North Carolina Psychiatric Commitment Law, Part II

Adventures in Destroying Intangible Property

This is a sequel to Part I of my meandering through North Carolina’s psychiatric commitment laws. Part I laid out my philosophy behind why I think it is useful and morally relevant for psychiatrists to read and understand commitment laws, and then walked through the entry of voluntary patients into the system. You should probably start by reading that first.

This part will be focused on the involuntary side of things and I think will be more interesting to non-physician readers.

I will also repeat my disclaimer from my last essay:

I am not a lawyer. I have no formal legal training. I listen to Supreme Court arguments, the Advisory Opinions podcast, and have gotten semi-familiar with Massachusetts civil commitment and healthcare proxy laws as a hobby. Please do not read this and assume that my interpretations are correct and then make legal decisions based off of them.

When I quote the text of various statutes and their chapters, articles, subsections, etc. I will try and make it clear which statute I am referring to so you can read the primary text itself. There is no bolding, all caps, or italicization used in the original text, so when you see it, assume that I did it.

I will also be omitting parts of the text that are not useful to the conversation; things like “an advanced practice registered nurse authorized to practice as such under regulations promulgated pursuant to section 80B of said chapter 112.”

If you want to follow along, check my work, or just read the law for yourself, North Carolina General Statute, Chapter 122C (aka the Mental Health, Developmental Disabilities, and Substance Abuse Act of 1985) is the statute I will be talking about here. Specifically, we will be pulling from Article 5, Parts 6, 7, and 8; we will also be talking a lot about Article 1, Section 122C-3, which holds the definitions for Chapter 122C.

Part 6 - Involuntary Commitment - General Provisions

There’s not much to comment on here aside from §122C-252, which partially answers a previous question from Part 1 on how facilities are designated. (blah, blah, blah’s mine)

State facilities, 24-hour facilities licensed under this Chapter or hospitals licensed under Chapter 131E may be designated by the Secretary as facilities for the custody and treatment of involuntary clients. Designation of these facilities shall be made in accordance with rules of the Secretary that assure the protection of the client and the general public. blah, blah, blah…

I did a cursory search to see if I could find any of these rules… but I couldn’t and I’m not terribly interested in chasing them down, so I’m just gonna move on.

Part 7 - Dangerousness. You Just Need To Be A Little Clairvoyant

§122C-261

§122C-261 provides rules for requests for involuntary commitment when “immediate hospitalization is not necessary.” More on what that means later, since we’re going to get immediately sidetracked here thanks to this first bit of §122C-261(a):

Anyone who has knowledge of an individual who has a mental illness AND is either (i) dangerous to self, as defined in G.S. 122C-3(11)a., or dangerous to others, as defined in G.S. 122C-3(11)b., or (ii) in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness, …

I already addressed North Carolina’s definition of mental illness in the last essay, so I will just remind the reader that it is so expansive that meeting its definition is trivial, and will drop the full text in the following footnote.¹ I will also include a case called In the Matter of Michael Charles Hayes that I did not come across until the writing of this part, but offers an excellent discussion regarding the definition of mental illness in the context of North Carolina’s legal system.

I think this text really needs to be rewritten to say (bolded italics are my additions):

Anyone who has knowledge of an individual who has a mental illness AND in whom it is found reasonably likely that, due to their mental illness, is either…

I think that this idea is implied in context, but I don’t like implication in my laws. Why do I care about this? Well, I don’t think that every example of extreme behavior can be lain at the feet of “mental illness.” Just because you have an anxiety disorder doesn’t mean that it’s the source of the murderous rage you feel towards your wife’s newly discovered paramour, and definitely does not mean that you need to be psychiatrically hospitalized. That is — as we say — outside of our scope of practice.

