In Re The Detention Of: B.L.R.

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
DIVISION II
In the Matter of the Detention of: No. 53904-7-II
B.L.R.,
Appellant.
UNPUBLISHED OPINION
CRUSER, J. — BLR appeals a trial court order extending his involuntary commitment for
an additional 180 days of mental health treatment with a less restrictive alternative. BLR argues
that the petition to continue his involuntary treatment did not make the requisite prima facie
showing that as a result of a behavioral health disorder, he presents a substantial likelihood of
committing acts similar to the charged criminal behavior. In addition, BLR argues that the trial
court’s conclusion that he continued to be gravely disabled was not supported by its factual
findings.
We hold that the trial court did not err when it extended BLR’s involuntary commitment
for an additional 180 days in a less restrictive alternative placement. We hold that the petition
made a prima facie showing that BLR continues to suffer from a behavioral health disorder that
results in a substantial likelihood of him committing acts similar to the charged conduct. We further
hold that the trial court’s conclusion that BLR continues to be gravely disabled was supported by
its factual findings.
Accordingly, we affirm.
Filed
Washington State
Court of Appeals
Division Two
March 2, 2021

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FACTS
BLR, who is 30 years old, has a schizoaffective disorder and has experienced symptoms of
a mental health condition since early childhood and adolescence. The schizoaffective disorder has
caused BLR to experience somatic delusions, such as a belief that he suffers from a seizure
disorder, and persecutory delusions stemming primarily from a perception of antagonistic
treatment by his family. BLR has also displayed circumstantial and rigid thinking with occasional
episodes of mood lability. BLR has received mental health treatment at various facilities and has
been admitted to Western State Hospital on five occasions.
BLR’s fifth admission to Western State Hospital occurred following an incident in which
BLR repeatedly struck and choked his father. BLR, who had been living with his father at the time,
was charged with one count of malicious harassment and one count of second degree assault. BLR
was found incompetent to stand trial, and after two attempts at competency restoration at Western
State Hospital, the trial court found BLR non-restorable, and the charges against him were
dismissed without prejudice.
BLR’s examining mental health professional and examining physician petitioned for 180
days of involuntary treatment, alleging that BLR was gravely disabled and that due to BLR’s
mental health condition, he posed a substantial likelihood of repeating acts similar to the violent
felony with which he was charged. The trial court found that BLR had committed acts constituting
the charged felonies. The trial court concluded that involuntary treatment was warranted for both
reasons alleged by the petitioners, and BLR was civilly committed for 180 days. Following a
second petition for involuntary treatment, BLR was recommitted for an additional 180 days.
Before the second period of involuntary treatment expired, Western State Hospital
psychologist Jordan Charboneau, Ph.D. and psychiatrist Greg Longawa, M.D., petitioned for an

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additional 180 day extension. The petition alleged that BLR continued to be gravely disabled and
that due to his mental health condition, BLR continued to present a substantial likelihood of
repeating acts similar to the violent felony offense with which he was charged.
While the declaration in support of the petition described some improvement in BLR’s
behavior, noting that BLR has maintained cognitive and volitional control, it also stated that BLR
“continued to exhibit symptoms of mental illness, including mood lability and agitation,
persecutory and somatic delusions, thought disorganization, poor motivation, as well as notably
impaired insight and judgment.” Clerk’s Papers (CP) at 82. In particular, BLR expressed paranoia
regarding his parents and his treatment team, including persecutory beliefs related to the reasons
for his commitment and the events involved in the charged offense. The declaration further
illustrated BLR’s lack of “insight and judgment regarding his mental health symptoms, the
difficulties that have resulted from such symptoms, and his need for ongoing treatment and mental
health services.” CP at 83. The petitioners described BLR’s consistent refutation of his mental
health diagnosis and his resistance to ongoing treatment. During an interview with Doctors
Charboneau and Longawa, BLR expressed that he could stop his medications without any impact
to his behavior, denying that the medications were helpful to him.
The petitioners’ declaration detailed the difficulty in constructing a safe discharge plan for
BLR due to his limited insight into his own condition. BLR was ambivalent toward the idea of
residing in “structured and supported housing,” and expressed his preference for being discharged
to a “homeless shelter or [to a] small house community.” 1 Verbatim Report of Proceedings (VRP)
Aug. 27, 2019 at 134; CP at 85. BLR was resistant to applying for Supplemental Security Income
(SSI) because it would require him to agree with his mental health diagnosis and it would “prevent
him from gun ownership, something he believed he was entitled to.” CP at 85.

