Massachusetts Court Considers the Likelihood of Serious Harm from Substance Use as a Basis for Involuntary Commitment of Juveniles
In the Matter of J.P., 494 Mass. 654 (Mass. 2024), details two separate cases wherein juveniles J.P. and E.S. were civilly committed for inpatient substance use disorder treatment under Mass. Gen. Laws ch. 123, § 35 (2011), which permits state courts to involuntarily commit those with an alcohol or substance use disorder that poses “a likelihood of serious harm” to themselves or others. Both juveniles appealed their commitments, arguing due process violations. The Supreme Judicial Court of Massachusetts ruled that an order of commitment is justified if a causal nexus between a substance use disorder and a likelihood of serious harm is established with no less restrictive alternatives to commitment available.
Facts of the Case
The mother of E.S. petitioned the Essex County Division of the Juvenile Court Department in April 2023 to commit her daughter involuntarily. Five months prior to the hearing, E.S. was transferred to a recovery high school after being found “pretty much passed out [drunk] in a classroom” at her public school (J.P., p 656). E.S.’s parents and school officials staged an intervention, which she fled from and was then missing for four days until returning to her mother’s home the morning of the commitment hearing. E.S.’s parents testified at the commitment hearing that she abused substances daily and that drug and alcohol paraphernalia had been found at both their homes.
A court-affiliated clinician testified E.S. began using alcohol and marijuana following her parents’ separation a few years prior and that her substance use was escalating. Testimony revealed E.S. had used fentanyl three times the previous month and had tested positive for fentanyl, benzodiazepine, and methadone a week prior to the hearing. E.S.’s psychiatric history included psychiatric hospitalization twice for suicidal ideation, diagnoses of depression and posttraumatic stress disorder, extensive outpatient treatment, and recent participation in a drug diversion program. The clinician opined E.S. had a substance use disorder and there were no less restrictive alternatives to involuntary commitment immediately available but that she did not meet the criteria of imminent “likelihood of serious harm” required by the commitment statute.
The juvenile court judge granted the petition for involuntary commitment, emphasizing that E.S.’s substance use was not “normal adolescent behavior” and that the “toxic” nature of fentanyl posed “a very imminent and very substantial risk of physical impairment or injury” (J.P., p 658). The judge also cited her fleeing the intervention, her multiple failed urine drug screens, and her history of intoxication to a degree where her safety could be compromised because of being “unable to walk, unable to talk, [or] unable to maneuver stairs” as evidence of the harm that E.S. posed to herself (J.P., p 658).
The mother of J.P. petitioned the Bristol County Division of the Juvenile Court Department in May 2023 to commit her son involuntarily. J.P.’s mother testified at the commitment hearing that his behavior was noticeably different beginning in 2021, and he had precipitously declined in the months before the hearing. J.P. was suspended from school twice for vaping nicotine and reportedly told others “he’s high every day.” Prior to the hearing, J.P.’s mother took away his car keys after she discovered he was driving under the influence of marijuana. He subsequently left home for days, shaved his head, and drank alcohol heavily but continued attending school. J.P. had no history of mental health treatment. The court clinician opined J.P. had a substance use disorder and was “not on a good track” but that he was not a danger to himself or others (J.P., p 660). The juvenile court judge ordered the commitment of J.P. for 30 days of inpatient substance use disorder treatment, citing the “likelihood of serious harm” by virtue of having a substance use disorder.
To issue an order of commitment under Mass. Gen. Laws ch. 123 § 35, there must be clear and convincing evidence of three findings: an alcohol or substance use disorder in the person for whom commitment is sought, likelihood of serious harm as a result of the alcohol or substance use disorder, and that there is no available less restrictive alternative.