A Detour Back To §122C-3(11)(a)’s Definitions

Now we have to jaunt back up to §122C-3(11)(a) to figure out what exactly this “dangerous to self or others” language means. I will first reproduce in full, and then break it down (NB: (a)(1)(a) and (a)(1)(b) here are supposed to be (a)(1)(I) and (a)(1)(II), but Substack’s formatting can’t be changed):

a. Dangerous to self - Within the relevant past, the individual has done ANY of the following:

1. The individual has acted in such a way as to show ALL of the following:

   1. The individual would be unable, without care, supervision, and the continued assistance of others not otherwise available, to exercise self-control, judgment, and discretion in the conduct of the individual's daily responsibilities and social relations, or to satisfy the individual's need for nourishment, personal or medical care, shelter, or self-protection and safety.

   2. There is a reasonable probability of the individual's suffering serious physical debilitation within the near future unless adequate treatment is given pursuant to this Chapter. A showing of behavior that is grossly irrational, of actions that the individual is unable to control, of behavior that is grossly inappropriate to the situation, or of other evidence of severely impaired insight and judgment shall create a prima facie inference that the individual is unable to care for himself or herself.

2. The individual has attempted suicide or threatened suicide and that there is a reasonable probability of suicide unless adequate treatment is given pursuant to this Chapter.

3. The individual has mutilated himself or herself or has attempted to mutilate himself or herself and that there is a reasonable probability of serious self-mutilation unless adequate treatment is given pursuant to this Chapter.

Previous episodes of dangerousness to self, when applicable, may be considered when determining reasonable probability of physical debilitation, suicide, or self-mutilation.

Honestly, it’s not terrible! Fairly readable, and with numbered lists!² Still, let’s go chunk by chunk here:

Within the relevant past, the individual has done ANY of the following:

What does “relevant past” mean? I can’t find any clear case law on that question, though in the half-dozen cases I’ve read, nobody has contested that any evidence/testimony presented at trial about historical behavior has fallen outside of the “relevant past”. I think this is probably fine to approach common-sensically: the farther in the past something happens, the more attenuated its relevance to the current situation, but the more severe a previous behavior, the less it is attenuated by time.

§122C-3(11)(a)(1)(I)

Ok, splitting out 1(I) first.

1. The individual has acted in such a way as to show ALL of the following:

   1. The individual would be unable, without care, supervision, and the continued assistance of others not otherwise available, to exercise self-control, judgment, and discretion in the conduct of the individual's daily responsibilities and social relations, or to satisfy the individual's need for nourishment, personal or medical care, shelter, or self-protection and safety.

What, exactly, does it mean to “be unable… to exercise self-control, judgement, and discretion in the conduct of [an] individual’s daily responsibilities and social relations”? I see what is being reached for, but as written it’s hard to see how this wouldn’t apply to anyone who does something inadvisable. Think about a person — we all know one — who just cannot seem to stop making stupid, terrible, sometimes dangerous relationship choices. Think about me, who just cannot exercise the self-control necessary to not eat the entire bag of chips before my wife has had any, resulting in considerable marital strife!³ This is just another reason that I think the behavior(s) in question must be reasonably tied to a person’s mental illness.

Similarly, it’s not so clear what it means to “satisfy individual’s need for nourishment, [etc.]…” I would argue that the word “need” here indicates that this is not merely just what is advisable, but close to the bare minimum necessary.

A Brief Aside on Social Relations

I do want to highlight something relatively unusual here, the inclusion of “social relations” as a concept. Prior to reading §123C I’d never seen a commitment statute that mentioned anything besides the risk of bodily harm, but much of the damage is done through the destruction of social relationships and support systems. I remember one patient in particular whose mania resulted in him become estranged from his wife and young children and caused him to lose his job as a very successful professional. His mania would eventually resolve, but his relationships could not be repaired.

I struggle with whether or not severe risk to social relations should be permitted to be included as a reason for commitment. I neither question that patients suffer serious, often irreparable harm to their social lives, nor that such harm is likely to worsen long-term outcomes. Indeed, strong social supports are usually a sine qua non of effective treatment for the severely ill. However, I cannot see how you write legislation that avoids lending itself to indefinite commitment periods without being so narrow as to be functionally useless.

