In re Jonas H.
| Decision Date | 22 July 2022 |
| Docket Number | Supreme Court No. S-17810 |
| Parties | In the MATTER OF the Necessity for the Hospitalization of JONAS H. |
| Court | Alaska Supreme Court |
George W. P. Madeira, Jr., Assistant Public Defender, and Samantha Cherot, Public Defender, Anchorage, for Jonas H.
Anna Jay, Assistant Attorney General, Anchorage, and Treg R. Taylor, Attorney General, Juneau, for State of Alaska.
Before: Winfree, Chief Justice, Maassen, Carney, and Henderson, Justices. [Borghesan, Justice, not participating.]
A man appeals superior court orders authorizing his involuntary commitment for mental health treatment and the involuntary administration of psychotropic medication, asking us to vacate both orders. He argues that the superior court relied on erroneous facts to find that he was gravely disabled and that the court did not adequately consider the constitutional standards established in Myers v. Alaska Psychiatric Institute before authorizing medication.1 Because the evidence supports the court's finding that the man was gravely disabled, we affirm the commitment order. But we vacate the medication order because the court's analysis of the Myers factors was not sufficient.
In April 2020, Jonas's2 mother petitioned the superior court to order her son hospitalized for evaluation of his mental health. She wrote in the petition that he had been diagnosed with schizophrenia
in 2002 and that his illness had been successfully controlled by medication until he stopped taking it in 2015. Jonas's mother asserted that he "ha[d] progressively gotten worse" and was "[u]nable to take care of his basic needs." The superior court granted the petition the next day, and Jonas was transported to the Alaska Psychiatric Institute (API) for evaluation. A few days later, API filed petitions requesting an order to commit Jonas to API for 30 days and an order authorizing API to involuntarily administer psychotropic medication to Jonas.
In early May, a superior court master held two separate hearings to address the commitment and medication petitions. The court first addressed the commitment petition. Jonas's mother testified about his deteriorating condition. She testified that Jonas's behavior had become "much more erratic" in the past year, he had threatened his father with a knife, and he had started sending her alarming emails. While she once had contact with Jonas every other week, he had largely stopped communicating with her, and she had become afraid to go to his apartment. On the day she filed the petition, she went to his apartment with two police officers, but Jonas did not answer the door. She said she went inside the apartment because she "was afraid that he had killed himself." She testified she was "shocked" because there were "[h]oles in every door[,] ... holes punched in every wall, [and] garbage everywhere," as well as signs that Jonas had lit fires inside the apartment.
Jonas's mother also testified that she and other family members did not feel safe around Jonas. In response to questioning, she explained that she deposited money into Jonas's account every month and paid for his apartment but that she would not lease a different apartment for Jonas because she was afraid of the damage he would do. She stated that she did not believe Jonas could provide food or housing for himself if she did not help him, that he had a car but he would not use it, and he had taken apart his cell phone. And she was not aware of any friends and family who would be willing to help him.
The State then called Jonas's treatment provider from API. She testified that Jonas had one prior admission to API and had been diagnosed with schizoaffective disorder
, bipolar type. She testified Jonas was "acutely psychotic," "exhibit[ed] manic symptoms," and had "delusion[s]" such as "believing he [was] God" and "that [his] food [was] drugged." The treatment provider testified that "the severity of his delusions" would "affect his ability to care for himself" and that because he had "no insight into his mental illness ... he probably [wouldn't] be able to ... find help if he need[ed] it." She stated that Jonas's mental illness would interfere with his ability to keep himself safe if he were released. Jonas interrupted her testimony, asserting,
The provider testified that Jonas told her he wanted a new apartment because the current one was "cursed." She had been unable to discuss the process for obtaining a new apartment with Jonas because "usually[ ] the conversation [went] into a tangent about religion." She acknowledged that at API Jonas had been eating all of his meals, had not acted in a violent or unsafe manner, and had been having appropriate interactions with his peers. But she believed he was doing well because API provided his food and prompted him to eat, shower, and socialize. She believed that his condition could improve if he stayed at API and took his medications.
When asked where he would go if he were released from API, Jonas testified:
I would ... go to my address to gather my things. And then I would sort it out from there. I'm not too worried about such things actually. I know there's a shelter. I've actually stayed at the shelter a few nights before when I got locked out of my house ....
He also testified that he was "not worried about walking overnight" and could buy groceries at a gas station.
Jonas testified that his mother had not provided him enough money to live on and that she was cruel to him. He also declared that he "would definitely leave" his apartment because it was cursed and "the curse is tied to the premise[s]." He stated he was getting "a lot more rest" at API "because the house is cursed." When asked what he would do if released, he responded,
The master made findings on the record. The master found that Jonas's mother had testified she could not provide him an apartment any longer, "especially given the condition that the last apartment was left in." And the master found that Jonas was "very intelligent and very articulate" but had been so focused on "curses and religion," he was not able to discuss "basic discharge planning ... even when it was rephrased in a very simple fashion." The master concluded that Jonas was mentally ill and gravely disabled, and recommended granting the commitment petition.
The master held a hearing on the medication petition the following day. The court visitor3 testified that Jonas was "oriented in all spheres" but that Jonas denied having a mental illness and believed instead that he was "being spiritually attacked." She testified that Jonas had both reasonable and unreasonable objections to medication. Jonas told the visitor that the medication was unhelpful and caused several negative side effects, which the court visitor believed were reasonable objections. But she also stated Jonas had unreasonable objections that the medications made him feel he was "about to ... enter into death" and left him "spiritually threatened"; he also believed that the doctors were "trying to overprescribe him." The court visitor testified that Jonas "exhibited pressured speech," an irrational thought process, and a concern that "people [were] trying to harm him through the administration of medication." The court visitor also testified that Jonas's mother had said while Jonas was living with her, he recognized he needed treatment and had been taking Seroquel
. But his mother told her that after he moved out he had stopped taking medication and decompensated. She concluded that Jonas did not have the capacity to give informed consent.
Jonas's treatment provider again testified. She clarified that although the medication petition contained multiple medications, she would prescribe only one mood stabilizer and one antipsychotic medication at a time. She explained the medications and dosages and how possible side effects would be treated. She testified that she had not been able to have a reasonable conversation with Jonas because he claimed to have "been on all of these medications before" but was
The provider testified that it was "very important" for Jonas to receive treatment and that his treatment needs could not be met without medication. She believed the proposed medication plan was in his best interest because "without medication, there ... [was] no chance" that he would improve. She also stated that Jonas's symptoms were too severe to be treated with just one medication, even one that could act as both a mood stabilizer and an antipsychotic.
Jonas testified that he had taken every medication listed in the petition "extensively." And although he was "desperate to get rid of [his] condition," the medications and side effects "made [him] more dysfunctional than functional." He testified that he had tried to find psychologists to help him, but because they did not have similar religious beliefs they were unable to understand what was psychosis
and what was religion. And he testified that he was not mentally ill, that it was "a spiritual phenomenon" and "not really a problem with the mind."
The State argued that Jonas was not competent to consent to a medication plan because he lacked capacity4 due to his failure to appreciate that he had a mental illness, and that medication was in his best interests because he would otherwise "decompensate and get worse." The State further argued that Jonas did not have capacity to make an informed decision, because he was not rational about his treatment plan despite being intelligent and well-spoken. Jonas...
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