Both juveniles appealed their commitments, raising two due process arguments. They asserted commitment orders under the state statute did not require supporting clinical evidence, and thus, the statute was not “narrowly tailored” in serving a compelling government interest. Second, they claimed the use of “chronic or habitual” within the statutory definition of “substance use disorder” were overly broad terms, and the statute was therefore void for vagueness. The juveniles also challenged the sufficiency of the evidence used to justify their commitment orders. The Supreme Judicial Court of Massachusetts granted direct appellate review.
Ruling and Reasoning
The Supreme Judicial Court of Massachusetts ruled that a substance use disorder diagnosis is an inherently clinical determination, and the state statute requires diagnoses be supported “at least in part” through clinical evidence, allowing the statute to be “narrowly tailored” in serving a compelling government interest. The court emphasized the importance of supporting clinical evidence in commitment hearings for juveniles, as “a judge is required to assess an individual’s judgment, self-control, and social functioning, precisely those areas of juvenile brains that are recognized as underdeveloped” (JP, p 665, citing Matter of a Minor, 484 Mass. 295 (2020), p 301). Unlike the first factor of the commitment statue, neither the likelihood of serious harm nor the consideration of least restrictive alternatives requires supportive clinical evidence. The court reasoned that the latter two factors are “well within the scope of judicial knowledge and discretion” (J.P., p 663). The court highlighted the importance of establishing a causal nexus from the substance use disorder to the “likelihood of serious harm” for juveniles facing commitments, stating that merely “rebellious or difficult teenage misbehavior cannot support a petition for commitment” (Minor, p 301).
The court ruled that the commitment statue was not void for vagueness, as the meaning of the terms “chronic or habitual” are “sufficiently clear” within the statute. The court found that “statutes do not contravene constitutional requirements [or become void for vagueness] simply because they include general terms” (J.P., p 667).
Finally, the court examined the sufficiency of evidence for the orders of commitment. For E.S., the court ruled there was sufficient evidence to affirm her commitment, as there was a “likelihood of serious harm” because of her past suicidal ideation, the “extremely toxic” nature of fentanyl, and a lack of immediately available intensive outpatient programs. For J.P., the court vacated his order of commitment because of insufficient evidence, as there was no clear nexus of a “likelihood of serious harm” to his marijuana use. J.P. had no history of psychiatric treatment or self-harm, and although he once drove under the influence of marijuana, there was no evidence suggesting it was a recurring event. The court also cited the clinician’s testimony that J.P. was not a danger to himself or others because of his substance use.
Discussion
In Matter of J.P., the court addressed the constitutionality of a state statute granting the involuntary commitment of a juvenile to a substance abuse treatment program. Matter of J.P. has parallels to Parham v. J.R., 442 U.S. 584 (1979), with both courts reconciling due process and liberty interests at stake regarding the involuntary commitment of juveniles. The cases differ regarding the statutory requirements governing the evidence necessary to justify involuntary commitment. In Parham, the U.S. Supreme Court reasoned that a neutral fact finder, such as a physician, may opine in a nonadversarial hearing if the commitment petition of a juvenile initiated by their parents or guardians was justified based on a comprehensive review of the clinical evidence. In Matter of J.P., the court emphasized that involuntary commitment of juveniles requires a causal nexus between substance use disorder and a likelihood of serious harm.
Much like the classic “balancing test” of Mathews v. Eldridge, 424 U.S. 319 (1976), in Matter of J.P., the court weighed the necessity of civil commitment against the destabilizing psychosocial effects it may have on a juvenile’s familial, academic, and social functioning. The decision highlights the role that readily available, less restrictive alternatives to civil commitment could serve by introducing greater equipoise to mitigate undue deprivations of juveniles’ liberty. Massachusetts is among many states that require courts to establish the causal nexus between someone’s substance use and the danger posed to self or others. Notably, the harm referenced in § 35 is a legal determination statutorily couched within the context of serious physical harm that does not require clinical evidence, nor does the statute require courts to consider that juveniles, from a neurodevelopmental perspective, are vulnerable to different potential psychological harms relative to adults.
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