as choice to whether to or refuse psychotropic medication." Koch Dr. concluded that "[t]here [Mr. nothing J.'s] suggest record to there any significant change has been in his status. He patient history improved continues to be a who has a appropriately behaviors when medicated and deterio- ability community ration in the to function in the when appropriately not medicated." "mentally The form defines ill" as "a substantial disorder *8 mood, thought, of perception, memory orientation or which impairs grossly judgment, behavior, capacity recognize re ality, ability or the ordinary to meet the of life." demands 8Dr. Koch checked the box form expresses on the that his belief Mr. dangerous that J. is "[t]here because a is substantial likelihood, record, based on this individual's treatment proper subject individual would a be for commitment if were treatment withdrawn." County's petition hearing
¶ on the the 8. At consis- commitment, Dr. Koch testified Mr. J.'s extend report. particular, tently Mr. J.'s he said In with his when schizophrenia the extent that treatable "to improved . . . his behavior medications treated with explained community." He in the he can survive disordering Mr. J.'s of lessens the that this perception. thought, mood, and why explained Mr. he believes Dr. Koch also "history dangerous. is one Mr. J.'s He testified that J. is psychotropic medications. of utilization of inconsistent appropriately medicated, he becomes he's not When grandiose agitated, paranoid, increasingly at more having hallucinations, demand he started times, and How- himself or others." harm to either hallucinations "[wjhen taking medications, while some he's ever, may present, experiences still be those them." act on he doesn't Mr. J. he does not believe Koch said 10. Doctor do order to a court absent take his medications
would report "[T]he from the extension evidence current so: history my prior behaviors him and his with as as well psychotropic to take not ordered that when indicates it." And without do that he doesn't medications require con- J. would said, Mr. medications, Dr. Koch inpatient care. finement for hearing concluded, the circuit 11. When County's petition. granted It found that court (in form mental illness from a to suffer
J. continues proper schizophrenia), for paranoid he is a in the can function it, from he treatment and benefits large part treatment, community of this because "dangerousness" be- the definition and he satisfies proper cease, he would be if treatment were cause subject J.'sMr. court extended The commitment. *9 involuntary commitment order for 12 months. It also extended the order, medication which requires appointments, J., alia, inter to attend his prescribed, engage any take his medications as not in attempts acts or others, threats to harm himself or any non-prescription and not take controlled sub- beverages. stances or alcoholic appeals, opinion, 12. The court of in a concise f respects. affirmed the circuit court all The court of appeals applied analytical framework we described County E.F., Fond du Lac v. Helen WI 50, 2012 340 Wis. 2d 500, 179, N.W.2d and found that because potential, "proper Mr. J. has rehabilitative he was a subject of treatment." granted petition
¶ 13. We Mr. J's for review and now affirm.
II. STANDARD OF REVIEW
requires
interpret provi
14. This case
us to
f
questions
sions of
Stat.
Wis.
ch. 51. While our review of
independent
of law is
from the circuit court and court
appeals,
analyses.
we benefit from their
State v.
Steffes,
53, WI
347 Wis. 2d
832 N.W.2d
County
15. We must also review whether the
proof
support
has met its burden of
extension of Mr.
presents
question
J.'s commitment. This
a mixed
uphold
findings
law and
We
fact.
a circuit court's
of fact
they
clearly
unless
are
Buhler,
erroneous.
v.
K.N.K.
(Ct.
1987).
App.
Wis.
190, 198,
2d
III. ANALYSIS *10 ¶ 16. Mr. J. wishes to live his life free of Wauke- County's sha commitment and medication orders be- they brought cause he believes have him as much they capable bringing. rehabilitation as are of Wauke- County, says sha however, that Mr. J.'s condition will lapse, making danger deteriorate if the orders him a himself and those around him.
