Hearts of darkness: Getting help for a loved one

PALMER -- Most of us cannot imagine circumstances so dire that we would seek to have a friend or loved one locked up for his or her own good.

We live in a society in which personal freedom is valued above all other rights, and our Alaska laws are written to assure that freedom is not abridged easily or lightly.

That system of protections can seem to be an insurmountable barrier to a family desperately seeking help for a mentally ill person who does not want it. Unless the person commits a crime for which he or she is placed in custody, there may seem to be nowhere for the family to turn.

When a family, friend or other concerned adult has exhausted all efforts to see that a mentally ill person is safe and secure, a sense of desperation sets in.

The role of law enforcement

According to Sgt. Dennis Ponder of the Alaska State Troopers, it is a common misconception in such cases to believe that law enforcement is able to step in and take responsibility for the mentally ill friend or loved one. Ponder said, however, that unless a person has committed a crime or presents an immediate and imminent danger to themselves or someone else, troopers have no statutory authority to take them into custody.

"That statute is my rule book," Ponder said. "The greatest thing given to American people is our freedom."

"I would rather take the risk of letting someone go than incarcerate one person wrongfully accused," he added. "To do otherwise is to violate their constitutional rights."

Ponder explained that, although they do welfare checks on individuals when requested by a third party, troopers are not trained mental health professionals with the ability to determine in a brief contact interview whether a person represents a clear threat to himself or to other people unless that danger is obvious.

What is a welfare check?

"Often a request for a welfare check comes from a person from Outside who hasn't heard from an Alaskan family member," Ponder said. "We check on them and get them to call and let someone know they are okay."

Troopers deal with requests for welfare checks on a case-by-case basis. When they contact a person at the request of a third party, they look for obvious signs that the person's condition meets the statutory criteria for them to be taken into custody involuntarily.

"I use the prudent man rule," explained Ponder. "Would a prudent man who did not know this person be able to say that he represents an imminent and immediate danger to himself or others."

So how do family members or friends seek help for someone who refuses treatment, someone who may not accept that they might be mentally ill?

The community

mental health center

According to Alaska statute, any adult can petition for an ex partŽ court order to secure emergency psychiatric evaluation, and possibly involuntary hospitalization, of another person at the Alaska Psychiatric Institute in Anchorage -- Alaska's only state-run psychiatric hospital.

Once a person is treated and ready for discharge, API coordinates their return to the community with LifeQuest Comprehensive Mental Health Services, the Valley's principal community mental health center.

But should the courthouse be the family's first stop, or should it be the "court of last resort?"

"Check with Life Quest before going to court," advised Bill Hogan, chief executive officer of LifeQuest. "We can help and intervene to keep the person in the Valley with their family."

Hogan explained that, even if the family member or friend is resistant to treatment, the mental health professionals at LifeQuest can help overcome that barrier.

If LifeQuest already knows and has a continuing relationship with the troubled person, Hogan said the staff can do home visits to check on the person and try to find out why they have not been taking medication or keeping appointments.

But even with a brand-new individual, Hogan wants to get out the message that LifeQuest is willing to explore options for getting the person to come in for help.

According to Hogan, one method that sometimes works is to involve another third party than the person trying to get the help.

"There is often someone that the person trusts enough to come in with," Hogan said. "It can be a minister, a doctor or some other person that can convince the person to accept treatment."

The key is to get a face-to-face meeting between the troubled person and LifeQuest staff.

"Court should be a last resort," Hogan said.

Hogan added that limited residential treatment is also available in the Valley, although not in locked custodial facilities.

One of these resources is Colony House, a crisis respite facility operated by LifeQuest where people can stay for treatment for from five to seven days. Colony House, which is sometimes used as a step-down facility for patients being released from API, can also serve to help stabilize individuals without resort to API.

In addition, Hogan said LifeQuest is currently involved in discussions with Valley Hospital to create up to seven Diagnostic Evaluation and Stabilization (DES) beds to meet the needs of individuals who might otherwise go to API because their condition meets the statutory criteria for involuntary treatment. The DES beds are expected to be available within the next year.

LifeQuest is located at 230 E. Paulson Avenue in Wasilla, with 24-hour service available by calling 376-2411 or toll-free 1-800-478-2410. Big Lake residents may call 892-8697.

Ex partŽ orders

Assuming that all reasonable attempts to get the person to seek or accept treatment have been exhausted, the concerned family member or friend can seek help through the courts.

The court system in the Valley is responsive to these emergency needs, but individuals who fear they might someday be required to seek such help will do well to learn in advance how the system works and what information will be needed in order to get the fastest possible response in an immediate crisis.

