In Re The Detention Of: A.m.d-l.

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
In the Matter of the Detention of
A.M.D-L.
No. 85138-1-I
DIVISION ONE
UNPUBLISHED OPINION
CHUNG, J. — The court issued a 180-day involuntary commitment order for
A.M.D.-L., a teenager with a history of severe mental health issues and
substance use. A.M.D.-L. claims the court erred by determining that involuntary
commitment was the only option because evidence supports that he would
voluntarily enter inpatient treatment. However, testimony by A.M.D.-L., his
mother, and a psychiatric nurse practitioner provided substantial evidence to
support the court’s findings that A.M.D.-L. did not want inpatient treatment and
would not voluntarily enter inpatient treatment. The 180-day involuntary
commitment was the only means of ensuring A.M.D.-L. would receive the
necessary treatment. Therefore, we affirm.
FACTS
A.M.D.-L. is a teenager who struggles with severe mental health issues
including major depressive disorder, unspecified substance use disorder,
unspecified disruptive impulse control disorder, autism spectrum disorder, and

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attention deficit hyperactivity disorder. He lives with his mother in Section 8
housing.
A.M.D.-L. has a history of suicide attempts and drug overdoses resulting
in hospitalizations. In August 2022, A.M.D.-L. overdosed on fentanyl at home.
First responders administered Narcan and transported him to Seattle Children’s
Hospital (SCH). After discharge from the hospital, A.M.D.-L. left drug
paraphernalia by a garden outside the family’s apartment. When his mother and
a social worker confiscated the items, A.M.D.-L. screamed about wanting to kill
himself and then grabbed a knife from the kitchen and chased them. A.M.D.-L.
“started crying that he wanted to commit suicide, that he wanted to die.”
On September 23, 2022, A.M.D.-L. was voluntarily admitted to SCH’s
Psychiatry and Behavioral Medicine Unit (PBMU) “because he was a danger to
himself and others.” By early November 2022, A.M.D.-L. was no longer willing to
remain hospitalized voluntarily. On November 8, 2022, a designated crisis
responder filed a petition for initial detention of a minor, alleging continuing
“aggressive, violent, and risky behaviors.” A.M.D.-L. “threatened to harm others,
caused property destruction, was physically violent with staff, tried to harm
himself, and he continues to lack insight into his behaviors.” He tested positive
for THC1 with suspected use of substances while hospitalized. SCH petitioned for
14 days of involuntary treatment on November 15, 2022. A.M.D.-L. agreed to the
14-day commitment on December 22, 2022.
1 Tetrahydrocannabinol.

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Because SCH’s PBMU is a crisis stabilization unit that typically treats
patients for seven to 10 days, it does not have the capacity for “more
longstanding, ongoing work.” However, A.M.D.-L. was denied from “essentially
every referral” for treatment programs—both in Washington and out of state—
due to “the significance and severity” of his behavior. SCH was working to
transition A.M.D.-L. to the Children’s Long-term Inpatient Program (CLIP) facility
for treatment, including family engagement and a “step down process” to
integrate back into the community.
SCH subsequently petitioned on December 30, 2022, for 180-day
involuntary treatment, alleging “an extensive history of psychiatric
hospitalizations, high lethality suicide attempts, violent behaviors towards self
and others, and property destruction.” A.M.D.-L. also continued to exhibit drug-
seeking behavior while hospitalized, “as evidenced by [a] recent attempt to
smoke his medication when he gained access to a lighter.”
After hearing testimony from a psychiatric nurse practitioner from SCH’s
PBMU, A.M.D.-L., and his mother, the trial court granted the petition for 180 days
of involuntary treatment. A.M.D.-L. appeals.
DISCUSSION
Medical professionals from the Inpatient Psychiatry Unit of SCH filed a
petition for 180-day involuntary treatment of A.M.D.-L. For a 180-day
commitment of a minor:
The court must find by clear, cogent, and convincing evidence that
the minor:
(i) Is suffering from a mental disorder or substance use disorder;