To illustrate the dilemma, consider borderline personality disorder. A hallmark of borderline behavior is intense interpersonal conflict coupled with an extreme fear of abandonment. This often results in repeated breakups/divorce, estrangement from close friends/family/children, and idealization of abusive and violent partners. If we kept the sort of broad language used in the NC statute, I think it would be relatively easy to argue that borderline patients are at such a risk of causing severe, irreparable harm to their social lives that they simply cannot be released until they have undergone years of psychotherapy and social-skills training. Really, you could apply the same argument to most other personality disorders and most schizophrenics.

I think you might be able to solve this problem by adding wording that only allows hospitalization for this reason in episodic conditions like bipolar disorder. Though, defining “episodic conditions” again gets me asking the question “is this really something we want the legal system to decide?”

§122C-3(11)(a)(1)(II)

For all of the time I’ve spent on (1)(I), it’s (1)(II) that is the most important prong of our two-part analysis:

II. There is a reasonable probability of the individual's suffering serious physical debilitation within the near future unless adequate treatment is given pursuant to this Chapter. A showing of behavior that is grossly irrational, of actions that the individual is unable to control,⁴ of behavior that is grossly inappropriate to the situation, or of other evidence of severely impaired insight and judgment shall create a prima facie inference that the individual is unable to care for himself or herself.

Before we talk about what the first sentence means, I think it will be helpful for me to clarify how the North Carolina Supreme Court (NCSC) has interpreted what the second sentence is doing here.

You would be forgiven for assuming that the second sentence is in some way related to the first.⁵ You know, because it’s in the same subsection and comes right after the first sentence. That said, it looks like it was supposed to be at the end of (1)(I), doesn’t it? And since we are (obviously) sophisticated readers, with very good reading comprehension and the ability to use context clues, the second sentence’s inclusion in (1)(II) must mean that the behaviors/lack of insight that it describes serve as prima facie evidence that the individual faces a reasonable probability of suffering serious physical debilitation, right? RIGHT?

No, idiot.

The NCSC interpretation, since at least In re: Monroe (1980), treats the first sentence of 1(II) as laying out an independent prong of the inquiry. Basically, you should just move the second sentence up to 1(II), and read 1(II) as:

II. There is a reasonable probability of the individual's suffering serious physical debilitation within the near future unless adequate treatment is given pursuant to this Chapter.

That solves… a little bit, at least. We still need to figure out where the boundaries are for “reasonable probability” and “near future,” though. Fortunately, there is a decent amount of precedent on exactly these questions from the NCSC.

An Ultrabrief Primer on How US Courts Are Structured

Let me quickly explain some terminology, especially for non-US readers, so you can understand what I’m talking about here.

First, it is important to know that — except for the state of Louisiana — justice systems in the United States are based on a common law approach. In very simple terms, this means that when judges determine “what the law is” they are required to give great deference to previous judicial decisions in cases on the same or a similar question (stare decisis), even if there could be multiple different legally rational outcomes.

This is in contrast to civil law, where judges look to legal codes enacted by a legislative body, which describe general principles of law, rights and entitlements, and how basic legal mechanisms work instead of addressing specific fact based scenarios. Notably, civil law systems do not incorporate the idea of case law or legally binding precedent.⁶

Courts in the US can generally be separated into trial courts and appellate courts. Trial courts are what you see when you watch legal dramas on TV. They are courts of first impression. That is, they are where cases are first heard, evidence is presented, witnesses are called, and a judge and/or jury decides the case.

Appellate courts are where you go to complain about legal errors that happened in trial court. Here, lawyers argue not to a jury, but to a panel of judges who decide particular questions of law. It is important to note that appellate courts do not answer questions of fact; there do not review new evidence, hear new witnesses, etc.

US state courts exist in a multi-level hierarchy, where lower courts are required to defer to precedent from higher courts in their decision making. In North Carolina, that hierarchy looks like this:

Source: Ballotpedia.