The petition for involuntary evaluation and possible commitment of someone believed to be at risk or a danger to others because of mental illness is called an ex partŽ order (temporary custody for emergency examination/treatment).

With an approved ex partŽ order, the person can be taken into custody for up to 72 hours for evaluation by mental health professionals so that a determination can be made as to the proper course of treatment, if any is found to be needed.

Subsequent involuntary commitments, if determined to be necessary by the hospital, can follow the initial 72-hour evaluation.

What is an ex partŽ order?

"Ex partŽ" is a legal term taken from Latin which means "from or on one side only to a dispute," according to the Random House Unabridged Dictionary.

Judges ordinarily must meet with all parties in a case instead of just one side or the other. Only under very special circumstances can a judge meet with only one side in a dispute.

In ex partŽ proceedings, the person seeking the order is called the "petitioner." This can be a family member, friend, mental health professional, or another responsible adult. The person for whom involuntary help is being sought is called the "respondent."

The ex partŽ process in Mat-Su

In the Valley, the petitioner must request the ex partŽ order from the Palmer Superior Court. Forms are available at the front desk of the Palmer Court House during normal business hours.

According to Linda Bogart, a deputy clerk of the Court in Palmer, it is important for petitioners to be prepared to provide specific information when requesting an ex partŽ order.

"In an emergency situation, petitioners are often not thinking clearly themselves," said Bogart. It is her job to screen the petitions to assure the petitioner has included all necessary information.

At the front desk in the courthouse, petitioners will be given a two-page court form and a single sheet Alaska State Troopers form to fill out.

The court form requires the name of the petitioner and the name, age and residence of the respondent. If the respondent is already in law enforcement or mental health custody at the time of the request and the petitioner is seeking only the evaluation, the petitioner must include the name of the officer or mental health professional with custody.

Details are critical

Most important, the form requires the petitioner to list the facts that make the respondent a person in need of evaluation or custody.

Bogart said she looks first for timeliness or recency of information. How recent was the incident or incidents that have caused the concern? If an incident is described that occurred one or two weeks ago, the petitioner must be able to articulate what the current emergency is.

The facts should consist of sufficient narrative information for presentation to the court. It is not enough, Bogart said, to state simply that "he is very sick."

The court looks for specific detail that demonstrates the respondent's current actions (or in some cases lack of action) that supports the request.

For example, if the petitioner believes the respondent is depressed or suicidal, details should be included that show why this is the case.

The petitioner should clearly state any current or very recent specific symptoms or actions that show that the respondent presents a danger to himself or to others.

According to Bogart, describing the respondent's history of mental illness, if any, is secondary to describing the current crisis, but still very important.

The petitioner should provide, if possible, dates of past institutionalization or arrest related to the current problems or alleged mental disorder.

It is important to include that the respondent is refusing to take medications prescribed for a mental disorder and the current emergency would not exist if the respondent were taking the prescribed medications, if that is in fact the case.

Bogart pointed out that the crisis might also involve a respondent's refusal to take critical medications prescribed for a life-threatening physical condition rather than for a mental imbalance. An example would be a refusal to take insulin required for a diabetic.

The form itself may not provide sufficient space to list all the information a petitioner can provide, but additional sheets of paper can be used.

The names of other persons who can corroborate the facts should be listed on the second page of the court form. Those individuals can be other family members, clergy, counselors, doctors, friends, law enforcement officers, teachers or anyone who has direct knowledge of the facts. The address must be included for each person and a telephone number is helpful.

Once the form is filled out, the petitioner signs it and makes a sworn statement that the information provided is true. The clerk at the court notarizes the statement.

It should be pointed out here that Alaska statutes make it a felony for a petitioner to initiate an ex partŽ order without having good cause to believe that the other person is suffering from a mental illness and as a result is gravely disabled or likely to cause serious harm to themselves or others.

Since Alaska State Troopers will be taking the respondent into custody should the petition be approved, the AST form requires specific identifying information about the respondent to include full name, sex, race, height, weight, date of birth, hair and eye color, social security number, driver's license number, and physical characteristics such as clothing, scars, other identifiable marks.

The form also asks for the respondent's location, if it is known, address and telephone number, whether there are weapons at the residence and what kind, whether the respondent is on medication and what kind, whether the respondent has a history of violence, and whether anyone else is at the residence where the respondent is located.

Setting the process in motion

Although the courthouse is open until 4:30 p.m., Bogart said ex partŽ petitions must be filed prior to 4 p.m. Petitions must be complete and ready to present to the Superior Court judge when they are filed.