¶ 17. is, There of course, an inherent tension public's involuntarily treating between the interest in liberty an individual and that individual's interest.9 people On the treatment side, the of Wisconsin have recognized challenges develop- that mental illness, present— mental disabilities, and substance abuse public suffering both to the and the individuals from "[i]t policy such disorders. So is the of the state to provision range assure the of a full of treatment and rehabilitation services . . . for all mental disorders and developmental disabilities and illness, for mental alco- 51.001(1). drug holism and other § abuse." Wis. Stat. However, not all who could benefit from partake such services will of them. And of those who not, will there will abe subset whose condition will dangerous—either make them to themselves, or to against danger others. To ward their condition presents, provide involuntary our statutes for commit- mentally ment when: "1. The individual is ill or . . . drug dependent developmentally disabled and is a 9See, (1979) (A e.g., Texas, Addington 418, v. 441 U.S. "civil any commitment for purpose significant constitutes a deprivation liberty requires process protection."); due In L., 67, 43, re Melanie 2013 WI 349 Wis. 2d 833 N.W.2d ("The injection forcible of medication a nonconsenting into person's body represents a substantial interference with that person's liberty." (Quoting Washington Harper, v. 494 U.S. (1990))). 2. The individual and]
proper subject treatment^ 51.20(1). . . . Wis. Stat. dangerous § interests affected liberty 19. Because of the commitment, outpa- favors involuntary public policy per- whenever "To possible: protect tient can treated ad- liberties, person sonal no who be or other outside of a institution hospital, equately treated in such facility may involuntarily be inpatient 51.001(2). Indeed, the court facility." Wis. Stat. § means of delivering must use the least restrictive system effective treatment: "There shall be a unified provision of such conditions prevention will assure all in need of care people services which *11 restrictive treatment alternative access to the least 51.001(1). needs Further to their appropriate ...."§ an the on individual's lib- circumscribing imposition may the initial commitment order not exceed six erty, may months. Wis. Stat. And the order 51.20(13)(g)l. § can the county not issue at all unless the establish evi- convincing elements with clear and required 51.20(13)(e). dence. § extend a term of 20. each Upon petition
commitment, a must establish the same ele- county E.F., Helen ments with the same quantum proof. However, 2d 20. it the may satisfy Wis. by showing "a substantial "dangerousness" prong likelihood, subject based on the individual's treat- record, ment that the individual would be a proper if were subject for commitment with- 51.20(l)(am). drawn." Wis. Stat. An order extend- § commitment not exceed one ing involuntary may year. 51.20(g)l. § challenge
A. Mr. J.'s challenge 21. Mr. J.'s ais narrow one—he does f dispute dangerousness, not his mental illness or his only "proper subject he is a of treatment" within 51.20(1).10 meaning § the of Wis. "Treatment," Stat. specialized meaning. context, carries It com- prises psychological, educational, "those social, chemi- techniques designed bring cal, or medical somatic mentally drug ill, about rehabilitation dependent aof alcoholic, developmentally person." disabled Wis. 51.01(17) added). (emphasis § Stat. And so we arrive at the heart of Mr. J.'s
argument—he does believe not he can be rehabilitated. proper If he cannot be rehabilitated, he cannot be a involuntary of treatment or an commitment meaning focus, therefore, order. Our is on the "rehabilitation." acknowledges,
¶ 23. As Mr. J. this is not the first statutorily-undefined time we have had to address this separated term. In Helen E.F. we treatments into two camps: bring rehabilitation, Those that about recognize do those that not. We said we could ability former their control disorder question: functioning
If treatment will maximize individual *12 subject, help and maintenance of the but not in con- 10 questions only "proper subject Mr. J. whether a he is mentally argue treatment." Because he does not he is not ill or dangerous 51.20(1), meaning within the of Stat. Wis. we § he understand has conceded those issues. See Steel Racine Casings, Hardy, Div. 144 Evans Prods. Co. v. Wis. 2d (1988) n.1, (stating 557 426 N.W.2d that issue 33 where an argued "was neither briefed nor before the court in oral issue"). argument, we do not this address disorder, subject then the
trolling improving their potential, does not have rehabilitative individual However, if subject for treatment. proper is not a beyond controlling activity and will gowill controlling symptoms, and its then go to the disorder potential, and subject individual has rehabilitative the subject proper a for treatment. is (citing State, E.F., C.J. v. Helen 340 Wis. 2d (Ct. 1984) App. 355, 362, 2d 354 N.W.2d quotations, 120 Wis. (internal citations omit- alterations, ted)). understanding 24. Mr. J. asserts that properly account for some of
"rehabilitation" cannot paranoid schizophrenia, unique characteristics of deficiency can lead to an inaccurate conclusion which proper treatment. the individual is a assigns Specifically, frame- he four weaknesses to our work: evaluating patient paranoid a with schizo-
1. When treat- phrenia, it is difficult to decide whether a controlling opposed as ment "behaviors" "symptoms." say which, many, analysis does not or how
2. Our symptoms the treatment must be able to control patient we deem the to have rehabilitative before potential. by the concur- Picking up
3. on a concern discussed E.F., says analysis ring opinion in Helen Mr. J. our sufficiently imprecise physician's that a word (as opposed patient's actual condi- choice tion) deciding concluding a could factor be proper subject for treatment. person is a referring in the Helen Again concern raised concurring opinion, might we E.F. J. worries *13 potential determine rehabilitative on the based disorder, general a characteristics of class of as opposed focusing on the condi- patient subject tion of the individual who is the involuntary petition. commitment perceived 25. Based on these deficiencies, Mr. f modify J. asks tous our Helen E.F. framework for understanding "rehabilitation" as follows:
If will functioning maximize the individual subject, and maintenance of the but help not in con- trolling improving disorder, subject their then the individual does not potential, have rehabilitative subject However, is proper not a for treatment. if go beyond controlling treatment will activity and-will controlling improving go to &e his or her disorder and its symptoms, then the individual has rehabili- potential, tative proper subject is a treat- ment.11 26. We revisit Helen E.F. to determine whether logic supple enough accurately
its evaluate suffering para- whether someone from like condition schizophrenia capable noid of rehabilitation within 51.20(1). meaning doing § of Wis. Stat. In so, we will consider each of Mr. J.'s concerns in turn.
IV. POTENTIAL OF MODIFICATIONS
HELEN E.F. FRAMEWORK "Symptoms" A. "Behaviors" versus argument ¶ 27. Mr. J.'s first that Helen E.F. appropriately distinguish cannot between rehabilita- tive and non-rehabilitative on treatments relies some
11 Strikethroughs represent deletions, proposed J.'s proposed while underlined represents material additions. juxta- *14 prestidigitation. E.F., we In Helen rhetorical posed affecting nothing an indi- more than treatments "symptoms." affect with those that "activities" vidual's only J.Mr. the latter are rehabilitative. We said really responds no different from are that "activities" may just readily as ask and so one "behaviors," any treatments difference between whether there affecting "symptoms." affecting and those "behaviors" explanatory says, then Helen E.F.'s isn't, he If there power is an illusion. (the "activity"
¶ we used turn word 28. To E.F.) preferred "behavior," he term, into his Helen says Psychiatric American Association that the *15 potential heavily someone has rehabilitative we leaned appeals juxtaposed C.J. The in on court that case "habilitation" and "rehabilitation." The former relates to control of activities: daily
[HJabilitation is closely living more related to needs and than skills to treatment of a particular practical disorder. A definition habilitation would eating, include dressing, hygiene, minimum social things personal skills and such other that facilitate functioning. maintenance and Habilitation is a con- cept frequently long-term associated with the care of developmentally possible It disabled. that con- trolling person's restricting activities his or her carefully freedom putting and him or her on a defined regimen part be program. would of a habilitation position We also understand Mr. J.'s to be that if he plateau beyond improvement reaches a which no further possible, may longer subjected involuntary he no be commit This sense ment. makes when withdrawal of treatment would inevitably not result the deterioration of his condition. How ever, IV.E., part as we discuss is not Mr. J.'s circum stance.
C.J., 2d at 359-60. 120 Wis. hand, other ad- Rehabilitation, on the comprises symptoms. "treat- It the control of
dresses beyond going care to affect the disease custodial ment symptoms But rehabilitation is . . . ." Id. at 360. synonymous And it "has a broader with cure. Id. not previous meaning returning to a an individual than "[a]n an Thus, individual with of function." Id. level disability may physical mental illness or incurable capable of rehabilitation able considered still be symptoms can in the sense that from treatment benefit ability manage the illness and the controlled be Id. ameliorated." home extent we need to find a lexical 33. To the comfortably it most resides "behavior," we conclude dichotomy.13 analytical "symptom" side of our
in the immediate "behaviors" as the The C.J. court described psychiatrist symptoms. consequences said of C.J.'s The schizophre- symptom" paranoid primary of C.J.'s "the Id. at 357. He then ob- recurrent delusions." nia "is "impair judgment that these delusions served Impaired the direct conse- Id. behavior was behavior." primary symptom. quence we addressed When of C.J.'s the same condition, carried Helen E.F.'s "behavior" significance. Disease, Alzheimer's She suffered from "progressive demen- which included *16 inability memory informa- the to learn new tia, loss, E.F., Helen communication." tion, and limited verbal resulting ¶ included 500, 2d 3. Her behavior 340 Wis. agitation aggression. ¶ Id., 4. 13 departure "any phenomenon or "symptom" A morbid sensation, structure, function, experi or the normal from Symptom, by patient and indicative of disease." enced 2006). (28th Dictionary ed.
Stedman's Medical
560
(which
By
contrast,
"activities"
the C.J.
things
equated
court
to those
addressed
habilita-
tion)
capabilities
"eating,
relate to functional
as
such
dressing, hygiene, minimum social skills and such
things
personal
other
that facilitate
maintenance and
functioning." C.J., 120
2d at 360. In Helen E.F.
Wis.
we
found that Helen's treatment could not reach her
primary symptoms.14 Instead,
it could "maximize
[only]
functioning
E.F.,
her
and maintenance." Helen
omitted).
(internal
The
500,
340 Wis. 2d
37
marks
I
appeals
court of
maintained the same distinction
County
Community
Milwaukee
Combined
Services
(control
describing
Athans,
v.
habilitation
of
Board
activities)
impaired
assist[s] an
as treatment "which
community,"
person's ability to live in the
whereas
(control
symptoms)"ameliorate [s]
im-
rehabilitation
pairments
capability
facilitate[s]
an individual's
(Ct.
331, 336,
function." 107 Wis. 2d
¶ 36. Habilitation, therefore, refers to interven- help patient put exogenous things tions that to his (that activities). is, benefit Rehabilitation, to the con- trary, improving patient's refers to condition through ameliorating endogenous factors such as why and behaviors. That is we said Helen go beyond controlling E.F. that "if treatment will activity go controlling and will the disorder and its symptoms, then the individual has rehabilita- potential, proper subject tive and is a for treatment." (internal quoted Wis. 2d alterations, omitted). quotation source, and marks Because we are distinguish symptoms, able to between activities and part argument of Mr. J.'s does not disclose a need modify analytical the Helen E.F. framework. impairments (symptoms) will improving have the effect of (his activities). patient's capability to function key The is that the rehabilitative treatment addresses not the activities. symptom, itself to the *18 Many Symptoms Must a Treatment Control? B. How modify says ¶ the Helen we should 37. Mr. J. also especially precise not we were E.F. framework because determining symptoms must be a treatment which patient reha- conclude a has control before we able to provided Specifically, potential. he notes we bilitative "symptoms" qualifier in the test we term no for the symptoms say adopted, the controlled did not whether disabling ones, and did had to be the most obvious symptoms quantify a treatment the number of not E.F.'s condi- referred to Helen must control. When we that uncontroverted evidence tion, said "there is we underlying disorder, Disease, Alzheimer's as Helen's symptoms, majority do not its well as the vast (em- techniques ¶ respond Id., . . . ." to treatment added). phasis from this that our Mr. J. concludes requires leave less than the treatment framework disorder's] symptoms" [the majority unim- the "vast proved, open question. is an how much less but provided We no a fair observation. 