Appeals from either of the two trial courts (district and superior) go to the North Carolina State Court of Appeals,⁷ whose decisions in turn can be appealed to the North Carolina Supreme Court. The NCSC has the final say on all matters of state law.⁸

Reasonable Probability, Nexus Requirements, and NCSC Case Law

I think In re: C.G. (2022) is quite on-point here. Following an order for involuntary commitment, C.G. argued that “…the trial court's written findings of fact failed to support its conclusion that [C.G.] was mentally ill and posed a danger to himself so that he could be involuntarily committed…”

In its opposing argument, the State of North Carolina attempted to argue that the trial court’s findings about C.G. were sufficient to show that there was a “reasonable probability of serious physical debilitation.” Those findings were (here in an abbreviated form):

• C.G. was acutely psychotic

• C.G. was not taking care of his “dental” and “nourishment” needs

• C.G.’s ACT team⁹ said he was not taking his medication and that they felt they could not care for him in the community

• That C.G. “lives with a person with anger issues … and that he has, in fact, become a victim of assaultive behavior and disturbing thoughts, which caused deterioration and leaves him unable to perceive dangers to himself resulting in his being assaulted.”

• He met the first prong of the danger-to-self inquiry (i.e. he showed deficiencies in self-care)

The NCSC rejected the state’s argument. You can read the full reasoning here, but this quote sums up the central idea:

The trial court's findings, as written, cannot be deemed sufficient to support a determination that respondent posed a danger to himself given its failure to find that there was "a reasonable probability of [respondent] suffering serious physical debilitation within the near future" unless he was involuntarily committed.

There is a reading of this decision that goes something like this: The NCSC’s holding is actually quite narrow. It did not say that trial court could not have shown that that the facts before it would place the respondent at risk for serious physical debilitation within the near future. It only said that the trial court’s findings “as written” did not properly demonstrate how the facts before it would lead to that same risk.

I think that’s a very, how do I put this… lawyerly way of reading the opinion. I’d like to show you why that’s a possible — but I think pretty clearly incorrect — reading of the decision.

We start with the NCSC referencing a decision of the NC Court of Appeals, In re: Monroe (1980). In this case, the trial court found that Monroe (a schizophrenic) was a danger to himself and others because: he became “uncontrollable at times,” his sleep was irregular, he was standing in his front yard making “all kinds of loud noises [and] calling inappropriately to anyone passing by,” and he disregarded his nutritional needs by “fasting for some periods and then eating a whole chicken or a whole loaf of bread” and that he “[ate] about five pounds of sugar every two days.” The Court of Appeals held that:

…neither the facts recorded by the trial court nor the record supports a conclusion or ultimate finding of dangerousness to self…

on the basis that

even if indicative of some danger, the facts do not support the finding that there is a reasonable probability of serious physical debilitation to the [r]espondent within the near future.

The NCSC points out that even though these findings demonstrated a deficiency in self-care, the statute “mandates a specific finding of a probability of serious physical debilitation resulting from the more general finding of lack of self-caring ability.”

The NCSC also references another case from the Court of Appeals, In re: Whatley (2012), in which “the trial court's findings reflect respondent's mental illness, but they do not indicate that her illness or any of her aforementioned symptoms will persist and endanger her within the near future.”

There are yet more examples in the C.G. opinion, but I think you get the gist. The bottom line is that:

1. Symptoms of mental illness alone — even acute psychosis — do not demonstrate a “reasonable probability of the individual's suffering serious physical debilitation.”

2. The NCSC understands the word “serious” in the phrase “serious physical debilitation” to mean just that. Mild/moderate negative effects from poor judgements cannot be used to assume that a serious physical debilitation will follow.

