In re S.M.

176 A.3d 927

IN RE: S.M.

Appeal of: S.M.

No. 906 WDA 2016

Superior Court of Pennsylvania.

Submitted September 19, 2017

Filed December 15, 2017

Nicole L. Carnevale, Public Defender, Pittsburgh, for appellant.

Lee M. Dellecker, Pittsburgh, for Allegheny County, participating party.

BEFORE: MOULTON, J., SOLANO, J., and MUSMANNO, J.

OPINION BY MOULTON, J.:

S.M. appeals from the May 25, 2016 order entered in the Allegheny County Court of Common Pleas concluding that S.M. is severely mentally disabled and directing S.M. to remain involuntarily committed to an inpatient facility for 30 days, to be followed by 150 days of outpatient psychiatric treatment. After a careful review of the record, we reverse. While appellee Allegheny County ("County") cites to a history of conduct that might support the involuntary commitment at issue, little of that history is part of the record before this Court. Because the record before us contains insufficient evidence to support the commitment, we reverse.

On May 25, 2016, S.M. was involuntarily recommitted to the care of the Western Psychiatric Institute and Clinic ("WPIC") and Pathways Long–Term Structured Residence ("Pathways"). This commitment was the latest in a series of commitments that our review of the record suggests began on September 26, 2014, when S.M. was involuntarily committed to the care of the WPIC for 20 days under section 303 of the Mental Health Procedures Act ("MHPA"), 50 P.S. § 7303.¹ On May 19, 2016, after S.M. had been involuntarily committed for almost 180 days under section 305 of the MHPA, a hearing was held at Pathways to determine whether S.M.'s involuntary commitment² should be extended under section 305. At the end of that hearing, the presiding Mental Health Review Officer ("MHRO") recommended that S.M. be committed for another 180 days. That same day, S.M. filed a petition for review of the MHRO's recommendation with the Court of Common Pleas of Allegheny County.

On May 25, 2016, the trial court held a de novo hearing, after which it ordered S.M. to receive another 180 days of involuntary treatment, with inpatient treatment not to exceed 30 days. On June 23, 2016, S.M. timely filed a notice of appeal.

The trial court explained the basis for its decision in an opinion filed pursuant to Pa.R.A.P. 1925(a), which provides in full:

On May 19, 2016, a hearing was held before a ... MHRO ... who committed S.M.... pursuant to the provisions of 50 P.S. § 7305 for a period not to exceed 180 days. On May 19, 2016, [S.M.] petitioned the Court for a review of the MHRO's recommendation. On May 25, 2016, a hearing was held and the Court affirmed the MHRO's recommendation of the 180[–]day commitment. The Court further ordered in-patient treatment not to exceed 30 days effective May 25, 2016, to be follow by out-patient treatment. On June 23, 2016, a [n]otice of [a]ppeal was filed.

At the hearing before the Court held on May 25, 2016, evidence was received that [S.M.] has a 20 year history of violent and aggressive behavior. In December of 2015, while living at a step-down mental health facility, [S.M.] stopped taking the majority of her medications resulting in her not sleeping for several nights in a row, not eating, and not taking care of herself. [S.M.] was also using racial slurs towards other residents of the facility creating an atmosphere of hostility and concern regarding retaliation from other residents.

[S.M.] was then readmitted into [WPIC]'s acute care unit. On or about February 10–12, 2016, [S.M.] was discharged with the understanding that she would need to continue on her medications. [S.M.] did not continue with her medication and that resulted in the instant commitment.

The Superior Court reviews determinations pursuant to the MHPA "to determine whether there is evidence in the record to justify the hearing court's findings." In re T.T. , 875 A.2d 1123, 1126 (Pa.Super. 2005), citing Commonwealth ex rel. Gibson v. DiGiacinto , 497 Pa. 66, 439 A.2d 105, 107 (Pa. 1981).

The Court in this matter conducted a hearing, reviewed the documents provided, listened to the recording of the hearing before the MHRO several times, considered the statements of [S.M.] at the review hearing, and weighed all the arguments made. Based on the aforementioned, the Court believes there was clear and convincing evidence presented in this case to affirm the MHRO order. [S.M.] has a 20 year history of violent and aggressive behavior, and was not taking her prescribed medication. Thus, she was, at a minimum, a danger to herself. Therefore, the Order entered by this Court should be AFFIRMED .

Opinion, 9/12/16, at 1–2 ("1925(a) Op.") (emphasis in original).