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The doctors noted that due to BLR’s ongoing symptoms, and in particular his “impaired
insight, and persecutory ideation,” BLR’s release presented a “risk of psychiatric decompensation
and violence in the community.” CP at 90. The declaration described BLR’s “difficulty
maintaining stability in the community previously due to noncompliance with treatment,”
observing that BLR was in his “fifth admission to [Western State Hospital].” CP at 90. For these
reasons, the petitioners expressed their belief that due to his mental health condition, BLR
presented a substantial likelihood of repeating behavior similar to that which led to the felony
charges.
At a hearing on the petition, BLR did not present his own expert. Over BLR’s objection,
the trial court found that the petition presented prima facie evidence that BLR’s mental health
condition results in a substantial likelihood of him committing acts similar to those charged.
Dr. Charboneau testified consistently with the facts as stated in the petitioners’ declaration
supporting the petition. Dr. Charboneau expounded that BLR does not have difficulty with
activities of daily living and that BLR is generally able to maintain cognitive and volitional control
with no violent or assaultive episodes since his commitment. However, Dr. Charboneau clarified
that BLR’s persecutory delusions were less impactful on his behavior within the ward because the
delusions did not involve other patients. Emphasizing his particular concern that BLR lacked
insight into his own condition and the risk that BLR would cease taking his medications and
decompensate in an unstructured environment, Dr. Charboneau believed BLR should remain at
Western State Hospital and that he should not be released to a less restrictive alternative placement.
BLR also testified at the hearing. He explained that his intent on discharge would be to find
temporary residence at a homeless shelter until he could secure sufficient income to stay at a clean
and sober house. For income, he intended to find minimum wage employment and expressed that

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he would not accept SSI because he did not believe he had a mental health condition. BLR stated
that he would take his medication in injection form upon release.
The trial court granted the petition to extend BLR’s involuntary treatment for 180 days,
concluding that BLR continued to present a likelihood of repeating acts similar to the charged
criminal behavior and that BLR continued to be gravely disabled. It found by clear, cogent, and
convincing evidence that “though he ha[d] substantially improved over time,” BLR met the
standard for grave disability under former RCW 71.05.020(22)(b)1 (2019). 1 VRP Aug. 27, 2019
at 148.
In support of its decision, the trial court emphasized BLR’s history, his multiple admissions
to mental health treatment facilities, his ongoing symptoms, and his denial that he has a mental
health condition. The trial court also expressed a concern that if BLR were released to an
unstructured environment, he would cease taking medication and decompensate.
Contrary to the petitioner’s recommendation, however, the trial court believed that BLR
was ready for a less restrictive alternative placement. Because BLR had been participating in
treatment and showing improvement, the trial court believed that BLR could function in less
restrictive placement, so long as the environment was “highly structured.” CP at 144; 1 VRP Aug.
27, 2019 at 149. The trial court emphasized, however, that “WITHOUT CLEAR STRUCTURE
AND OVERSIGHT, THE COURT BELIEVES [BLR] WOULD LIKELY DECOMPENSATE.”
CP at 144 (emphasis in original).
1 Under former RCW 71.05.020(22)(b), a person continues to be gravely disabled if, as a result of
a behavioral health disorder, that person “manifests severe deterioration in routine functioning
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.” We note that the
language in RCW 71.05.020 is the same in both the former (22)(b) and current (23)(b) versions of
the statute.