3. NCSC requires the trial court to “draw a nexus between past conduct and future danger.”

Fortunately for me, this is already pretty close to how I practice, but I think this is a much stricter standard than is typically applied. In my experience — particularly with psychosis and mania — psychiatrists are quick to make the argument that the symptoms themselves are evidence of significant risk in the near-future. We look at the consequences many of these patients face from their untreated illness, imagine ourselves in that position, and see lack of treatment as headed towards a catastrophic outcome. And, hey, over the long-term, for most patients that is where things are headed… but, BUT! the law (at least in NC) does not permit us to involuntarily hospitalize patients because we think their lives are headed for catastrophe, unless that catastrophe happens to involve “serious physical debilitation within the near future.”

To be fair to the “narrow” reading of the C.G. decision I outlined above, there has been a case from the NC Court of Appeals In re: D.H. (2023) that appears to approve of such a reading. To my eyes, the evidence from the trial court in D.H. is much the same as the cases reviewed above; it showed that the patient was psychotic (he was experiencing delusions, paranoia, hearing voices, and behaving strangely), but the evidence did not give any specific examples about how these symptoms would put D.H. at risk. Still, the Court of Appeals upheld the commitment order, reasoning:

The trial court then directly linked Respondent's inability to care for himself based on his past behavior and current symptoms to a risk of future harm: “If released from Wake[B]rook in this current condition, Respondent's inability to care for himself makes it reasonably probable that he would suffer serious physical debilitation within the near future.” In so finding, the trial court appropriately drew the requisite “nexus between [R]espondent's past conduct and future danger.” C.G., 383 N.C. at 249, 881 S.E.2d at 551

I think this would probably be overturned by the NCSC if it went up on appeal, but I looked at the NCSC docket and previous orders and it doesn’t seem to have been appealed.

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122C-3(11)(a)(2) & (3)

I’m going to package 122C-3(11)(a)(2) & (3) together here, because they say the same things except with the word “mutilitation” swapped out for “suicide”:

2. The individual has attempted suicide or threatened suicide and that there is a reasonable probability of suicide unless adequate treatment is given pursuant to this Chapter.

3. The individual has mutilated himself or herself or has attempted to mutilate himself or herself and that there is a reasonable probability of serious self-mutilation unless adequate treatment is given pursuant to this Chapter.

There is not much case-law I have found on this topic, except for In re: C.C. (2018), which is a pretty boring case¹⁰ in which a 15 year-old tells his psychiatrists that he is suicidal, has attempted suicide, will try and do so again, and is not going to take any useless medication thank you very much. He then turns around and argues that the trial court did not find sufficient evidence that he was a danger to himself to commit him. He loses, unsurprisingly.

“Mutilation” is not defined, and I was wondering if it might sweep in minor self-harm (e.g. cutting, burning). It’s not defined in the statute, though, and dictionary definitions universally define it as severe bodily harm (e.g. destroying, removing, or severely damaging a limb), so I don’t think superficial cutting is going to get us there.

122C-3(11)(b) - Dangerous to Others

We’ve reached a whole second letter of the alphabet. Thrilling!

122C-3(11)(b) provides the following definition for “dangerous to others”:

Within the relevant past, the individual has inflicted or attempted to inflict or threatened to inflict serious bodily harm on another, or has acted in such a way as to create a substantial risk of serious bodily harm to another, or has engaged in extreme destruction of property; and that there is a reasonable probability that this conduct will be repeated. Previous episodes of dangerousness to others, when applicable, may be considered when determining reasonable probability of future dangerous conduct. Clear, cogent, and convincing evidence that an individual has committed a homicide in the relevant past is prima facie evidence of dangerousness to others.

I noticed that the North Carolina statute differs in an important way from the Massachusetts statute I’m familiar with in an important way. See if you can spot the difference:

a substantial risk of physical harm to other persons as manifested by evidence of homicidal or other violent behavior or evidence that others are placed in reasonable fear of violent behavior and serious physical harm to them.

The key thing here is that the NC statute does not care about the perceptions of others.