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(ii) Presents a likelihood of serious harm or is gravely disabled; and
(iii) Is in need of further treatment that only can be provided in a
one hundred eighty-day commitment.
RCW 71.34.750(6)(a). Clear, cogent and convincing evidence “means the
ultimate fact in issue must be shown by evidence to be ‘highly probable.’ ” In re
Det. of LaBelle, 107 Wn.2d 196, 209, 728 P.2d 138 (1986). “Generally, where the
trial court has weighed the evidence, appellate review is limited to determining
whether substantial evidence supports the findings and, if so, whether the
findings in turn support the trial court’s conclusions of law and judgment.” Id.
Substantial evidence is evidence sufficient to persuade a fair-minded person that
the premise is true. In re Det. of A.M., 17 Wn. App. 2d 321, 330, 487 P.3d 531
(2021). For the clear, cogent and convincing standard, the findings must be
supported by substantial evidence in light of the “highly probable” test. LaBelle,
107 Wn.2d at 209. We evaluate the evidence in the light most favorable to the
petitioner, the State. A.M., 17 Wn. App. 2d at 330.
A.M.D.-L. does not contest the court’s findings that he suffers from a
mental disorder2 and presents a likelihood of serious harm. Nor does he argue
that treatment other than inpatient care at CLIP is appropriate. Rather, A.M.D.-L.
challenges the court’s determination that a 180-day commitment order was the
only available option to ensure necessary treatment. According to A.M.D.-L., the
180-day order “was not the ‘sole’ or ‘exclusive’ option” because “the record
demonstrates voluntary treatment was a viable option.” A.M.D.-L. supports this
2 The court found that A.M.D.-L. “suffers from behavioral health disorders.” A “behavioral
health disorder” means a mental health disorder or substance use disorder as defined by RCW
71.34.020, or co-occurring mental and substance use disorders. RCW 71.34.020(9).

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argument with evidence from the record that he filled out the CLIP voluntary
application, indicated he was looking forward to the CLIP program, repeatedly
asked for updates on his application, and expressed hope that he could move to
CLIP soon.
The court determined that “a less restrictive treatment alternative is not
appropriate nor in Respondent’s best interests because the evidence shows he is
too symptomatic to comply and would be unable to keep himself safe, which
does not bode well for compliance with a less restrictive treatment order at this
time.” The court noted that A.M.D.-L. had said that he did not want any more
treatment. In assessing A.M.D.-L’s expressed desire to go to CLIP, the court was
“not convinced that he would actually—when a CLIP bed become[s] available,
voluntarily go . . . if he’s released from the hospital at this time and waiting a
bed.” The court based this conclusion on testimony from A.M.D.-L.’s mother and
the nurse practitioner.
The nurse practitioner testified that A.M.D.-L’s expressions of intent to
enter CLIP voluntarily have been “very back and forth.” She said, “There has
been expression of going voluntarily. There’s always been numerous statements
about not needing further treatment.” In fact, the day before the commitment
hearing, A.M.D.-L. told the nurse-practitioner he “didn’t need any more
treatment.” He also said that felt he was mentally stable and that ongoing
treatment was not necessary. When the nurse-practitioner told A.M.D.-L. of her
concerns about his high-risk behavior, including suicide attempts, A.M.D.-L
responded that the behavior happened in the past and he would not be engaging

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in the behavior moving forward. The nurse-practitioner testified that “the
message that [A.M.D.-L.] was telling me is that ongoing treatment following the
hospital wasn’t necessary.” A.M.D.-L.’s mother testified that similarly, A.M.D.-L.
told her “that he just wants to see his friends and have fun with his friends, and
he doesn’t seem to think that he needs any more treatment. He thinks that he’s
gotten all the help he needs at Children’s Hospital, PBMU.” The nurse-
practitioner noted concern that if A.M.D.-L. “were to go voluntarily, that [he] would
also leave voluntarily very quickly.”
A.M.D.-L. expressed to the court that he did not want to be “held against
my own will.” He testified that he was willing to go to CLIP and would continue his
application to CLIP if he were released. But A.M.D.-L.’s testimony demonstrates
that he was resistant to inpatient treatment in general. He said he would continue
to pursue CLIP but “I’m not going to like it.” A.M.D.-L. said, “I feel like I should be
given more options” and wanted to explore other outpatient treatment. His
explanation for self-harming behavior while inpatient at SCH provided insight into
his preference for outpatient care: “I feel trapped inside of here and I feel like it’s
just not good for me to be not in my life. I’m just stuck here against my own
will . . . .”
Because CLIP—whether entered voluntarily or involuntarily—is an
inpatient facility, while there, A.M.D.-L. would again “be not in [his] life.” Even if at
points A.M.D.-L. indicated he would go voluntarily, testimony from all three
witnesses, A.M.D.-L., his mother, and the nurse practitioner, demonstrates that
A.M.D.-L. was resistant to inpatient treatment and provides substantial evidence

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for the court’s finding that A.M.D.-L. would not voluntarily go to CLIP for inpatient
treatment. Given A.M.D.-L.’s history of, and continued resistance to, voluntary
treatment, the court properly concluded that a 180-day involuntary commitment
was the sole option to secure A.M.D.-L. the treatment he needs.
Affirmed.
WE CONCUR: