Civil Commitment at the Expiration of a Prison Sentence

Facts of the Case

AA is an elderly man with a lengthy history of incarceration dating back to his youth. In 1976, when AA was 25 years old, he was convicted on firearm and drug-related charges. In 1985, while on parole, he was found guilty of attempted murder, aggravated battery, and unauthorized possession of a firearm and sentenced to 40 years in state prison. In 2005, he was transferred to federal prison for the 1985 parole violation. While in federal custody, AA developed several delusional beliefs, including that he was married to a federal district judge (pseudonym Judge Doe), was an emperor, and was a wealthy business owner. AA was prescribed medication but was only intermittently compliant.

AA subsequently had four parole violations during periods of release from custody. During his first release in 2013, AA stopped taking medication, missed meetings with his probation officer, and made efforts to meet with Judge Doe. In 2015, AA absconded from a residential reentry program. Twice in 2017, AA contacted Judge Doe despite being instructed not to do so. During this period, AA was diagnosed with schizoaffective disorder and antisocial personality disorder. He continued to intermittently refuse medication and, motivated by his persecutory delusions, was at times violent. As a result, he was evaluated by numerous risk assessment panels. The first occurred in May 2016 and recommended that AA not be released until his statutory release date because of ongoing delusional beliefs about Judge Doe. AA was evaluated again in December 2017 by a second risk assessment panel. At that time, the panel did not find a clear association between AA’s previous criminal behavior and his mental disorder. He was released from custody. After his release, AA violated parole once again. During his subsequent incarceration, his psychotic symptoms worsened. As he neared the expiration of his sentence in 2020, a third risk assessment panel was convened. AA told the panel that he did not require mental health treatment and he planned to acquire a firearm to protect his fortune. The panel concluded that, as a result of his severe mental illness, AA posed a substantial risk of harm to others if released.

Relying on the conclusions of the risk assessment panel, the government filed a petition for AA’s civil commitment. At the evidentiary hearing, the magistrate judge appointed by the district court found that the government had established a link between AA’s mental illness and violent conduct and AA’s history furthermore supported the conclusion that he posed a substantial risk to others. The district court, in accepting the magistrate’s conclusions, granted the petition for AA’s civil commitment. AA appealed to the First Circuit Court of Appeals.

Ruling and Reasoning

First, the First Circuit reviewed the relevant statutory and case law that governs civil commitment of inmates following the expiration of their prison sentence. The First Circuit noted the district court must find “by clear and convincing evidence that the individual is presently suffering from a mental disease or defect as a result of which his release would create a substantial risk of bodily injury to another person or serious damage to property of another” (Anonymous, p 580, citing 18 U.S.C § 4246(d) (1997)). Additionally, the First Circuit pointed out that the district court can consider a wide array of factors when determining the presence of a substantial risk.

Guided by principles set forth in the case of United States v. Sahhar, 917 F.2d 1197 (9th Cir. 1990), the court can give weight to “any activity that evinces a genuine possibility of future harm” (Anonymous, p 580, citing Sahhar, p 1207). Factors can also include a history of violence, whether the individual has identified a target, previous use of weapons, substance or alcohol misuse, and past adherence with medication, as established in both United States v. Mahoney, 53 F. Supp. 3d 401 (D. Mass. 2014) and United States v. Ecker, 30 F.3d 966 (8th Cir. 1994). Moreover, the First Circuit pointed out that, in the case of United States v. LeClair, 338 F.3d 882 (8th Cir. 2003), lack of monitors and inability to ensure treatment adherence outside a structured setting are also factors that support a finding of substantial risk.

The First Circuit then countered AA’s arguments. First, AA contended that his stated intent to obtain a firearm did not necessarily indicate that he was likely to acquire or use a firearm, because his statement was grounded in his delusion that he needed to protect his fortune. The court cited the case of United States v. Dalasta, 3 F.4th 1121 (8th Cir. 2021), which recognized that delusions and threats, regardless of whether the respondent had acted on them, were sufficient evidence to prove dangerousness. In AA’s case in particular, he not only had delusions and a threat to obtain a weapon, but he also demonstrated a tendency to act on his delusions. AA next argued that the district court erred by placing greater weight on his violent acts during custody rather than his nonviolent behavior on parole. The First Circuit acknowledged that AA did not behave violently while on parole but pointed out that his violent conduct in custody further established a propensity for acting on his delusions.

Finally, AA argued that the totality of circumstances did not support the finding that he posed a substantial risk. He drew parallels between his case and that of the respondent in United States v. Smith, 964 F. Supp. 2d 167 (D. Mass. 2013), in which the respondent, who was diagnosed with schizophrenia, was not civilly committed at the expiration of his prison term for a violent conviction. The First Circuit noted that, unlike AA, the respondent in Smith had not exhibited violent behavior in the prior four years, had only one violent offense, and had never been convicted of using a weapon. The First Circuit further said that other appellate courts have upheld civil commitment findings based on evidence of substantial risk similar to AA: in Dalasta, the court affirmed civil commitment for a respondent who planned on obtaining firearms if released, and in United States v. Steil, 916 F.2d 485 (8th Cir. 1990), the court affirmed civil commitment for a respondent with psychotic symptoms writing threatening letters to public figures.

In conclusion, the First Circuit affirmed, finding no error in the district court’s ruling. The First Circuit found that AA’s criminal history, repeated attempts to contact Judge Doe, repeated parole violations, history of medication nonadherence, and violent acts in custody were sufficient grounds to civilly commit AA.

Discussion

Civil commitment criteria for inmates nearing the end of their custodial term have been well established in federal statutory law. Courts must find, by clear and convincing evidence, that an individual has a mental illness and, as a result, poses a substantial risk of harm to another’s person or property (U.S.C § 4246(d) (1997)). The statutory language, however, lacks guidance on which factors district courts should consider when determining a finding of dangerousness. In the case of Anonymous Appellate, the First Circuit reviewed extensive case law, ranging from Steil in 1990 to Dalasta in 2021. This review of case law reinforced that the clear and convincing standard is a demanding one to meet, such that a violent conviction and mental illness alone is not sufficient criteria for civil commitment at the end of a prison term, while also highlighting the ability of district courts to consider a wide range of factors when establishing dangerousness, including a tendency to act on delusions, menacing behaviors, lack of medication adherence, and the prospect of decompensation in a less structured setting.

This case further underscores the importance of giving latitude to district courts to examine each situation on its own merits, rather than codifying a checklist of criteria that must be fulfilled to establish a finding of dangerousness. As the First Circuit noted in this case, “There is no boilerplate set of facts that must be established to show that a substantial risk exists. Each case must be evaluated on its singular facts” (Anonymous, p 581). Indeed, a boiler plate approach would be at odds with an evidenced-based methodology of violence risk assessment, which requires that forensic psychiatrists examine in depth each evaluee’s unique situation.

Importantly, this case offers further instruction to forensic psychiatrists tasked with performing violence risk assessments on an inmate nearing the expiration of a prison sentence and providing testimony on their opinion in courts. As courts welcome consideration of the totality of the circumstances in their review of risk of dangerousness, then so too are psychiatrists allowed to expand their testimony to include factors, often less emphasized but well known to be associated with violence risk, such as history of violence and recidivism, lack of insight into mental illness, noncompliance with medication, persecutory delusions, and access to weapons. The finding in the case and the others reviewed also better align with a forensic psychiatrist’s use of clinical judgment and structured professional judgment approach to violence risk assessment, which better contextualize the risk factors in some instances, in contrast to the algorithmic approach of actuarial risk assessment tools.