Readers still in possession of their neocortex will be unsurprised to hear that mentally ill people tend to do things that people find frightening, intimidating, and threatening. Imagine a schizophrenic that believes that today (and every day) is the day in which the FBI and the CIA will finally make good on their subliminal messaging to murder everyone in town, and so they run around telling people about how they will be murdered, that they must flee, that they have come to tell you about the murder that will be happening to them, very soon now. They also might mention that they have a knife in their pocket, which they decline to mention is purely for their own protection, because why bother stating the obvious?

You can see how this might not come off well.

In Massachusetts, I think this fact pattern clearly demonstrates that someone would be placed in “reasonable fear” of violent behavior and serious physical harm.

In North Carolina, though, I would argue that nothing in this individual’s behavior constitutes either an “[attempt] to inflict or [a threat] to inflict serious bodily harm" in the absence of some other behavior. The schizophrenic in my example is not threatening, but warning!

That’s just my first impression, though. Let’s see what the case law has to say.

I Literally Just Said What This Section Would Be

NB: In all of these cases, the individual is always clearly mentally ill, so I’m going to just skip over that part of things and talk about the dangerousness determination.

First, a pretty easy one from the NC Court of Appeals, In Re: O.L. (2020), which concerned an intellectually disabled schizophrenic who was committed on the day he was released from prison after serving a murder sentence. The petitioning psychiatrist argued that the following facts satisfied the criteria for dangerousness to others:

• Commitment of a homicide in 2007

• Engaging in violent conduct while in prison (for the murder)

• “recently” threatening to kill a nurse while psychiatrically hospitalized

The trial court granted the commitment order, with which the NC Court of Appeals agreed.

In re: D.G. (2022) is an appeals case in which the appellant “won” by which I mean the appeals court sided with the appellant by saying this:

In the instant case, the record contains evidence that would allow a reasonable trier of fact to find Respondent was a danger to herself or others…. The trial court's findings of fact were insufficient to warrant Respondent's involuntary commitment… The trial court failed to make findings that a reasonable probability of some future harm existed to Respondent or others, absent Respondent's commitment… Accordingly, we vacate the Order and remand the matter to the trial court to allow for entry of additional findings of fact to support its ultimate findings, without the need to take additional evidence or hold additional hearings.

I am not fluent in legalese, but I think this roughly translates to:

Hey trial court. Buddy! Friend! Listen, it kinda seems like you had… uh, how do we put this nicely… everything you needed to find D.G. dangerous to herself and others. In fact, we think this is so obvious that we are going to do you a solid and explicitly tell you that there’s no need to take additional evidence or hold additional hearings, because we wouldn’t want anyone to have to do any more pointless extra work. That’d be pretty annoying, huh? So, why don’t you give this one another go with a little more, I dunno… attention to detail? You know, so we never have to hear about this again? Thanks, champ.

What did the Court of Appeals see in the record that was so obvious, you might ask? Well, D.G. engaged in a high-speed police chase wherein she “hit two vehicles, attempted to ram the law enforcement vehicle that pulled her over, and had to be tased after resisting arrest. Respondent was brought to the Duke University Hospital Emergency Department by the Durham Police Department.” Two days later (after eloping?? being released????) she “hit two vehicles on a highway, almost hit two officers on foot, and threatened to shoot officers.”

In re: T.S. (2022) helps to give a little more clarity because this time the patient actually wins, not just “wins.” In this case, the Court of Appeals found that the following facts were insufficent to establish a finding of danger to others:

• T.S. was screaming, cussing, and yelling at her psychiatrist

• She threatened to sue the psychiatrist

• She refused to take a COVID-19 test during an outbreak on the psychiatric unit

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Property -or- That Word Doesn’t Mean What You Think It Means

I can’t find a lot on what counts as “extreme destruction of property.” This is unfortunate, because it is clear that this can be the sole reason for commitment.

There is one case (that of course I can no longer find) that includes the burning of a couch outside as one of the relevant facts contributing to a properly ordered commitment, so that’s at least some indication of what “extreme” means.

