Involuntary Commitment for a Competency to Stand Trial Evaluation Must Be the Least Restrictive Means
In Commonwealth v. A.Z., 493 Mass. 427 (Mass. 2024), the defendant challenged her involuntary commitment to a state psychiatric hospital for a competency to stand trial evaluation. The Supreme Judicial Court of Massachusetts held that the commitment violated the defendant’s due process rights because there was not an express finding that hospitalization was, by clear and convincing evidence, the least restrictive means to complete the evaluation and the clinician that conducted the initial competency evaluation was not asked to opine directly on the problem.
Facts of the Case
In Massachusetts, the state code provides for two categories of competency to stand trial evaluations. Under Mass. Gen. Laws ch. 123, §15(a) (2020), a judge may order an evaluation by a court clinician if there are concerns regarding the defendant’s competency to stand trial. The examination is typically brief and takes place in the courthouse or where the defendant is being detained prior to trial. Under Mass. Gen. Laws ch. 123, §15(b), a judge may also order the defendant be involuntarily hospitalized if, based on the court clinician’s evaluation, the court has reason to believe that such observation and further examination are necessary to determine competency to stand trial.
A.Z. was arraigned for a “bomb/hijack threat” on July 9, 2018. She underwent a §15(a) competency to stand trial evaluation on January 10, 2019 while released on personal recognizance. The district court held a hearing later that day to determine whether a §15(b) evaluation was necessary. The defense asserted that hospitalization was not necessary and requested an outpatient examination. The defense offered an independently retained clinician that could complete an evaluation on an outpatient basis. The court clinician, Dr. Leah Robertson, testified that A.Z. did not possess “the ability to consult with her attorney in a rational manner in her own best interest” and recommended further evaluation at a psychiatric hospital (AZ, p 429). The judge ordered that A.Z. be committed to the Solomon Carter Fuller Mental Health Center for 20 days for observation and further examination.
A.Z. appealed the involuntary commitment order, claiming that §15(b) requires a judge to find a likelihood of serious harm absent hospitalization and that hospitalization is the least restrictive means of determining competency. The District Court Department, Appellate Division affirmed. An application for direct appellate review was then filed and granted by the Supreme Judicial Court of Massachusetts.
A.Z. was ultimately found competent to stand trial, but the case was dismissed on October 1, 2019.
Ruling and Reasoning
First, the Supreme Judicial Court of Massachusetts ruled that the appeal was not moot despite dismissal of A.Z.’s case. The court considered that, previously, when considering other provisions regarding involuntary civil commitment, it had determined that the continuing stigma of a potentially wrongful commitment was enough to defeat a claim of mootness. Because this same continuing stigma follows an involuntary commitment under §15(b), A.Z. had a surviving personal interest in adjudication of whether the nature of her commitment was wrongful. The court further acknowledged that, independent of this surviving interest, it is well established that involuntary commitment of mentally ill individuals presents classic examples of problems that are capable of repetition and evasion of review and thus warrant appellate review even after the commitment ends.
Next, the Supreme Judicial Court of Massachusetts conducted a de novo review of the defendant’s claims regarding statutory interpretation of the involuntary commitment statute. The court declined to adopt the defendant’s claim that a judge must find that a failure to detain the defendant would create a likelihood of serious harm to the defendant or others. The court noted that this standard was expressly excluded from §15(b) despite being present in several related provisions of the General Law, Chapter 123, demonstrating that the legislature did not intend for this standard to govern §15(b) determinations.
The court found that involuntary hospitalization under §15(b) infringes upon the fundamental right of an individual to be free from physical restraint and is subject to strict scrutiny. To satisfy strict scrutiny, the law must be “narrowly tailored to a compelling government interest” and “be the least restrictive means available to vindicate that interest”(AZ, p 432). A judge may therefore only involuntarily hospitalize a defendant under §15(b) if the judge finds that the Commonwealth, which bears the burden of proof, demonstrates by clear and convincing evidence that hospitalization is the least restrictive means of determining competency. The judge must consider whether there are any other viable less restrictive alternatives. Expert testimony may be used to meet this burden. It can also be proved that an alternative suggested by the defendant is not a plausible option or that an outpatient evaluation is not a viable option based on evidence demonstrating that the defendant has a history of not appearing in court or failed to comply with mental health appointments while on pretrial release. Prior to ordering involuntary hospitalization, the judge must make a specific finding that there are no less restrictive alternatives for completing the competency evaluation and must make clear, in writing or orally on the record, the evidence used to support such a finding.
The Supreme Judicial Court of Massachusetts found that the provisions set forth in this opinion were not met because the judge did not make an express finding, by clear and convincing evidence, that the least restrictive means to complete the evaluation was hospitalization, and Dr. Robertson was not asked to directly opine on the problem. A.Z.’s due process rights were violated when she was hospitalized absent such an express finding. The order of commitment was vacated, and the matter was remanded to the district court.
Discussion
Involuntary hospitalization has long been recognized as an infringement of an individual’s fundamental liberty interests. The concept of the least restrictive alternative was first advanced in the federal case Lake v. Cameron, 267 F. Supp. 155 (D. D.C. 1967), during the time of deinstitutionalization. The U.S. Supreme Court’s landmark decision in Olmstead v. L.C, 527 U.S. 581 (1999), further implemented the least restrictive alternative as it applied to individuals with disabilities.
In consideration of involuntary hospitalization, a person’s fundamental liberty interest is balanced against governmental interest. The governmental interest must warrant the infringement on personal liberty. Psychiatrists are familiar with this balancing test regarding cases of civil commitment, where the principles of parens patrie and police power are the considered governmental interests. In criminal matters, the government also has a substantial interest in determining the adjudicative competency of a defendant.
Involuntary hospitalization for criminal matters is no less of an infringement upon an individual’s fundamental liberty rights than an involuntary hospitalization for civil commitment purposes. This ruling by the Supreme Judicial Court of Massachusetts reinforces the importance of carefully considering the balance of governmental and individual interests when deciding whether a defendant should be involuntarily hospitalized for a competency to stand trial evaluation. Specifically, the court recognized that an appraisal of the least restrictive alternative is essential to appropriately balancing these disparate interests.
Although this is a ruling specific to the state of Massachusetts, the principles governing this decision are well established nationwide. This case serves as a reminder to all psychiatrists that involuntary commitment infringes on the rights of the individual and careful consideration needs to be given to the least restrictive alternative. Specific to forensic psychiatrists, this case recognizes that the forensic examiner’s testimony may be essential in determining the least restrictive means of completing a competency to stand trial evaluation and the forensic examiner may be asked to directly opine on this problem.
- © 2024 American Academy of Psychiatry and the Law
