In the Matter of N.W., Alleged to be seriously Mentally Impaired

IN THE COURT OF APPEALS OF IOWA
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No. 25-0687
Filed January 7, 2026
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In the Matter of N.W.,
Alleged to be seriously Mentally Impaired,
v.
N.W.,
Respondent–Appellant.
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Appeal from the Iowa District Court for Dubuque County,
The Honorable Thomas A. Bitter, Judge.
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AFFIRMED
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Bridget L. Goldbeck of Hughes & Trannel, P.C., Dubuque, attorney for
appellant.

Brenna Bird, Attorney General, and Sarah A. Jennings, Assistant Attorney
General, attorneys for appellee.
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Considered without oral argument
by Ahlers, P.J., and Chicchelly and Sandy, JJ.
Opinion by Chicchelly, J.

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CHICCHELLY, Judge.

N.W. appeals a district court order finding she is seriously mentally
impaired and involuntarily committing her for treatment. On appeal, N.W.
argues the district court erred in finding she was likely to (1) physically injure
herself and (2) inflict serious emotional injury on members of her family.
Upon our review, we affirm.

BACKGROUND FACTS AND PROCEEDINGS
In March 2025, N.W. came to the attention of the Dubuque Police
Department (DPD). DPD became involved when N.W. posted a picture from
a shooting range after a January 2025 hospital admission. While DPD officers
were correct that N.W. was hospitalized in January 2025, they were mistaken
that she was involuntarily committed.

Thereafter, officers encountered N.W. at her residence where she
reported her roommate was poisoning her and her son. But N.W.’s son told
DPD that they had contracted norovirus and were not poisoned. Later N.W.
reported her roommate for practicing witchcraft. N.W. also made several
complaints against police officers.

N.W.’s son told DPD during another visit to the home that N.W. was
not in compliance with her prescription medication. N.W. called DPD
dispatch regarding this visit and stated that DPD officers had gone into the
bathroom while her son was showering.

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Based on the totality of these interactions, DPD filed an application
alleging N.W. was a danger to herself and others and lacked judgmental
capacity due to serious mental impairment.1

N.W. was ordered to the custody of MercyOne Hospital where a
psychiatrist evaluated her. During this time, N.W. refused to provide a test
for substance use. Because of that refusal, the hospital was unable to
determine if N.W. was suffering from substance-abuse psychosis or bipolar
disorder. So, the doctor diagnosed her with “unspecified psychotic
disorder.”

At a hearing on DPD’s application, the doctor testified N.W.
“definitely had manic and psychotic symptoms” during her time at the
hospital. He also stated N.W. was responsive to treatment but was a danger
and needs continued treatment. The magistrate found N.W. was suffering
from a psychotic disorder and was a danger based on her inability to make
rational decisions and ordered N.W. involuntarily committed on an
outpatient basis.

N.W. appealed the magistrate’s decision to the district court. After a
hearing, the district court confirmed the magistrate’s findings and found by
clear and convincing evidence that if N.W. was “not properly treated, she is
a danger to herself and others.” N.W. was ordered to continue treatment on
an outpatient basis. N.W. now appeals.

STANDARD OF REVIEW
Challenges to the sufficiency of the evidence in involuntary
commitment proceedings are reviewed for correction of errors at law. In re
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DPD based its application in part on the January 2025 commitment, but that fact
was mistaken.

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V.H., 996 N.W.2d 530, 536 (Iowa 2023). “The allegations made in an
application for involuntary commitment must be proven by clear and
convincing evidence.” In re B.B., 826 N.W.2d 425, 428 (Iowa 2013). “Clear
and convincing evidence” means that “there must be no serious or
substantial doubt about the correctness of a particular conclusion drawn from
the evidence.” Id. (citation omitted). The district court’s findings of fact
“are binding on us if supported by substantial evidence.” V.H., 996 N.W.2d
at 536 (citation omitted).