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BLR appeals the recommitment order extending his involuntary treatment for 180 days at
a less restrictive alternative placement.
DISCUSSION
I. SUBSTANTIAL LIKELIHOOD OF COMMITTING A SIMILAR ACT TO THE CHARGED BEHAVIOR
BLR argues that the petition to extend his involuntary commitment failed to present prima
facie evidence that he continues to suffer from a behavioral health disorder that results in a
substantial likelihood that he will commit acts similar to the charged offense. BLR asserts that
although he continues to experience symptoms of his mental health condition, the petition showed
that he did not act violently while in treatment and that he maintained cognitive and volitional
control with only mild episodes of mood lability. Because, according to the petition, BLR’s
symptoms had not manifested in a recent violent episode, BLR asserts that it failed to make the
requisite showing that there was a substantial likelihood that he would commit an additional
violent act on release.
The State responds that BLR’s history, his lack of understanding regarding the reason for
his commitment, and his continued denial of his mental health condition constitute prima facie
evidence that BLR is likely to repeat acts similar to the charged behavior. The State denies that a
petition must describe a violent episode while in treatment to constitute sufficient prima facie
evidence, explaining that the lack of an episode might have more to do with the setting than an
improvement in BLR’s condition.
The petition presented sufficient prima facie evidence that BLR poses a substantial
likelihood of repeating acts similar to the charged conduct. While BLR did not exhibit violent
behavior in treatment and showed signs of improvement, the State presented sufficient prima facie

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evidence based on BLR’s lack of insight into his condition and the circumstances that caused him
to become involuntarily committed.
A. LEGAL PRINCIPLES
Upon finding that an individual is incompetent to stand trial for a felony charge, all charges
shall be dismissed without prejudice, and the individual must “undergo a mental health evaluation
for civil commitment and treatment.” In re Det of M.W., 185 Wn.2d 633, 642, 374 P.3d 1123
(2016) (citing former RCW 10.77.086(4) (2013)). Involuntary commitment is imposed on a short-
term periodic basis, and the committed individual must be released at expiration of the treatment
period unless a new petition for involuntary treatment is filed. Former RCW 71.05.320(4) (2018);
M.W., 185 Wn.2d at 642.
When initially seeking involuntary treatment for an individual found incompetent to stand
trial for felony charges, “[t]he State must prove that ‘as a result of a mental disorder, [the person]
presents a substantial likelihood of repeating similar acts.’” M.W., 185 Wn.2d at 642 (quoting
former RCW 71.05.280(3) (2013)). And where the underlying charge is classified as a violent
felony, the trial court must make an affirmative determination as to whether the individual
committed acts that constitute a violent felony under RCW 9.94A.030. Id. (citing former RCW
71.05.280(3)(b)).
After the initial treatment period expires, if the State seeks recommitment, it may file a
new petition asserting one of the grounds listed in RCW 71.05.280. Id. When seeking
recommitment of an individual who has been previously found to have committed an act
constituting a violent felony under RCW 71.05.280(3)(b), the State must satisfy its initial burden
of presenting a petition that sets forth prima facie evidence that “the person continues to suffer
from a behavioral health disorder or developmental disability that results in a substantial likelihood

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of committing acts similar to the charged criminal behavior.” Former RCW 71.05.320(4)(c)(ii).
Prima facie evidence is “evidence that is ‘sufficient’ to sustain a judgment.” M.W., 185 Wn.2d at
657 (quoting Murphy v. Immigration & Naturalization Serv., 54 F.3d 605, 610 (9th Cir.1995)).
“If the State fails to meet this burden, then the petition will be dismissed, and the person is
released unless the State can proceed on alternative grounds for recommitment.” Id. at 644. But
where the State’s petition presents sufficient prima facie evidence, “then the individual may rebut
the State's showing by presenting ‘proof through an admissible expert opinion that the person's
condition has so changed such that the mental disorder or developmental disability no longer
presents a substantial likelihood of the person committing acts similar to the charged criminal
behavior.’” Id. (quoting former RCW 71.05.320(3)(c)(ii) (2013)).
If the individual does not present any expert opinion in rebuttal, then the court will extend
the individual’s commitment for an additional 180 days. Id. If the individual does produce an
expert opinion, then the court will hold a full evidentiary hearing. Id. at 656. Regardless of whether
the committed individual presents any rebuttal evidence, the State retains the burden of proving
the grounds asserted for recommitment by clear, cogent, and convincing evidence. Id. at 657.
B. APPLICATION
Here, at the initial petition hearing, the trial court made a special finding under former
71.05.280(3)(b) (2018) that BLR committed acts that constituted a violent felony. Therefore, on
seeking to extend BLR’s involuntary commitment for an additional 180 days, the State was
required to present a petition setting forth prima facie evidence that as result of BLR’s mental
health condition, BLR posed a substantial likelihood of committing acts similar to the charged
crimes. Former RCW 71.05.320(4)(c)(ii) (2018).