38. This is necessary. was measure, however, because none such expert testimony that in Helen E.F. demonstrated The untreatable; and "is incurable Alzheimer's Disease remedy only maintenance—not available medical progresses." Id., it the disease as treatment—of only techniques maxi- can that "medical We concluded functioning individual" maintenance of an and mize the (internal suffering alterations Id. from this disorder. omitted). only quotations reach would So treatment and only symptoms/behaviors we matters. The habilitative treatment were medical told could be affected were anxiety aggression. however, These, were sec- her symptoms: progressive ondary primary demen- her inability memory information, new to learn loss, the tia, Medical communication. and limited verbal any could not reach of these. All treatment could do was palliate aspects some of the minor ofher condition. So it apparent potential. was she did not have rehabilitative may day
¶ 39. There come a when we need to quantify qualify a treatment must concluding patient reach before has rehabilitative potential. day. But this is not that 40. The uncontroverted facts show that Mr. J. potential. has rehabilitative Doctor Koch said Mr. J.'s paranoid schizophrenia was a "substantial disorder of thought, perception" "grossly mood, his pair[s] im- judgment expresses and behavior." Mr. J. by becoming "agitated, paranoid, gran- these disorders *19 at times," diose with "demand hallucinations to either harm himself or others." The treatment he receives disordering thought, the lessens mood, his and perception. experiences And while some of these symptoms may present still be while under treatment, he does fact, not act on them. In his treatment is so controlling symptoms effective at his that he can live society taking outpatient. while his treatment anas Doctor Koch that, said treatment, without Mr. J.'s inevitably point condition would decline to the he inpatient would have to be confined so he could receive treatment. policy provide 41. The of this State is to treat- appropriate
ment "the least restrictive alternative 51.001(1). patient's § to" a needs. Wis. Stat. If a treat- symptoms degree ment controls to such a that with- drawing patient it would the to a more restric- tive alternative, then the treatment controls enough symptoms patient to establish the has reha- potential. appeals bilitative The court of said in C.J. meaning that rehabilitation "has a broader than re- turning previous an individual to a function," level of simple logic requires that it 360, so 120 Wis. 2d at withdrawn, Mr. J.'s If treatment at least that. means point symptoms a more restric- the that worsen to will (confinement necessary be of care would tive level inpatient treatment); of treatment reintroduction (treatment previous as level him to the return would enough outpatient). can accom- that treatment It is an patient plish has rehabilitative the this to demonstrate potential. there is no need to case, Thus, to resolve significance identify of the the number treatment controls. Dispositive Word Choices C. that our Helen E.F. concerned Mr. J. is also may on that turn not to outcomes lead
framework may physician prognosis, the words a but on medical pros- patient's condition to describe choose concurring opinion pects. in Helen E.F. described The very risk: Athans] [C.J. in the two cases individuals The paranoid the same condition—chronic suffered from opposite two courts reached schizophrenia—yet re- The of "rehabilitation." possibility results on by expert chosen the words appear driven sults impact various medi- describing the medical witnesses individual. have on the cations would *20 (Abrahamson, ¶ J., 51 E.F., 2d 340 Wis. Helen concurring). certainly legitimate But This
¶ concern. a 43. distinguish between need to from the it arises not need to make symptoms from the activities, but testimony expert at all. medical based on distinctions framework, adopt we to our J.'s revision If we making would We such distinctions. cease would not simply distinguishing shift to between treatments that improve patient's a that disorder and those do not. Expert testimony, guide medical of course, would us in currently deciding if that task. So we are at risk wrongly vagaries expert's because of the of an choice of proposed change nothing words, Mr. J.'s will do protect just give opportunity It would us. us an to err making in a different distinction. Group
D. versus Individualized Determinations Finally, empha- Mr. J. believes we need inquires size that the Helen E.F. framework into specific patient whether the at issue has rehabilitative potential. say, That is to he wants to we are ensure not developing taxonomy ailments, one branch of comprises which conditions have rehabilitative potential, while the other branch contains those that again expression do not. He finds his concern the concurring opinion: Helen E.F.
A [Chapters tension exists the texts of the statutes (and statutes) 55] 51 and application of the be- lumping tween the one together people on hand all with a certain condition and on the other hand consid- ering and conduct of the individual. The rigid categories tension between the more of people with a certain condition and the more flexible behav- palpable majority opinion. ioral standards in the opinion govern Does this all patients Alzheimer's only E.F.? Helen (Abrahamson, concurring). Wis. 2d J., genesis
¶ 45. We can see the of Mr. J.'s concern. In Helen E.F. we described Alzheimer's Disease as only untreatable; "incurable available medical remedy is maintenance—not treatment—of the dis- *21 categorical progresses." ¶ Id., This is a it ease as strongly suggests that, of the and because statement Disease and the state of medical nature of Alzheimer's suffering from that condition has reha- science, no one may potential. true medical While that be as a bilitative "may"), (emphasis it does not mean that our matter on the automatic rel- Helen E.F. framework countenances patients egation cat- of such the non-rehabilitative egory. analysis explicitly requires inquiry an 46. Our potential and for reha- each individual's condition
into through fact, It shot with references is, bilitation. individual: the functioning
If treatment will maximize the individual subject, help the but not in con- and maintenance of disorder, subject trolling their then the improving or potential, have not rehabilitative individual does However, if subject for proper is not a treatment. activity beyond controlling and will gowill symptoms, then disorder its go controlling potential, and has rehabilitative individual proper subject for treatment. is a (emphasis added; internal alterations Id., omitted). always hope quotations There that seem- ingly Alzheimer's Disease conditions like intractable someday may de- Our standard become tractable. potential termining foreclose does not rehabilitative possibility. individu- individual We evaluate each ally. Convincing Evidence
E. Clear and County says he did not establish 47. Mr. J. proper subject Helen under either the of treatment is a objection proposed His revision. E.F. rubric *22 largely continuing improve. that his disorder is not to acknowledges getting He he is not but worse asserts continually improving treatment unless his potential. condition, does he not have rehabilitative He say why supporting so, does not this should be and no immediately suggests rationale itself. length, supra,
¶ 48. As we at discussed Mr. J.'s achieving Currently, laudable results. he integrate society receiving can while his treatment outpatient. as an treatment, Without condition his will point involuntary to deteriorate that an commit- subject ment will order him to confinement so he can inpatient. adopted receive treatment as an If we Mr. argument, J.'s we would condemn to him a never- ending yo-yo paranoid schizophrenia, of uncontrolled by involuntary inpatient followed confinement treatment until his inpatient are controlled and his lifted, commitment order is followed an- paranoid schizophrenia, other bout of uncontrolled Nothing logic on and on ad mortem. law or instructs ignore reality, County us to this we so will not.16 The provided convincing clear and evidence that treatment 16 also subject Mr. J. asserted he should not be to an involuntary Chapter commitment order because 51 is meant to be used for "short term treatment and rehabilitation intended with re-integration culminate of the committed individual society," already into continuously and he has been to such orders Presumably,
since 2009. Mr. J. meant this obser vation support be free County's bid to of Waukesha However, orders. might suggest this instead he would abe involuntary, long-term protective placement candidate for un der Wis. Stat. ch. 55. But he develop because did not argument no chapters one has briefed how 51 and 55 (or complement other, complement) don't each we will not Wisconsin, consider it here. See Clean v. Pub. Inc. Serv. Wis., n.40, Comm'n 2005 WI 282 Wis. 2d ("We arguments."). N.W.2d will undeveloped not address symptoms to an controls Mr. J.'s such extent that he integrate society posing into without a threat can and that of treatment himself or others withdrawal eventually require his confinement so he could would Consequently, inpatient treatment. the evi- receive proper dence is sufficient to demonstrate J. is meaning subject of treatment within the of Wis. Stat. 51.20(1). §
V. CONCLUSION challenge ¶ 49. Mr. J. did not the circuit court's findings, factual and both the circuit court and *23 appeals properly applied Helen E.F. to con- court of proper subject a of treatment because he clude Mr. J. is Consequently, potential. we affirm has rehabilitative appeals. court appeals By decision of the court of the Court.—The affirmed. is my
¶ ABRAHAMSON, I S. J. renew 50. SHIRLEY confusing E.F. case set forth a concern that the Helen subject interpret "proper unpredictable a test to and County Chapter du Lac under 51. Fond for treatment" E.F., 50, 500, 2012 340 Wis. 2d 814 N.W.2d v. Helen WI possibly mag- opinion and The continues 179. instant problem. nifies the analyzed
¶ com- E.F., this court and 51. In Helen Chapters pared Statutes. 51 and 55 of the Wisconsin ostensibly Chapters Despite 51 and 55 the fact that overlap purposes, different there substantial serve and aspects chap- similarity of the two between some (Abrahamson, ¶ E.F., 500, 45 340 Wis. 2d ters. Helen concurring). C.J., undisputed important
¶ distinc- But one length Chapters of the and 55 is the tion 51 between 569 provides. chapter or that commitment each Chapter Mr. J. been under 51 for a has almost decade. Although Chapter an initial 51 commitment cannot possible, exceed six months and extensions are Wis. 51.20(13)(g), Chapter applies § Stat. 55 to a commit- disability permanent ment caused "a that 55.08(l)(d). likely permanent." § E.F., to be Helen See opinion, majority ¶¶ 44. The Wis. 2d n.16, over this slides issue. Although
¶ 53. This distinction matters. both provide involuntary Chapter commitments, 55 con- procedures protections tains numerous additional long-term for an individual to a commitment Chapter simply doesn't.1 interpret- 54. Because the court is faced with ing applying Chapter briefly 51 to Mr. J., I restate my concerns with the Helen E.F. test. See Rights also Wisconsin Coalition for Advocacy, & II,
Reality An Action to the Rights People Guide with (2001): Disabilities in Wisconsin 342 general, Chapter long-term placement In 55 is used for or services Chapter while 55 is used for more time-limited treatment. helpful way statutes, separate This ais the two but there will many they overlap. example, person be situations where For *24 permanent disability with a like mental would ordi- retardation narily Chapter 55, receive services under but could also have a Chapter mental health crisis be which would handled under 55 voluntary involuntary with either or treatment. Persons with incompetent guardian chronic mental illness who are and have probably Chapter can be either served under 55 or 55. Some younger persons with severe mental health who live in needs group apartments or in homes their own with intensive services (CSP) Community Support Programs may such as be under exactly Chapter orders. 55 Others in the same are situation under Chapter year. year 55 commitments which are renewed after This by county. varies Although agree majority opinion ¶ I with the 55. suggested of the Helen E.F. test Mr. J.'s revisions unavailing, I remain concerned that the Helen E.F. are unavailing. also test is appears linchpin
¶ to be the 56. "Rehabilitation" Cty. statutory Milwaukee Com- definition. See of this Cmty. Athans, Bd. v. 107 Wis. 2d bined Servs. 1982). (Ct. App. 334-36, 320 N.W.2d controlling activity ¶ ver- The line between 57. controlling and the disorder—that sus is habilitable or is, an individual whether any brighter clearer to me in not rehabilitable—is opinion than in Helen E.F.. the instant Unfortunately, ¶ the court maintains the con- 58. failing fusing adopted E.F., to differen- it Helen test Chapter Chapter from 55 com- 51 commitments tiate mitments. my may suggestion that "it be time I renew 59. goals legislature intended to reassess the
for the chapters." scope E.F., 2012 WI Helen of the two (Abrahamson, concurring) (citing Wis. Stat. C.J., 13.83(1)(c), 13.92(2)(j)). §§ separately. reasons, I For these write 60.
f ¶ ANN I am authorized to state that Justice joins opinion. BRADLEY WALSH notes "[schizophrenia delusions, halluci- is characterized disorganized speech behavior, and other and nations, dysfunc- occupational symptoms that cause social or dictionary, Referring he finds "be- to an online tion." activity in a human an "observable defined as havior" schizophre- that, if From this he concludes or animal." (at part) behavior, and a as a manifests least nia may safely activity, then he substitute is an behavior "activity" in Helen E.F. framework. "behavior" principle, much however, functions The transitive neatly than it does in semantics. in mathematics more certainly attempt reason to this 29. Mr. J. has frequently Koch referred substitution. Doctor dictional describing the effectiveness when J.'s behavior receiving under the involun- the treatment he was melding By tary order. behaviors commitment challenge how can then us to describe activities, Mr. J. symptom. might differ from a a behavior Assuming unable to rise to 30. we would be any challenge, proposes reference Mr. J. we eliminate the assessment of from to activities or potential. us, instead, He invites rehabilitative inquire only into whether the treatment would im- By prove phrase "improve his disorder. his disor- der," we take Mr. J. to mean that would need continually improve experi- condition until he plateau beyond ences either a cure or a which no improvement possible.12 further We decline this invitation. challenge Furthermore, we decline Mr. J.'s "symp- to find a distinction between "behaviors" premise proper toms" because its is invalid. The dis- junctive categories in Helen E.F. are "activities" and "symptoms," apart. we can tell them When we developed determining the framework for whether