Full Opinion

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON In the Matter of the Detention of: No. 88847-1-I A.C. DIVISION ONE UNPUBLISHED OPINION COBURN, J. — A.C. challenges a superior court’s order committing her to 14 days of involuntary detention and treatment for her mental health disorder. She argues that the superior court’s findings of fact are not supported by sufficient evidence and do not support the conclusion that A.C. is gravely disabled. We disagree and affirm. FACTS A.C. is a 42-year-old woman who holds a master’s degree in library sciences and was previously employed for a couple of months at a learning center in Pullman. In 2022, A.C. completed her third hospitalization for a behavioral health disorder and regularly took her medication upon release. A.C. was scheduled to attend mental health counseling monthly with a mental health counselor she selected. According to I.C. 1, A.C.’s behavioral health regressed as she stopped taking her 1 We refer to A.C.’s mother as I.C., using the initials that reflect her chosen name. 88847-1-I/2 medication, stopped consistently attending counseling, no longer worked, and began having increased symptomatic behaviors. A.C. became more and more confused about things she previously understood. For example, A.C. attempted to put aluminum foil in the microwave oven and forgot how to change the printer cartridge. Her sleeping habits were “off,” and I.C. had to remind A.C. about hygiene and grooming. A.C. began talking to voices “all day long” and “saw things around the house.” According to I.C., A.C. believed she was conversing with CIA 2 agents and with many different boys she accused of sexual abuse. According to I.C. and A.C.’s own testimony, others, including the government, would steal and use her voice. These conversations with voices would cause A.C. to get angry and frustrated. A.C. began to throw dishes, bowls, and books, creating holes all over the house. One time, a year and a half ago, I.C. saw her wooden kitchen chair broken into pieces. Sometime in January 2025, when A.C. was angry, she pushed I.C. after I.C. attempted to stop A.C. from throwing things, injuring I.C.’s back and tailbone. I.C. said she kept her distance from her daughter when she was angry after that incident because I.C. was afraid. In early August 2025, A.C. threw a mug into the kitchen sink, cracking the sink and making the sink leak. Two days later, I.C. found a pot burning on the stove. When she went to locate A.C., she found her “half sleeping and half talking to the voice.” I.C. said she kept asking A.C. to take her medication, but A.C. would tell her she is fine and did not need medication. On August 15, 2025, A.C.’s mother, I.C., called the designated crisis responder 2 Although not specifically identified in the record, it appears from context that “CIA” is in reference to the Central Intelligence Agency. 2 88847-1-I/3 hotline to report that A.C.’s mental state had declined. The same day, the superior court granted the King County designated crisis responder’s petition to commit A.C. for initial involuntary mental health evaluation and treatment. A.C. was subsequently detained and evaluated at Valley Medical Center, MultiCare Auburn Medical Center. A.C. was transferred to Navos Inpatient Services (Navos) the next day. Navos filed a petition for 14 days of involuntary treatment on August 20. The superior court held a probable cause hearing on the 14-day petition. Navos presented testimony from I.C. and Dr. Timothy Miller, a licensed mental health counselor who evaluated A.C. during her initial detention at Navos. A.C. testified on her own behalf. I.C. testified in detail how A.C.’s behavior had declined as her conversations with voices increased. I.C. feared that if her daughter were to not receive treatment, she would “continue all those things,” referring to incidents when A.C. cracked the kitchen sink or left a pot on the burner. Based on his evaluation of A.C. at Navos, Dr. Miller testified to giving A.C. a “working diagnosis” of schizophrenia based on symptoms and behaviors including: delusion, paranoia, anxiety, internal stimuli, confusion, and flat affect. Miller stated that A.C. denied having a mental illness. Miller also disclosed that Navos obtained a compel order for A.C. to take her medications in the hospital due to non-compliance. He also reviewed A.C.’s medical charts from Navos, which included that A.C. denied having a mental illness or need for medication. A.C. told doctors that she did not want to be at Navos and wanted to go home because the people at Navos raped her the last time she was there. A.C. also feared the nurses and staff in her exam room, claiming that Navos is the CIA, who is also raping her. Accordingly, Miller opined that, 3 88847-1-I/4 due to A.C.’s schizophrenia, A.C. poses a substantial risk to others and is gravely disabled. During her testimony, A.C. admitted to throwing a mug into the sink, causing it to leak. A.C. made several nonsensical statements during the hearing while also stating she would continue to take her medications if released. When asked if she thought the medication was necessary for her well-being, A.C. stated, “I think it’s a good idea for me to say I think it’s necessary for my well-being.” The trial court found I.C. and Miller credible and A.C. not credible. Additionally, the court found that A.C. “is a substantial risk of physical harm to others as evidenced by behavior which has caused such harm or which places another person or persons in reasonable fear of sustaining such harm as a result of a mental disorder.” The court also found that A.C. “is gravely disabled [under RCW 71.05.020(25)(b)] 3 showing severe deterioration in routine functioning, evidenced by repeated [and] escalating loss of cognitive and volitional control over his/her actions such that, outside the hospital setting, she would not receive care that is essential to her health and safety.” The court granted Navos’ petition for up to 14 days of continued treatment. A.C. appeals. DISCUSSION Under the Involuntary Treatment Act (ITA), a trial court may order 14 days of involuntary commitment if it finds by a preponderance of the evidence that the person presents a likelihood of serious harm or is gravely disabled. RCW 71.05.240(1), (4)(a); see also In re Det. of A.F., 20 Wn. App. 2d 115, 125, 498 P.3d 1006 (2021). 