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The State’s petition set forth facts that were sufficient to satisfy its initial burden. In
particular, the State’s petition described BLR’s lack of insight regarding the incident that resulted
in the criminal charges and in his subsequent commitment. The petition recounts multiple
statements BLR made denying that he had engaged in any violent acts against his father and
asserting that his parents and Western State Hospital imposed involuntary treatment under false
pretenses. The State’s petition further noted that BLR consistently refused to acknowledge that he
had a mental health condition. Moreover, BLR told the petitioners on numerous occasions that he
did not think the medications were helpful or necessary. Due to this lack of insight, the petitioners
stated that BLR presented a substantial risk of stopping his medications and decompensating on
discharge. The petition detailed BLR’s history of prior involuntary admissions to Western State
Hospital and explained that because BLR had “difficulty maintaining stability in the community
previously due to noncompliance with treatment,” his lack of insight was of particular concern.
CP at 90.
While the petition did not refer to a recent violent incident, BLR does not identify any
support for his assertion that to extend involuntary treatment under former RCW
71.05.320(3)(c)(ii), a recent act of violence must be alleged. Moreover, to the extent that BLR
relies on his recent symptomatic improvement while in treatment, this evidence indicates the
efficacy of the treatment setting for BLR, but it does not countervail concerns raised in the petition.
Primarily, the fact that BLR has shown improvement while in a structured, supervised environment
at Western State Hospital does not dispel the evidence that BLR’s lack of insight into his condition
creates a substantial likelihood of decompensation once he is no longer in such an environment.
Therefore, between BLR’s history of multiple admissions for involuntary treatment, coupled with

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his lack of insight, the petition set forth sufficient prima facie evidence that BLR posed a
substantial risk of committing acts similar to the charged offenses.
II. SUBSTANTIAL EVIDENCE OF A GRAVE DISABILITY
BLR argues that the State failed to present substantial evidence in support of the trial
court’s finding that he continues to be gravely disabled as defined under former RCW
71.05.020(22)(b). BLR contends that while he may lack insight into his own health condition and
continues to exhibit some symptoms of somatic and persecutory delusions, he has not exhibited
severe deterioration of his mental functioning such that he could be considered gravely disabled.
BLR further asserts that the trial court substituted its belief about what kind of treatment would be
in his best interest in place of the statutory standard which concerns only whether he is able to
make a rational decision regarding his treatment.2
The State contends that the trial court’s conclusion that BLR was gravely disabled under
former RCW 71.05.020(22)(b) was supported by its findings regarding BLR’s history of
hospitalizations prior to his most recent admission, the nature of the event that lead to his
commitment, his continued denial of his mental health condition, and his continued exhibition of
certain symptoms. The State asserts that the standard under former RCW 71.05.020(22)(b) was
designed to aid in the treatment of individuals with similar characteristics to BLR, who if left
unsupported, present a risk of decompensating on release.
2 BLR relies almost exclusively on In re Det. of M.K., 168 Wn. App. 621, 630, 279 P.3d 897 (2012)
to support his argument that the trial court’s finding that he was gravely disabled within the
meaning of former RCW 71.05.020(22)(b) was not supported by substantial evidence. But M.K.
was published only on the mootness issue, and the portion BLR cites to support his argument, in
which we addressed the merits, was unpublished and was filed in June 2012. Opinions filed prior
to March 1, 2013 have no precedential value and are not binding on any court. GR 14.1(a). BLR’s
reliance on the unpublished portion of M.K. is thus improper, and any arguments he raises that are
predicated solely on the unpublished portion lack support from legal authority.