DISCUSSION
N.W. argues the district court erred in finding she was likely to
(1) physically injure herself and (2) inflict serious emotional injury on
members of her family. A person who has a “serious mental impairment”
may be committed involuntarily “for a complete psychiatric evaluation and
appropriate treatment.” Iowa Code § 229.13(1) (2025). The definition of
serious mental impairment in section 229.1(22) has three elements. See V.H.,
996 N.W.2d at 543. The respondent must be found to (1) have a mental
illness; and, because of that illness, (2) lack sufficient judgment to make
responsible decisions with respect to hospitalization or treatment, and
(3) meet any of the following four grounds:
a. Is likely to physically injure the person’s self or others if allowed to
remain at liberty without treatment.

b. Is likely to inflict serious emotional injury on members of the person’s
family or others who lack reasonable opportunity to avoid contact with the
person with mental illness if the person with mental illness is allowed to
remain at liberty without treatment.

c. Is unable to satisfy the person’s needs for nourishment, clothing,
essential medical care, or shelter so that it is likely that the person will
suffer physical injury, physical debilitation, or death.

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d. Has a history of lack of compliance with treatment and any of the
following applies:

(1) Lack of compliance has been a significant factor in the need for
emergency hospitalization.

(2) Lack of compliance has resulted in one or more acts causing
serious physical injury to the person’s self or others or an attempt to
physically injure the person’s self or others.

Iowa Code § 229.1(22). The third element is known as the “endangerment
element,” which we have said is necessary to justify the significant
deprivation of personal liberty that results from a civil commitment. In re
L.E.B., No. 14-0989, 2015 WL 7575399, at *2 (Iowa Ct. App. Nov. 25, 2015).
N.W. only challenges the third element, so we confine our review to the
sufficiency of the evidence supporting the district court’s endangerment
finding. See In re M.D., No. 24-1083, 2025 WL 408635, at *3 (Iowa Ct. App.
Feb. 5, 2025).

The third element requires N.W. must meet one of four criteria of
dangerousness. Iowa Code § 229.1(22)(a)–(d). The endangerment element
“requires the threat the patient poses to herself or another be evidenced by a
recent overt act, attempt, or threat.” V.H., 996 N.W.2d at 543 (cleaned up).
“The element requires a predictive judgment, based on prior manifestations
but nevertheless ultimately grounded on future rather than past danger.” Id.
(citation omitted). “Behavior that is socially unacceptable, standing alone,
does not satisfy the overt act requirement.” L.E.B., 2015 WL 7575399, at *3
(citing In re Mohr, 383 N.W.2d 539, 542 (Iowa 1986)). Instead, the “‘overt
act’ must indicate ‘past aggressive behavior or threats’ that manifest ‘the
probable commission of a dangerous act’ by the respondent ‘that is likely to
result in physical injury.’” V.H., 996 N.W.2d at 544 (quoting In re Foster, 426
N.W.2d 374, 378 (Iowa 1988)). “Stringent proof under the dangerousness

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standard is necessary because predicting dangerousness is difficult and, at
best, speculative.” Foster, 426 N.W.2d at 377–78. Upon our review of this
record, we find the evidence is sufficient to establish the dangerousness
element.

The district court found N.W. met both (1) a likelihood to “physically
injure the person’s self or others if allowed to remain at liberty without
treatment” and (2) a “likelihood to inflict serious emotional injury on
members of the person’s family or others who lack reasonable opportunity to
avoid contact with the person with mental illness if the person with mental
illness is allowed to remain at liberty without treatment.” Id. § 229.1(22)(a),
(b). The district court adopted the fact findings of the magistrate as follows:
The psychiatrist testified she is a danger based on her inability to make
rational decisions upon her admission. This is respondent’s second
admission this year. She presented with manic and psychotic symptoms
upon admission. She was unwilling on both admissions to give a UA to rule
out drug or alcohol induced psychosis. She was very disorganized and
paranoid upon admission. She has a number of conspiracy theories about
those around her. She believes the law enforcement is targeting her. She
has previously required restraints. Upon her admission [N.W.] was not in
a state to take care of her basic needs. She has become more stable over
the course of her admission, but she continues to adhere to paranoid
conspiracy theories. Officer Nugent testified that he has been working
with Respondent and her family since November to address respondent’s
paranoia, mania, and belief in conspiracy theories. Approximately two
weeks ago he received calls for service regarding Respondent over disputes
with her son and roommates claiming that there were attempts to poison
her son. She made continued calls for service. She was posting photos of
herself at a shooting range, using hand guns and making statements about
the police department and other individuals.

