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Matter of Commitment of N.N.

August 5, 1996

IN THE MATTER OF THE COMMITMENT OF N.N., APPELLANT.


On certification to the Superior court, Law Division, Cumberland County.

Justices Pollock, O'hern, Garibaldi, Stein and Coleman join in Justice HANDLER's opinion. The opinion of the Court was delivered by Handler, J.

The opinion of the court was delivered by: Handler

(This syllabus is not part of the opinion of the Court. It has been prepared by the Office of the Clerk for the convenience of the reader. It has been neither reviewed nor approved by the Supreme Court. Please note that, in the interests of brevity, portions of any opinion may not have been summarized).

IN THE MATTER OF THE COMMITMENT OF N.N. (A-70-95)

Argued January 16, 1996 -- Decided August 5, 1996

HANDLER, J., writing for a unanimous Court.

In November of 1994, N.N., a fifteen-year-old, was arrested after an altercation in which she allegedly assaulted another youth with a box cutter. N.N. claimed that she acted in self-defense. N.N. was charged with juvenile delinquency and spent approximately one month at a county detention center. On December 6, 1994, N.N. signed a request for voluntary admission to the Bridgeton Hospital because the Judge in the juvenile proceeding wanted her to have a seven-day evaluation. During her stay, N.N. showed no behavioral problems, nor did she need any medication to control her behavior. When N.N. was told that her psychiatrist at the hospital, Dr. Williams, recommended that she stay at least another week, she had a short behavioral outburst. N.N. did not hit or threaten anyone during this episode.

Because N.N. revoked her voluntary status under the statutory and regulatory standards, a hearing was conducted by the trial court to determine whether N.N. should be involuntarily committed. Dr. Williams testified that N.N. suffered from a conduct disorder that he described as a disturbance of mood, but not as a disturbance of thought, perception or orientation. Dr. Williams believed that he was justified in seeking involuntary commitment because, in his opinion, N.N. met both the "dangerousness" standard and the alternative "in need of intensive psychiatric therapy" standard necessary for involuntary commitment. Based on the testimony, the court declined to find N.N. could be committed under the "dangerousness standard." Instead, the court found that N.N. should be committed because she needed inpatient intensive attention and because she suffers from a disturbance of mood.

The Public Defender appealed to the Appellate Division and then petitioned the Supreme Court for certification of the appeal pending unheard. The Court granted certification.

HELD:

A standard that would authorize the involuntary commitment of a minor under fourteen years of age requires: 1) a showing that the minor is mentally ill, as defined in terms of childhood mental illness; 2) a demonstration that the child is in need of intensive, institutional psychiatric treatment that cannot be provided in the home, the community or on an out-patient basis; 3) a determination that, due to mental illness, the minor's condition poses a danger to that minor or to others, which may include the substantial likelihood of significant developmental harm if that treatment is not provided; and 4) that the above prerequisites for involuntary commitment be established by clear and convincing evidence, determined by specific and particularized findings of fact.

1. The standards governing civil commitment are provided by statute, at N.J.S.A. 30:4-27.1 to -27.23, and in Rule 4:74-7. Rule 4:74-7 is the only codified standard applicable to the commitment of minors. Rule 4:74-7(f) specifies the involuntary commitment standard applicable to adults, which requires a mental illness that causes a danger to self or others. The involuntary commitment of minors also is governed by an alternative standard (the "necessary-treatment" standard) that omits any need to demonstrate mental illness that causes dangerousness to self or others. It requires, instead, the need for intensive psychiatric therapy. (pp. 6-10)

2. The Civil Practice Committee has proposed, based on the recommendations of the Subcommittee on Mental Commitments, a Rule that addresses only minors under the age of fourteen. All minors fourteen years or older would be governed by the adult standard for commitment. The proposed rule would provide an alternative commitment standard for minors up to fourteen years. That standard requires a finding of mental illness and dangerousness or "a need of intensive [institutional] psychiatric therapy." This appeal arose before the Civil Practice Committee's proposed Rule could be considered by the Court. The Court did not act on the proposal, deciding to determine the standards that must govern the involuntary commitment of minors through the adjudication of this case. Although a decision with regard to N.N. is moot, a decision by this Court is necessary because the issues posed involve significant matters of public policy, are extremely important and undoubtedly will recur. (pp. 10-15)

3. The current Rule is construed to required mental illness as a precondition for involuntary commitment. Because civil commitment implicates significant individual liberty interests of minors, the protections necessary to adequately safeguard those interests reasonably require a clear and convincing demonstration that the minor is suffering from or is afflicted with a mental illness, before commitment can be authorized. The standard for involuntary commitment of minors must include a requirement of "childhood mental illness" defined in comparative developmental terms. (pp. 15-17)

4. The language of the necessary-treatment standard denotes minimally that involuntary commitment must be based on a showing of a need for inpatient care, consisting of intensive psychiatric therapy that can be provided only at a psychiatric hospital. That meaning is sufficient to overcome the claim of constitutional vagueness. (pp. 17-22)

5. The State has an interest in providing treatment and care for children who suffer from mental illness, and who may benefit from such care. That interest, however, is not sufficiently compelling to justify the curtailment of a child's liberty interest by involuntary commitment to a psychiatric hospital. A standard based only on the "need of intensive [institutional] psychiatric therapy" as a condition for the involuntary commitment of minor does not vindicate a compelling state interest, and is insufficient to protect the individual liberty interests of the minor. Involuntary commitment of a minor who is mentally ill and found to be in need of intensive institutional psychiatric therapy may not be undertaken without a finding based on clear and convincing evidence that the minor without such care is a danger to others or self. (pp. 22-26)