S.M. raises only one issue on appeal: "Was there insufficient evidence presented at the civil commitment hearing to support the Orphan[s'] Court's order of commitment?"³ S.M.'s Br. at 4.

I. The Structure of the MHPA

The MHPA provides for involuntary emergency examination and treatment of persons who are "severally mentally disabled and in need of immediate treatment." 50 P.S. § 7301(a). It then authorizes increasingly long periods of commitment for such persons, balanced by increasing due process protections in recognition of the significant deprivations of liberty at stake. See In re A.J.N. , 144 A.3d 130, 137 (Pa.Super. 2016) (highlighting MHPA's purpose as "an enlightened legislative endeavor to strike a balance between the state's valid interest in imposing and providing mental health treatment and the individual patient's rights") (quoting In re Hutchinson , 500 Pa. 152, 454 A.2d 1008, 1010 (1982) ); In re Ryan , 784 A.2d 803, 807 (Pa.Super. 2001) ("The legislative policy reflected in the [MHPA] is to require that strict conditions be satisfied before a court order for commitment shall be issued. Such a policy is in accord with the recognition that commitment entails a massive deprivation of liberty.") (quoting Commonwealth v. Hubert , 494 Pa. 148, 430 A.2d 1160, 1162 (1981) ). Accordingly, "[i]n applying the [MHPA,] we must take a balanced approach and remain mindful of the patient's due process and liberty interests, while at the same time permitting the mental health system to provide proper treatment to those involuntarily committed to its care." In re S.L.W. , 698 A.2d 90, 94 (Pa.Super. 1997).

Under section 301(a):

A person is severely mentally disabled when, as a result of mental illness, his capacity to exercise self-control, judgment and discretion in the conduct of his affairs and social relations or to care for his own personal needs is so lessened that he poses a clear and present danger of harm to others or to himself.

50 P.S. § 7301(a). Section 301(b)(2) defines "clear and present danger" to oneself⁴ as follows:

Clear and present danger to himself shall be shown by establishing that within the past 30 days:

(i) the person has acted in such manner as to evidence that he would be unable, without care, supervision and the continued assistance of others, to satisfy his need for nourishment, personal or medical care, shelter, or self-protection and safety, and that there is a reasonable probability that death, serious bodily injury or serious physical debilitation would ensue within 30 days unless adequate treatment were afforded under this act; or

(ii) the person has attempted suicide and that there is the reasonable probability of suicide unless adequate treatment is afforded under this act. For the purposes of this subsection, a clear and present danger may be demonstrated by the proof that the person has made threats to commit suicide and has committed acts which are in furtherance of the threat to commit suicide; or

(iii) the person has substantially mutilated himself or attempted to mutilate himself substantially and that there is the reasonable probability of mutilation unless adequate treatment is afforded under this act. For the purposes of this subsection, a clear and present danger shall be established by proof that the person has made threats to commit mutilation and has committed acts which are in furtherance of the threat to commit mutilation.

Id. § 7301(b)(2).

Section 302 provides for emergency examination of persons, which

may be undertaken at a treatment facility upon the certification of a physician stating the need for such examination; or upon a warrant issued by the county administrator authorizing such examination; or without a warrant upon application by a physician or other authorized person who has personally observed conduct showing the need for such examination.

Id. § 7302(a). Under section 302(b), a physician must examine the person "within two hours of arrival ... to determine if the person is severely mentally disabled within the meaning of section 301 and in need of immediate treatment." Id. § 7302(b) (internal footnote omitted). If the physician so finds, then "treatment shall be begun immediately." Id. If not, then "the person shall be discharged and returned to such place as he may reasonably direct." Id. Section 302 allows a person to be committed up to 120 hours. Id. § 7302(d).

When a treatment "facility determines that the need for emergency treatment is likely to extend beyond 120 hours," section 303 provides that the facility may apply to have that involuntary commitment extended up to 20 days. Id. § 7303(a), (h). The facility files an application for such commitment with the court of common pleas, which then appoints an attorney for the person unless it appears "that the person can afford, and desires to have, private representation." Id. § 7303(b). "Within 24 hours after the application is filed, an informal hearing shall be conducted by a judge or ... [MHRO.]" Id. The court or MHRO must keep the record generated by these proceedings for at least one year. Id. § 7303(c)(2). Where the judge or MHRO "determines that extended involuntary emergency treatment is necessary," a "certification shall be filed with the director of the facility and a copy served on the person, such other parties as the person...