Commitment of N.N., Matter of

• Decision Date: 05 August 1996
• Citation: 146 N.J. 112,679 A.2d 1174
• Parties: In the Matter of the COMMITMENT OF N.N., Appellant.
• Court: New Jersey Supreme Court

Page 112

146 N.J. 112

679 A.2d 1174

In the Matter of the COMMITMENT OF N.N., Appellant.

Supreme Court of New Jersey.

Argued Jan. 16, 1996.

Decided Aug. 5, 1996.

Theodore S. Novak, Managing Attorney, argued the cause, for appellant (Susan L. Reisner, Public Defender, attorney; Mr. Novak and Stanley M. Shur, Staff Attorney, on the brief).

Daisy B. Barreto, Deputy Attorney General, argued the cause, for respondent, Attorney General of New Jersey (Deborah T. Poritz, Attorney General, attorney; Joseph L. Yannotti, Assistant Attorney General, of counsel).

The opinion of the Court was delivered by

HANDLER, J.

In this case, a fifteen-year-old girl was involuntarily committed to a psychiatric hospital because of conduct problems including an assaultive episode with another youth. She initially entered a psychiatric hospital for a seven-day examination. The examining psychiatrist attributed her condition to a mood imbalance amounting to a type of mental illness, and recommended a continued commitment. The court reviewing her commitment found that she did not present a threat of danger to herself or to others.

The Court's rule, under which the girl was committed, provides that a minor may be involuntarily committed if a court finds that the minor is in need of therapy that cannot be provided anywhere but in a psychiatric hospital. The issue in this case is whether the standard governing the involuntary commitment of minors, which does not require that the minor suffer from a mental illness that poses a danger to self or others, is unconstitutional.

I

In November of 1994, N.N., a fifteen-year-old, was arrested after an altercation in which she allegedly assaulted another youth with a box cutter. N.N. claimed that she was being harassed by the other youths, and stated that she acted in self-defense.

N.N. was charged with juvenile delinquency and spent approximately one month at the Atlantic County Detention Center (hereinafter "Harborfields"). On December 6, 1994, N.N. signed a request for voluntary admission to the Bridgeton Hospital because the judge in the juvenile proceeding wanted her to have a seven-day evaluation. The court did not issue a detainer requiring her presence at Bridgeton nor mandating her return to Harborfields after the seven-day examination.

N.N. had previously received psychiatric therapy during a month-long inpatient stay at the Child Guidance Clinic in Philadelphia in June and July of 1993. There are no records of her diagnosis from this clinic, although it is asserted that this treatment was due to N.N.'s "depression and poor impulse control." N.N. also had problems at school. She was expelled from Catholic school for yelling at a nun; she repeated the ninth grade, due to "family problems," and attended an alternative school for a time.

Apparently, N.N. did not exhibit any behavioral incidents or problems while at Bridgeton Hospital. No psychiatric medication was prescribed for her prior to her admission to Bridgeton Hospital, and none was administered during her seven days in the hospital.

N.N. believed that she would be returning home with her mother after the seven-day evaluation, and would subsequently attend a partial care program. The hospital's family therapist had made arrangements for outpatient referrals and follow-up care for N.N. following her discharge. However, when N.N. was told that her psychiatrist at the hospital, Dr. Williams, recommended that she stay at least another week, N.N. became tearful, started to curse, slammed the door and kicked a water fountain. However, N.N. did not hit or threaten anyone during this episode.

At a hearing reviewing the voluntary admission, the examining psychiatrist, Dr. Williams, noted that N.N. had requested to go home, thereby revoking her voluntary status under statutory and regulatory standards. N.J.S.A. 30:4-27.20; R. 4:74-7(k). Dr. Williams testified that he would attempt to obtain a temporary order for involuntary commitment, and a hearing for involuntary commitment was scheduled in the Superior Court, Law Division, Gloucester County. The trial court then conducted a hearing to determine whether N.N. should be involuntarily committed. N.N. testified that the episode lasted less than five minutes, and that she calmed down as soon as she was told to calm down. The doctor offered her medication to quiet her, but N.N. refused. The patient progress notes for that night indicate that N.N. was "placed in the quiet room for her own protection," but that she "was able to calm down and come out of the quiet room" and there were "[n]o suicidal tendencies noted" for that night.