6. The necessary-treatment standard for minors under the proposed Rule differs from the adult standard of dangerousness by requiring "dangerousness" only as an alternative to the necessary-treatment basis for juvenile commitment. That difference in approach responds to the criticisms of the adult dangerousness standard as applied to minors; acknowledges the uncertainty and difficulty in applying the concept of dangerousness to children; and reflects the desire not to foreclose needed and appropriate treatment for those children, not dangerous by adult standards, who seriously require intensive psychiatric therapy. The criteria for commitment of minors based on dangerousness must reflect their heightened needs and vulnerability and the State's concomitant greater responsibility to assure their health and well being. A dangerousness standard that applies to minors must be derived from and related to childhood mental illness. The standard of "dangerousness to self" applicable to a child suffering from mental illness as a basis for involuntary commitment must encompass the substantial likelihood that the failure to provide immediate, intensive, institutional, psychiatric therapy will create in the reasonably foreseeable future a genuine risk of irreversible or significant harm to the child arising from the interference with or arrest of the child's growth and development and, ultimately, the child's capacity to adapt and socialize as an adult. (pp. 26-32)

7. In the absence of a fuller record and more extended argument addressing the status of minors as they approach the age of maturity, the differentiation of minors at age fourteen, as proposed by the Civil Practice Committee, may be followed. (pp. 32-34)

8. The involuntary commitment of N.N. failed to satisfy the standards now adopted: the evidence was insufficient to establish that N.N. suffered a childhood mental illness, that she required intensive, institutional psychiatric therapy or that she suffered a condition of dangerousness that threatened irreversible or significant interference with her developmental capacity if such treatment were not promptly provided. (pp. 34-35)

9. The standards and procedures governing involuntary juvenile commitment should be addressed by the Legislature. In the meantime, the Civil Practice Committee is directed to consider and recommend a Rule of Court to implement the standards set forth in this opinion. (pp. 36)

Judgment of the trial court is REVERSED.

The opinion of the Court was delivered by

HANDLER, J.

In this case, a fifteen-year-old girl was involuntarily committed to a psychiatric hospital because of conduct problems including an assaultive episode with another youth. She initially entered a psychiatric hospital for a seven-day examination. The examining psychiatrist attributed her condition to a mood imbalance amounting to a type of mental illness, and recommended a continued commitment. The court reviewing her commitment found that she did not present a threat of danger to herself or to others.

The Court's rule, under which the girl was committed, provides that a minor may be involuntarily committed if a court finds that the minor is in need of therapy that cannot be provided anywhere but in a psychiatric hospital. The issue in this case is whether the standard governing the involuntary commitment of minors, which does not require that the minor suffer from a mental illness that poses a danger to self or others, is unconstitutional.

I

In November of 1994, N.N., a fifteen-year-old, was arrested after an altercation in which she allegedly assaulted another youth with a box cutter. N.N. claimed that she was being harassed by the other youths, and stated that she acted in self-defense.

N.N. was charged with juvenile delinquency and spent approximately one month at the Atlantic County Detention Center (hereinafter "Harborfields"). On December 6, 1994, N.N. signed a request for voluntary admission to the Bridgeton Hospital because the Judge in the juvenile proceeding wanted her to have a seven-day evaluation. The court did not issue a detainer requiring her presence at Bridgeton nor mandating her return to Harborfields after the seven-day examination.

N.N. had previously received psychiatric therapy during a month-long inpatient stay at the Child Guidance Clinic in Philadelphia in June and July of 1993. There are no records of her diagnosis from this clinic, although it is asserted that this treatment was due to N.N.'s "depression and poor impulse control." N.N. also had problems at school. She was expelled from Catholic school for yelling at a nun; she repeated the ninth grade, due to "family problems," and attended an alternative school for a time.

Apparently, N.N. did not exhibit any behavioral incidents or problems while at Bridgeton Hospital. No psychiatric medication was prescribed for her prior to her admission to Bridgeton Hospital, and none was administered during her seven days in the hospital.

N.N. believed that she would be returning home with her mother after the seven-day evaluation, and would subsequently attend a partial care program. The hospital's family therapist had made arrangements for outpatient referrals and follow-up care for N.N. following her discharge. However, when N.N. was told that her psychiatrist at the hospital, Dr. Williams, recommended that she stay at least another week, N.N. became tearful, started to curse, slammed the door and kicked a water fountain. However, N.N. did not hit or threaten anyone during this episode.

At a hearing reviewing the voluntary admission, the examining psychiatrist, Dr. Williams, noted that N.N. had requested to go home, thereby revoking her voluntary status under statutory and regulatory standards. N.J.S.A. 30:4-27.20; R. 4:74-7(k). Dr. Williams testified that he would attempt to obtain a temporary order for involuntary commitment, and a hearing for involuntary commitment was scheduled in the Superior Court, Law Division, Gloucester County. The trial court then conducted a hearing to determine whether N.N. should be involuntarily committed. N.N. testified that the episode lasted less than five minutes, and that she calmed down as soon as she was told to calm down. The doctor offered her medication to quiet her, but N.N. refused. The patient progress notes for that night ...


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