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BLR’s lack of insight into his condition, and his repeated admonitions that medication was
not helpful to him, as well as his history of decompensation, tend to show that he lacked the ability
to care for his health and safety if released to an unsupportive environment. Therefore, we agree
with the State that the trial court’s finding that BLR continued to be gravely disabled under former
RCW 71.05.020(22)(b) was supported by substantial evidence, and that this finding in turn,
supports the conclusion that BLR continued to be gravely disabled.
A. LEGAL PRINCIPLES
An additional ground for extending involuntary treatment for an additional 90 to 180 days
exists where a committed individual “[c]ontinues to be gravely disabled.” Former RCW
71.05.320(4)(d). Under former RCW 71.05.020(22) a person is “[g]ravely disabled” when that
person,
as a result of a behavioral health disorder: (a) Is in danger of serious physical harm
resulting from a failure to provide for his or her essential human needs of health or
safety; or (b) manifests severe deterioration in routine functioning 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; . . .
Here, the trial court found that BLR fit the second definition of grave disability within
former RCW 71.05.020(22)(b).
Former RCW 71.05.020(22)(b) incorporates the definition of decompensation and thus
“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 independently.’” In re Det. of LaBelle, 107 Wn.2d 196,
206, 728 P.2d 138 (1986) (quoting Mary L. Durham & John Q. LaFond, The Empirical
Consequences and Policy Implications of Broadening the Statutory Criteria for Civil Commitment,

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3 YALE L. & POL'Y REV. 395, 410 (1985)). This alternate definition of grave disability was added
by the legislature to “broaden the scope of the involuntary commitment standards.” Id. at 205.
To find that an individual continues to be gravely disabled within the meaning of former
RCW 71.05.020(22)(b), the evidence must show: (1) a severe deterioration in routine functioning
and (2) failure to receive treatment that is essential for health or safety. Id. (discussing former
RCW 71.05.020(1)(a) & (b) (1979)). With respect to the first requirement, evidence of a severe
deterioration in functioning “must include recent proof of significant loss of cognitive or volitional
control.” Id. at 208 (discussing former RCW 71.05.020(1)(b)).
With respect to the second requirement in former RCW 71.05.020(22)(b),
the evidence must reveal a factual basis for concluding that the individual is not
receiving or would not receive, if released, such care as is essential for his or her
health or safety. It is not enough to show that care and treatment of an individual's
mental illness would be preferred or beneficial or even in his best interests. To
justify commitment, such care must be shown to be essential to an individual's
health or safety and the evidence should indicate the harmful consequences likely
to follow if involuntary treatment is not ordered.
Id. (discussing former RCW 71.05.020(1)(b)). That is, the individual must be “unable, because of
severe deterioration of mental functioning, to make a rational decision with respect to his need for
treatment.” Id. (emphasis in original). This requirement exists to establish the necessary causal
nexus between “proof of ‘severe deterioration in routine functioning’” and proof that the person
so affected “‘is not receiving such care as is essential for his or her health or safety.’” Id. (quoting
but not citing to former RCW 71.05.020(1)(b)).
The State has the burden of proving that a person is gravely disabled by clear, cogent, and
convincing evidence. M.W., 185 Wn.2d at 656. We “will not disturb the trial court's findings of
‘grave disability’ if supported by substantial evidence which the lower court could reasonably have
found to be clear, cogent and convincing.” Labelle, 107 Wn.2d at 209. The “ultimate fact in issue