Once the petition is filed, the counter clerk will deliver it to the deputy clerk responsible for screening the forms, normally Bogart at the present time.

When Bogart finds the petition to be complete, she takes it to the Superior Court and leaves it with the office in case the judge is on the bench. The judge's office can notify the judge on the bench that a petition is waiting.

Bogart said petitioners should come to the courthouse prepared to stay until a determination has been made on their petition by a Superior Court judge. She notifies the petitioner if the judge expects to be tied up in court for longer than an hour or two so that the petitioner can leave the courthouse for that period of time if desired.

"But they must come back at the end of that time," added Bogart. "The petitioner can be called into the courtroom to go on record if the judge has any questions about the petition."

According to Bogart, such hearings, if needed, are closed proceedings and the ex partŽ petitions and orders are closed files.

Unless there are questions, the judge will make a determination on the petition depending upon the information presented.

The view from the bench

What does the court look for in a petition for an ex partŽ order?

According to Palmer Superior Court Judge Eric Smith, the petitioner must understand the court's responsibility to meet the burden of the legal standard.

"We do not do this lightly," said Smith Thursday, referring to the Superior Court's authority to rule on petitions for ex partŽ orders.

"We read the statute carefully and try to apply it just as carefully," Smith said. "Although we are aware that the petitioner has serious concerns, we are careful because the respondent has very important rights of his own. We have to balance the petitioner's concerns with the respondent's rights."

Smith said the petition must focus on what the law is looking for, i.e., that the respondent is mentally ill and as a result of that condition is gravely disabled or presents a likelihood of causing serious harm to himself or to others.

"The petition can be more persuasive if it includes a letter or statement from a qualified mental health professional," added Smith.

After the ruling

Whether the decision is yes or no, the petition comes back to Bogart for distribution of the copies.

If the judge's decision is not to grant the petition, the only distribution is to the petitioner along with the judge's ruling.

If the judge approves the petition, a packet is assembled for the petitioner to take immediately to the Alaska State Troopers.

During duty hours of 8 a.m. through 4 p.m., clerks direct the petitioner to deliver the packet to the troopers located in Judicial Services at the courthouse.

After duty hours, the petitioner must take the packet to the Alaska State Troopers Palmer Post a block away from the courthouse.

The troopers' packet includes a copy of the petition for API, one for the attorney general's office, and one for the public defender's office. The petitioner also receives a copy.

The petitioner must wait to talk with the troopers, who may have questions concerning the respondent's whereabouts and other important information that will help the troopers secure the respondent's safety for transport to API.

The petitioner may receive additional instructions from the trooper depending upon the circumstances.

Once the troopers have accepted the packet and transported the respondent to API, the Anchorage court has jurisdiction over subsequent proceedings.

The Alaska Psychiatric Institute

According to statute, API accepts the ex partŽ order and the respondent for an evaluation period not to exceed 72 hours. API notifies the Anchorage court of the date and time of a 30-day commitment hearing to be held if needed within the 72-hour time period.

Although held involuntarily during the 72-hour period, the respondent retains important rights: the right to be notified immediately of their rights both orally and in writing; the right to a 30-day commitment court hearing; the right to communicate with their guardian or adult designated by the respondent, and with an attorney designated by the respondent; the right to be represented by an attorney; the right to present evidence; the right to cross-examine witnesses who testify against the respondent at the hearing; and the right to be free of medication and other forms of treatment to the extent possible before the hearing.

"We hold court in the hospital," said Randall Burns, chief executive officer of API. Hearings are conducted normally on Tuesday and Friday afternoons at the hospital, with a probate master as the presiding official.

According to Burns, API is represented in the hearings by the state attorney general's office, while the respondent is normally represented by the state public defender's office.

Respondents may be voluntarily committed at any point, or discharged when a determination is made that they no longer require involuntary commitment. The statute also contains provisions for early discharge, and authorized absences.

Burns said API social workers and physicians work closely with the community health center (normally LifeQuest in the Valley) to assure that the respondent continues to receive non-resident services once they are discharged from API. Such services include follow-up appointments, group therapy, meetings with case managers, and welfare checks if warranted.

Unless the respondent has been discharged early, subsequent compliance with non-resident treatment programs is entirely voluntary.

Burns added, however, that should the respondent seem to be "decompensating," i.e., exhibiting once again symptoms that meet the crisis treatment criteria, LifeQuest could seek a further ex partŽ order for additional involuntary treatment.