Here’s the interesting thing about the word property though. In common usage, we typically think of property as referring to tangible property: books, furniture, cellphones. In the legal context, though, property has a much more expansive definition:

Property is anything (items or attributes/tangible or intangible) that can be owned by a person or entity.

Intangible property includes familiar and obvious things like patents, stocks, and technical data; however property also includes less familiar things like trade secrets, brand recognition, and business reputation.

Consider an individual with bipolar disorder who runs a successful, well known, well respected business and enters a manic episode. He becomes quite hypersexual and begins calling up all of his business associates and propositioning them for sex. He also develops bizarre and grandiose delusions about the products his company sells and believes that it would only be proper to sell them to Muslims because other religious adherents are subhuman filth who are not worthy of their power. To advertise this fact, he takes out several social media advertisements with his company’s name in big bold letters, a drawing of the Prophet Muhammad (that he made), and advertising copy that very clearly explains just how disgusting he finds non-Muslims.

Has this individual engaged in “extreme property destruction? Can he be involuntarily hospitalized?

Advanced “Winning”

Before I wrap Part II up, I want to continue beating this horse here on the ground come back to why I think psychiatrists have a duty to understand the contours of the law here. The harm that a patient suffers when they are involuntarily committed unlawfully is immediate.

You might assume that these appeals cases go up quickly — after all, they need to be addressed within the (relatively) short commitment period… right? Here are the cases I discussed above, the month and year in which the commitment order was issued, and the month and year in which the Court of Appeals’ decision was handed down:

In re Monroe: Order: Nov. 1979 — Decision: Oct. 1980
In re Whatley: Order: Jan. 2012 — Decision: Dec. 2012
In re C.C.: Order: Dec. 2016 — Decision: Feb. 2018
In re O.L.: Order: Nov. 2018 — Decision: April 2020
In re D.G.: Order: April 2021 — Decision: June 2022
In re D.H.: Order: April 2022 — Decision: April 2023

I don’t think a single one of these decisions were handed down during the patient’s original commitment period.

This is an advanced form of “winning” — getting a ruling in your favor more than a year after you were involuntarily hospitalized. Now, there can be some real and meaningful benefits to overturning a commitment order, but it seems like it’s a pretty hollow victory to me.

You might wonder if there are civil damages available. Not really! Remember that 122C gives pretty much everyone involved in the process immunity from liability except in cases of gross negligence, or when a commitment was unlawful, malicious, and corrupt. Unless the person doing the commitment is cartoonishly evil and keeps a notebook with the title “My Malicious Commitments: Locking The Mentally Ill Up For Profit Fun” you’re just not going to convince a judge or jury that the person in question was trying to do anything other than their job.

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I didn’t expect to need a Part III, but I think this is a good place to stop and digest before we jump back in to the rest of the text of 122C’s Part 7. Thanks for reading!

1. When applied to an adult, an illness which so lessens the capacity of the individual to use self-control, judgment, and discretion in the conduct of the individual's affairs and social relations as to make it necessary or advisable for the individual to be under treatment, care, supervision, guidance, or control.

2. Take notes Massachusetts

3. Seriously, she just buys the flavors that I don’t actually like so I don’t eat them.

4. How, exactly, do you should that someone is “unable to control” their actions in the context of a psychiatric illness?

5. I certainly did!

6. Generally. There are many countries that have legal systems that are a hybrid of civil and common law.

7. There are some edge cases not worth mentioning in the body of this essay. Criminal cases at the District Court level proceed to the Superior Court on appeal before reaching the Court of Appeals. Death penalty cases in the Superior Court go directly to the NCSC, which can also choose to take any case directly from the lower courts if it finds it necessary to prevent delay.

8. Except in rare cases where there are conflicts with federal law, I believe

9. A community treatment team that often will meet patients at their houses, manage their medications, bring them to appointments, provide them with financial support, etc.

10. I mean in terms of outcome, don’t be silly