Movement Restrictions During Involuntary Commitments Face Strict Scrutiny When Infringing on Protected Liberty Interests
In the Matter of F.A., 494 Mass. 673 (Mass. 2024), the Supreme Judicial Court of Massachusetts vacated a ruling from the Appellate Division of the District Court, which imposed continuing buildings and grounds restrictions on an involuntarily committed individual. The court found that such restrictions violated the patient’s rights to both substantive and procedural due process.
Facts of the Case
F.A. was found not guilty of a sexual offense because of mental illness and was involuntarily committed to the Worcester Recovery Center and Hospital (WRCH) in Massachusetts in 1999. F.A.’s commitment was renewed annually. In 2013, the Commonwealth imposed restrictions that confined F.A. to the facility without privileges for off-ground visits.
In 2020, F.A. opposed the annual renewal of these restrictions. The Worcester Division of the District Court Department nevertheless renewed F.A.’s commitment and held an evidentiary hearing concerning the buildings and grounds restriction. The hearing included expert testimony by two psychiatrists who had treated and evaluated F.A. for several years.
The Commonwealth’s expert witness described the policies and procedures utilized to determine whether patients could have off-grounds privileges. The expert detailed “enhanced clinical review” as part of the facility’s “actuarial risk assessment” of a patient’s readiness for supervised off-ground trips. Further, the psychiatrist explained that all patients received “one-to-one” supervision when leaving the facility and would be subject to “ongoing review” regarding their privileges while committed (F.A., p 674).
F.A.’s expert, another psychiatrist, reported that F.A. would not be considered for supervised off-ground privileges for “at least a year,” although F.A.’s behavior over the last five to 10 years did not warrant a buildings and grounds restriction and was “really not needed.” Despite stating that F.A. should remain committed, the psychiatrist did not concur with the necessity of additional restrictions based on to the patient’s clinical condition (F.A., p 675).
During the hearing, the judge dismissed F.A.’s argument that the state was required to prove beyond a reasonable doubt that the restriction was necessary to avoid a substantial and imminent risk of harm to others. Ultimately, the judge granted the buildings and grounds restriction and provided written justification 11 months after a motion for clarification. The judge offered “an all or nothing proposition,” suggesting that, without court-ordered restrictions, the facility could permit F.A. unsupervised off-ground visits (F.A., p 675). In 2021, F.A. again opposed the Commonwealth’s motion for buildings and grounds restrictions; the restriction was ordered without an evidentiary hearing.
F.A. appealed both the 2020 and 2021 decisions. The Appellate Division of the District Court affirmed the 2020 restriction but vacated the 2021 decision, stating that failing to hold an evidentiary hearing violated F.A.’s procedural due process rights.
Appealing the affirmance of the 2020 order, F.A. challenged the restriction on constitutional grounds, arguing that it was not the least restrictive means to ensure public safety and that the court had failed to provide clear and convincing evidence justifying the restriction. The Supreme Judicial Court of Massachusetts granted a direct appellate review.
Ruling and Reasoning
The Supreme Judicial Court of Massachusetts ruled that the lower court’s imposition of a buildings and grounds restriction violated F.A.’s substantive due process rights. The court determined that the judge failed to apply strict scrutiny to the restriction, which is required when a fundamental liberty is at stake, such as freedom from physical restraint. The court reaffirmed that an involuntarily committed individual retains fundamental liberty rights. It ruled that additional liberty restrictions must be narrowly tailored to serve a compelling government interest and represent the least restrictive means of achieving that interest.
The court found that the judge did not analyze whether the restriction was necessary, despite the state’s expert testifying that F.A.’s restriction was “really not needed” based on his observed behavior over most of the prior decade. Additionally, the Supreme Judicial Court of Massachusetts found that the judge failed to explain why the internal process at WRCH was inadequate in determining F.A.’s movements and privileges, given the facility’s extensive internal protocols.
Furthermore, the court ruled that F.A.’s constitutional rights to procedural due process were violated when the judge did not provide adequate procedural safeguards. Citing Mathews v. Eldridge, 424 U.S. 319 (1976), the court highlighted the three-prong Mathews procedural balancing test for determining necessary procedures to safeguard protected interests, which requires courts to weigh private interests, government interests, and the risk that the procedures in place will lead to erroneous decisions. By imposing the restriction without issuing findings on the record regarding its necessity, the judge deprived F.A. of liberty without immediate justification. The judge also applied an errantly low standard of proof, substantial evidence, a lower burden of proof than the constitutionally required clear and convincing standard. This lower standard increased the risk of wrongful deprivation of F.A.’s liberty. The court emphasized that the state must justify restrictions at the time of the ruling with clear and convincing evidence in cases affecting fundamental rights, referencing Addington v. Texas, 441 U.S. 418 (1979). The judge issued particularized findings supporting F.A.’s restrictions only 11 months after the initial hearing.
Discussion
Matter of F.A. has significant implications for forensic psychiatrists, particularly in offering risk assessment opinions and review of clinical decision-making. The court’s ruling reinforces the necessity of ensuring that restrictions on a committed individual’s liberty are justified by clear, individualized clinical evidence. Forensic psychiatric evaluations are crucial in shaping legal determinations regarding if a patient requires continued commitment or additional restrictions.
Forensic psychiatrists are often called upon to assess whether individuals pose sufficient risk to encumber their liberty interests. This case highlights the importance of structured risk assessment tools and clinical judgment in guiding such determinations. Although experts testified regarding the facility’s internal risk assessment procedures, the court’s rejection of the imposed restriction implies judicial preference for specific and compelling reasoning.
Matter of F.A. highlights the importance of documenting clinical reasoning for restrictions and aligning hospital policies with substantive and procedural safeguards of liberty protections. Patients are dynamic, and long-term confinement or additional restrictions should not be presumed necessary without similarly dynamic clinical assessment. Applied strict scrutiny means that experts must explicitly address why a specific restriction serves a compelling governmental interest, how the restriction is narrowly tailored to that interest, and why less restrictive alternatives would be insufficient.
Practically, this requires psychiatrists to provide evidence-based assessments rather than relying on local idiosyncrasies or norms. Psychiatrists must articulate why specific restrictions are necessary and whether hospital-based mechanisms, rather than judicial intervention, are adequate for risk management. In policy-development roles, consultants may fashion periodic review protocols as individually tailored risk assessments that integrate dynamic and static risk factors to ensure clinical decision-making is legally sufficient.
- © 2025 American Academy of Psychiatry and the Law