Dr. Williams regarded this outburst not as an episode caused by the stress of being told to remain in the hospital, but rather as the product of a mental illness that he diagnosed as a "conduct disorder" and post-traumatic stress disorder. Dr. Williams described this as a disturbance of mood, but not as a disturbance of thought, perception or orientation. The diagnosis of post-traumatic stress disorder related to an incident that N.N. recounted in her therapy session with Dr. Williams, in which N.N. was "gang-raped" by a group of five adolescents when she was eight years old. The doctor noted that N.N. "faulted herself for the rape" and kept this to herself until she was admitted to the Child Guidance Clinic program.

Generally, Dr. Williams felt that N.N. had poor impulse control and was "volatile" in the sense of having a "labile affect": she could be "very changeable, rather whimsical, based on something [internal] irregardless [sic] of what you might expect from the environment." The doctor conceded that he did not mean "volatile" in the sense of "out of control." The doctor believed that N.N. suffered from a "substantial disturbance of mood perception," which would have qualified her for commitment under the adult standard of mental illness.

Dr. Williams also felt that N.N.'s symptoms were not more severe only because she was in a protected environment. He expressed concern that N.N. would injure herself or another person if she were not receiving inpatient care. He stated that if stressed, "she will fall apart and lose her judgment; and, as long as she is not stressed and her needs are met, she can be quite cooperative." The doctor reported that if N.N. were involuntarily committed, she could receive individual and group therapy in a secure, locked-ward environment, "within ... total control and authority."

The doctor felt justified in seeking involuntary commitment, because in his opinion N.N. met both the "dangerousness" standard and the alternative "in need of intensive psychiatric therapy" standard necessary for involuntary commitment. The doctor stated that he would pursue involuntary commitment even if N.N.'s mother were to object to her continued institutionalization.

The trial court found that N.N. had a "disturbance of mood" evidenced by her behavior the night before the hearing. The court noted that the psychiatrist had characterized this behavior as being "out-of-control." However, the court declined to find that N.N. could be committed under the "dangerousness" standard. Instead, the court found that N.N. should be committed because she needed "inpatient, intensive attention," and because "she is subject to, or she did display, or does have a disturbance [of mood]." The trial court specifically declined to make a finding regarding whether N.N.'s mother consented to the commitment.

The Public Defender appealed the case to the Appellate Division, and then petitioned for certification of the appeal pending unheard. This Court granted certification. 142 N.J. 442, 663 A.2d 1352 (1995).

II

The United States Supreme Court has recognized that juveniles subject to involuntary commitment have significant liberty interests and are entitled to due process protections. Parham v. J.R., 442 U.S. 584, 601, 99 S.Ct. 2493, 2504, 61 L.Ed.2d 101, 118 (1979). "Because commitment effects a great restraint on individual liberty," this Court has stated that "this power of the State is constitutionally bounded," and its exercise must "comply with due process." In re S.L., 94 N.J. 128, 137, 462 A.2d 1252 (1983) (citations omitted). The fundamental issue posed by this appeal relates to the standard that must be followed by the State when it exercises its power to commit involuntarily a minor to an institution for psychiatric treatment. The issue is of constitutional dimension.

The standards governing civil commitment are provided by statute at N.J.S.A. 30:4-27.1 to -27.23, and in the current Rules of Court, Rule 4:74-7. The issue in this case involves the provisions for involuntary commitment contained in the Rules at R. 4:74-7(f). That rule specifies the commitment standard applicable to adults:

The court shall enter an order authorizing the involuntary commitment of an adult patient if it finds, by clear and convincing evidence presented at the hearing that the patient is in need of continued involuntary commitment by reason of the fact that (1) the patient is mentally ill, (2) mental illness causes the patient to be dangerous to self or dangerous to others or property as defined in N.J.S.A. 30:4-27.2h and -.2i, (3) the patient is unwilling to be admitted to a facility for voluntary care, and (4) the patient needs care at a short-term care or psychiatric facility or special psychiatric hospital because other services are not appropriate or available to meet the patient's mental health care needs.

[Ibid.]

The involuntary commitment of a minor is governed by an alternative standard, viz Alternatively, if the patient is a minor, the order may be entered if the court finds that the patient is in need of intensive psychiatric therapy that cannot practically or feasibly be rendered in the home or in the community or on an outpatient basis.

[Ibid.]

That alternative standard (hereinafter also referred to as the "necessary-treatment" standard) omits any need...