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must be shown by evidence to be ‘highly probable.’” Id. Our review is generally “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.
B. APPLICATION
Contrary to BLR’s assertions, his recent improvement in cognitive and volitional control,
as well as his averring that he will take his medications by injection upon release, do not negate
the fact that he has a grave disability within the meaning of former RCW 71.05.020(22)(b).
Explaining the rationale behind the legislature’s expansion of grave disability under this statue,
the Supreme Court in Labelle rejected an interpretation of former RCW 71.05.020(1)(b) that would
“exclude those persons whose condition has stabilized or improved, even if minimally (is not
“escalating”) by the time of the commitment hearing.” Id. at 205. The Supreme Court cautioned
that such an interpretation would:
result in absurd and potentially harmful consequences, for a court would be required
to release a person whose condition, as a result of the initial commitment, has
stabilized or improved minimally—i.e., is no longer “escalating”—even though
that person otherwise manifests severe deterioration in routine functioning and, if
released, would not receive such care as is essential for his or her health or safety.
Id. at 207. The Supreme Court also described a “‘revolving door’ syndrome, in which patients
often move from the hospital to dilapidated hotels or residences or even alleys, parks, vacant lots,
and abandoned buildings, relapse, and are then rehospitalized, only to begin the cycle over again.”
Id.
BLR’s circumstances present the potential for decompensation that the Supreme Court in
Labelle cautioned against, wherein a committed individual has benefited from treatment but not
so extensively so as to no longer meet the definition of grave disability under former RCW
71.05.020(22)(b). With respect to the first requirement under former RCW 71.05.020(22)(b), while

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BLR has improved in his cognitive and volitional control and has not had any violent episodes
since his commitment, he continued to exhibit cognitive challenges related to his lack of insight
into his condition. In particular, BLR continuously denied that he had a mental health condition.
BLR has also disagreed that he benefitted from the medication and stated that he was only taking
it because he was required to do so. While in treatment, BLR expressed persecutory delusions
related to the reasons for his confinement, explaining that he was in Western State Hospital because
the staff had to fill quotas and asserting that his parents “trap[ped]” him with the felony charges.
CP at 83.
With respect to the second requirement under former RCW 71.05.020(22)(b), there was
also substantial evidence establishing the necessary causal nexus between BLR’s deterioration in
his mental function and his inability to “make a rational decision with respect to his need for
treatment.” See LaBelle, 107 Wn.2d at 208 (discussing former RCW 71.05.020(1)(b)). Dr.
Charboneau testified that despite BLR’s improvement in his cognitive and behavioral controls, Dr.
Charboneau had “significant concern[s]” that BLR would experience a deterioration in routine
functioning if he were released. 1 VRP Aug.27, 2019 at 118. These concerns stemmed primarily
from BLR’s denial of his condition and of his need for treatment. Notably, the trial court found
and stated with particular emphasis, that “without clear structure and oversight, the court believes
[BLR] would likely decompensate.” CP at 144 (emphasis omitted). BLR does not challenge this
finding.
Due to BLR’s improvements however, the trial court found that a less restrictive alternative
placement was appropriate, “if it is highly structured, far more than just discharge to a shelter.
Something closer to . . . a Group Home.” CP at 144. Substantial evidence regarding BLR’s lack of
insight into his mental health condition supported the trial court’s finding that BLR continued to

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be gravely disabled as defined under former RCW 71.05.020(22)(b). In turn, this finding supported
the trial court’s conclusion that BLR continued to be gravely disabled. The trial court’s
recommitment order of an additional 180 days in less restrictive placement was properly entered.
CONCLUSION
We hold that the petition set forth sufficient prima facie evidence that as a result of his
behavioral health disorder, BLR presented a substantial likelihood of repeating acts similar to the
charged conduct. In addition, we hold that the trial court’s finding that BLR fits the definition of
grave disability set forth in former RCW 71.05.020(22)(b) was supported by substantial evidence,
and that this finding, in turn, supported the trial court’s conclusion that BLR continued to be
gravely disabled. Therefore, we hold that the trial court did not err in recommitting BLR to an
additional 180 days of involuntary treatment in a less restrictive alternative placement.
Accordingly, we affirm.
A majority of the panel having determined that this opinion will not be printed in the
Washington Appellate Reports but will be filed for public record in accordance with RCW 2.06.040,
it is so ordered.
CRUSER, J.
We concur:
MAXA, J.
SUTTON, A.C.J.