Constitutional Challenge to Grave Disability

Facts of the Case

On April 4, 2005, Dr. M. Lee of Valley Hospital submitted an application for the formal psychiatric evaluation of Roslyn Wetherhorn. Dr. Lee's application stated that Ms. Wetherhorn was mentally ill and gravely disabled, and she was subsequently taken into custody for purposes of psychiatric evaluation pursuant to Alaska Stat. § 47.30.705 (2007). On April 5, 2005, Dr. John McKean, who performed the psychiatric evaluation, filed an ex parte petition for initiation of civil commitment to the Alaska Psychiatric Institute (API). In supporting his claim that Ms. Wetherhorn was in need of involuntary hospitalization, Dr. McKean wrote that she was in a “manic state, homeless, and non-medication compliant × 3 months.” A superior court judge granted the petition the same day. Later that day, Dr. McKean and Dr. Laurel Silberschmidt filed for a 30-day commitment, stating that Ms. Wetherhorn was mentally ill, was “likely to cause harm to herself or others,” and was “gravely disabled.” Their supporting facts mirrored those listed on the commitment papers: “manic state, homeless, and no insight and non med[ication] compliant × 3 months.” The commitment hearing was held the same afternoon. On April 27, 2005 the judge issued orders approving involuntary hospitalization in API on the basis of grave disability, as well as involuntary administration of psychotropic medication.

Ms. Wetherhorn appealed, contesting the constitutionality of Alaska statutes governing civil commitment; specifically, she contested language in Alaska Stat. § 47.30.915(7)(B), the part of the gravely disabled criteria that states that a person … will, if not treated, suffer or continue to suffer severe and abnormal mental, emotional, or physical distress, and this distress is associated with significant impairment of judgment, reason, or behavior causing a substantial deterioration of the person's previous ability to function independently.

Ms. Wetherhorn argued that the criteria of Alaska Stat. § 47.30.915(7)(B) (2007) fell below the constitutional standard necessary for the “massive curtailment of liberty” associated with involuntary hospitalization.

Ruling and Reasoning

The Alaska Supreme Court ruled (in an opinion modified later, in which the original introductory passage and conclusion were withdrawn and replaced with modified versions, hereafter referred to as Wetherhorn II when modified sections are quoted), “We conclude that the definition of ′gravely disabled' in Alaska Stat. § 47.30.915(7)(B) is constitutional if construed to require a level of incapacity so substantial that the respondent is incapable of surviving safely in freedom” (Wetherhorn II, p 384). The Court ruled that because Ms. Wetherhorn had already been released from API, it was moot for them to consider whether the facts of the case actually warranted her commitment on the basis of grave disability.

In their original opinion, the Court noted that Alaska Stat. § 47.30.915(7)(B) was added to the Alaska Statutes in 1984 to expand the scope of civil commitment standards. Before 1984, Alaska's gravely disabled criteria included only language involving the need for “complete neglect … as to render serious accident, illness, or death highly probable if care by another is not taken.” The Court noted that the broader criteria outlined by Alaska Stat. § 47.30.915(7)(B) was added at a time when the intent was “to allow a person to be committed before it's too late” (Wetherhorn, p 377).

The Court stated, “The dispute between Wetherhorn and API is whether API must wait until the danger caused by a person's mental illness rises to the level indicated by [the narrower, former grave disability statute] before a person may be involuntarily committed” (Wetherhorn, p 377). While API relied on language in Addington v. Texas, 441 U.S. 418 (1979) which states that a person need only pose “some danger” (Addington, p 426) to self or others to argue that the commitment standard was properly expanded in 1984, the Court reasoned that this position ignored the United States Supreme Court's repeated admonition that, given the importance of the liberty right involved, persons may not be involuntarily committed if they “are dangerous to no one and can live safely in freedom.”

Discussion

Practically, this ruling vacates Alaska's addition of statutes intended to broaden the scope of civil commitment on the basis of grave disability, moving away from a need-for-treatment model based on deterioration from a previous level of functioning to a level of grave disability indicating incapacity to survive safely in freedom. Going forward, it seems that Alaskan patients must be closer to imminent harm as a result of self-neglect than the lawmakers had intended when the definition of “gravely disabled” was expanded in 1984. In a state with frequent, severe, freezing temperatures, where self-neglect leading to homelessness may in fact be a dangerous proposition for mentally ill patients, perhaps Alaskan lawmakers had all the best intentions in relation to the homeless mentally ill when they expanded the definition of grave disability. In fact, Ms. Wetherhorn was noted to be homeless in Alaska for 3 months (during most of January, February, and March) and that alone may be more dangerous than homelessness in most states in the contiguous United States.