3 The court did not find A.C. gravely disabled under RCW 71.05.020(25)(a). 4 88847-1-I/5 Appellate review of an involuntary commitment is limited to whether substantial evidence supports the trial court’s findings and whether those findings support the conclusions of law. In re Det. of H.T., 37 Wn. App. 2d 339, 345, 592 P.3d 663 (2026); In re Det. of LaBelle, 107 Wn.2d 196, 209, 728 P.2d 138 (1986). Substantial evidence is enough evidence to persuade a fair-minded person that the premise is true. H.T., 37 Wn. App. 2d at 345. The “burden is on the challenging party to demonstrate that substantial evidence does not support a finding of fact.” Id. (quoting In re Det. of T.C., 11 Wn. App. 2d 51, 56, 450 P.3d 1230 (2019)). We consider the evidence in the light most favorable to the petitioner. In re Det. of A.M., 17 Wn. App. 2d 321, 330, 487 P.3d 531 (2021). We do not review the trial court’s credibility determinations or its weighing of the evidence. In re Det. of A.F., 20 Wn. App. 2d at 125. We reject A.C.’s argument that A.C. did not present a likelihood of serious harm to others because there was no evidence of a recent overt act. A “likelihood of serious harm” means a substantial risk that “physical harm will be inflicted by a person upon another, as evidenced by behavior which has caused harm, substantial pain, or which places another person or persons in reasonable fear of harm to themselves or others.” 4 RCW 71.05.020(37)(a)(ii) (LAWS OF 2025, ch. 226, § 2). The court “shall give great weight” to recent violent acts before the hearing, but it may not rest its finding on past violence alone. RCW 71.05.245(3). “[R]ecent” means within three years of the hearing. RCW 71.05.245(3). A.C. relies on In re Det. of Harris, 98 Wn.2d 276, 284-85, 654 P.2d 109 (1982), to argue that a recent overt act is required to show that A.C. is a substantial risk of 4 The court did not find a substantial risk of physical harm inflicted on the property of another under RCW 71.05.020(37)(a)(iii). 5 88847-1-I/6 physical harm to others. However, Harris explained that imminent danger, such as a recent overt act, is only required for emergency detention rather than at the time of the hearing, because hospitalization itself usually removes any immediate danger. Id. at 282-84; see also LaBelle, 107 Wn.2d at 202-03. A.C. argues that the only recent overt act was the “alleged” pushing of I.C. eight months prior and that A.C. testified that she did not believe it was intentional. There is no requirement that the likelihood of serious harm must only be from intentional acts of harm to another. The trial court found I.C.’s testimony credible. I.C. testified that A.C. pushed I.C. down when I.C. tried to stop A.C. from throwing something. This caused I.C.’s injury to her lower back and tail bone. I.C. now keeps her distance when A.C. throws things. Substantial evidence supports the court’s finding that I.C. continues to avoid A.C. because of fear of her own physical safety. Substantial evidence supports that A.C. presented a substantial risk of harm to others. A.C. next argues that substantial evidence does not support the trial court’s finding that she is gravely disabled under RCW 71.05.020(25)(b). A person is gravely disabled under RCW 71.05.020(25)(b) if, as a result of a behavioral health disorder, the person “manifests severe deterioration from safe behavior evidenced by repeated and escalating loss of cognitive or volitional control over his or her actions and is not receiving such care as is essential for his or her health or safety.” RCW 71.05.020(25)(b) (LAWS OF 2025, ch. 226, § 2). “RCW 71.05.020(25)(1)(b) permits the State to treat involuntarily those discharged patients who, after a period of time in the community, drop out of therapy or stop taking their prescribed medication and exhibit rapid deterioration in their ability to function 6 88847-1-I/7 independently.” LaBelle, 107 Wn.2d at 206 (internal quotation marks omitted). The petitioner must show recent, significant loss of cognitive or volitional control, and a factual basis to conclude that the person would not receive essential care if released. Id. at 208. The deterioration must also leave the person unable to make a rational decision about treatment. Id. That requirement supplies the link between illness and lack of care. Id. Mental illness alone is not enough, and treatment must be essential rather than merely beneficial. Id. at 201, 208. Prior hospitalization is not required. H.T., 37 Wn. App. 2d at 349-50, 352. The record supports that A.C. was well educated and previously had a job but that she stopped taking medication and has decompensated where she talks to voices nonstop that led to an escalating loss of cognitive and volitional control over her actions. I.C. must remind A.C. regarding her personal hygiene. A.C. also engaged in dangerous behavior when trying to complete routine functions like feeding herself. This was exhibited by A.C. attempting to put aluminum in the microwave and leaving a pot burning on the stove while in her bedroom talking to voices. Though A.C. testified that she was willing to take medication, she was only taking medication in the hospital under an order to compel, and the court did not find her testimony credible. Dr. Miller testified that A.C. lacks insight into her diagnosis. During the hearing A.C. continued to exhibit delusional thinking. Substantial evidence supports the trial 7 88847-1-I/8 court’s findings, which support its conclusion that A.C. was gravely disabled. CONCLUSION 5 We affirm. WE CONCUR: 5 A.C. takes issue with a testy exchange between her counsel and the trial judge that stemmed from counsel declining to stipulate to the admissibility of medical records as business records. Counsel deferred to the court as to the records’ admissibility. Counsel then refused to answer, unless ordered to do so, the court’s question as to how long counsel had been practicing in the ITA court. A.C. does not assert that the trial court was biased against A.C. or that its exchange with counsel caused an adverse impact on the outcome of the hearing. A.C.’s appeal is not the proper forum to address general complaints of the trial judge demeaning defense counsel. We need not address this further. 8