We find these factual findings are supported by substantial evidence and so
we are bound by them. See V.H., 996 N.W.2d at 536. The record before us
demonstrates N.W. could not take care of herself or her sixteen-year-old

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child. The psychiatrist’s testimony that she could not take care of her basic
needs endangered the physical and emotional health of herself and her child
who relied on his parent for his basic needs. In re C.B., No. 22-2089, 2023
WL 3092076, at *3 (Iowa Ct. App. Apr. 26, 2023) (discussing an expressed
reluctance to take medication and reliance on another for food, shelter, and
medical compliance as recent overt acts). Additionally, the need for
restraints upon her admission to the hospital and the lack of impulse control
is an overt act which demonstrates a likelihood to physically injure herself
See In re R.K., No. 23-2001, 2024 WL 3517879, at *4 (Iowa Ct. App. July 24,
2024) (“R.K.’s history of aggression and her consistent lack of impulse
control does not suggest that the court erred in finding she is likely to
physically injure herself or others; in fact, it proves the opposite.”).

Further, the district court found that N.W’s conduct demonstrated a
likelihood to inflict serious emotional injury on members of the person's
family or others. See Iowa Code § 229.1(22) (requiring the respondent to
“meet[ ] any of the following criteria” (emphasis added)). We consider
whether there is substantial evidence in the record to show a person is likely
to inflict serious emotional injury on others who cannot avoid contact with
the person if the person is allowed to remain without treatment. See In re
C.D., No. 16-1491, 2017 WL 706389, at *3 (Iowa Ct. App. Feb. 22, 2017).
Our court has previously stated, “Emotional injury is not precisely
delineated, but it would include, for example, serious disruption of family
relations leading to depression or nervous breakdown of family members,
physical violence on the part of others, or medically diagnosable
complications.” In re J.K., No. 15-1621, 2016 WL 3002811, at *5 (Iowa Ct.
App. May 25, 2016) (quoting Randall Bezanson, Involuntary Treatment of
the Mentally Ill in Iowa: The 1975 Legislation, 61 Iowa L. Rev. 262, 302
(1975)).

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Based on our review, we agree that there is sufficient evidence to show
N.W. posed an emotional risk to her son supported by an overt act. The
recent overt act may be an act, attempt, or threat. See Mohr, 383 N.W.2d at
542. At the outset, we find N.W’s son cannot avoid contact with her. N.W.
is his primary caretaker, and his father has passed away. At sixteen years old,
it is not possible for him to wholly avoid contact with his mother. Further,
this record demonstrates that N.W poses a risk of serious emotional injury to
her son. N.W.’s discussion of a number of conspiracy theories about those
around her including that her roommate had positioned N.W. and her son
pose a risk of serious emotional injury to her son. See C.D., 2017 WL 706389,
at *3–4 (“The evidence showed the serious emotional harm the child
suffered and was likely to suffer in the future, which was causally connected
to the mother’s statements [about conspiracy theories].”). Additionally, she
believes the law enforcement is targeting her which has led to near daily law
enforcement contacts in their home. Law enforcement officers observed “a
lot of conflict between her family and her.” All of these instances
demonstrate circumstances which pose a likelihood of serious emotional
injury to N.W’s son. J.K., 2016 WL 3002811, at *5 Accordingly, we affirm
the district court’s finding that N.W’s conduct demonstrated a likelihood to
inflict serious emotional injury to her son.

CONCLUSION
Because substantial evidence supports the district court’s finding that
N.W. is likely to physically injure the person’s self or others if allowed to
remain at liberty without treatment, we affirm.

AFFIRMED.

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