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In re R. M.

Supreme Court of New Hampshire

November 22, 2019

IN RE R. M.

          Submitted: November 6, 2019

          10th Circuit Court-Brentwood Probate Division

          Boynton Waldron Doleac Woodman & Scott, PA, of Portsmouth (Christine W. Casa on the brief), for the petitioner.

          Casassa Law Office, of Hampton (Lisa J. Bellanti on the brief), for the respondent.

          HANTZ MARCONI, J.

         The respondent appeals an order of the Circuit Court (Leonard, J.) renewing an order for involuntary admission to New Hampshire Hospital for the purpose of allowing him to remain on a conditional discharge for a period of five years. See RSA 135-C:45, III, :46 (2015). On appeal, the respondent challenges the sufficiency of the evidence and argues that the five-year renewal was not the least restrictive treatment option. We affirm.

         The relevant facts follow. The respondent is a 30-year-old man who has been hospitalized on multiple occasions as a result of schizophrenia. When the respondent fails to take his prescribed anti-psychotic medication, he becomes paranoid, violent, and suicidal. In addition, he experiences hallucinations, paranoid delusions, and difficulties with impulse control and exhibits "a serious level of aggression."

         The respondent was first hospitalized in 2010 after voicing suicidal ideation, stating that he would be "better off dead." He was admitted on an emergency basis again in February 2015 due to concerns of suicidal threats, incapacity, and his paranoid belief that people were conspiring against him. The respondent was next hospitalized in January 2016 as a result of conduct that included locking his roommate in a closet. He was admitted to the hospital again in February 2016 due to an altercation with his roommate. He was discharged in May 2016 on a three-year conditional discharge. His conditional discharge was revoked in July 2016 because the respondent hit his mother. The respondent's most recent hospitalization was in January 2018 when he was found to have been "decompensating, going out in the cold without sufficient clothing, making poor judgments," and, possibly, experiencing auditory hallucinations as a result of failing to take his prescribed medication.

         In early March 2019, a few weeks before the respondent's three-year conditional discharge was set to expire, the local community mental health center filed a petition to renew his conditional discharge. The statement of the respondent's treating psychiatrist, appended to the petition, set forth the psychiatrist's opinion:

The events of multiple hospitalizations over an eight-year span [have] shown [the respondent] is not able to make decisions based on information provided to him, needing structure and support to follow through on self[-]care which a [conditional discharge] can provide. . . . [The respondent] has conducted himself in a way where he is dangerous to himself and/or others when not in treatment over the last eight years and has stated that he will not comply with his current treatment and medication regime if not court ordered via a [conditional discharge]. History has demonstrated when not compliant with medication, [the respondent] decompensates, becoming irrational in his behavior [and] delusional in his thinking. This leads him to conduct himself in a dangerous and threatening manner putting himself and others at risk, indicating a need for community-based treatment. A Conditional Discharge helps provide the structure [the respondent] requires to be compliant, prevent relapses, or make interventions before they become severe.
In my professional opinion, [the respondent] needs an extension of his [conditional discharge] to prevent him from becoming a danger to himself or others in the community.

         The trial court hearing on the matter took place on April 18, 2019. The treating psychiatrist, a court-appointed psychiatrist, and the respondent testified at the hearing. The treating psychiatrist testified that, in his opinion, the respondent's mental illness will create a potential likelihood of danger to himself or others if he fails to continue to take his prescribed medications and to participate in psychiatric treatment. The treating psychiatrist testified that the respondent has "very poor" insight into his mental health and need for treatment. He testified that, as recently as a week before the hearing, the respondent "made it very clear that he [does] not believe that he has schizophrenia and that he will not continue on an antipsychotic." According to the treating psychiatrist, when the respondent does not take his medication, he becomes "paranoid" and "violent." The treating psychiatrist testified that he recommends a conditional discharge for five years because, in the three years that the psychiatrist has been working with the respondent, he has "not seen any improvement in [the respondent's] insight and willingness for treatment . . . . If anything, [the respondent] has gotten more firm . . . in his belief that he does not have schizophrenia and does not need treatment."

         The court-appointed psychiatrist concurred with the recommendation for a five-year renewal of the respondent's conditional discharge based upon the respondent's lack of insight into his mental illness. The court-appointed psychiatrist testified that, without a court order, it is more likely than not that the respondent will not continue with his therapy and anti-psychotic medications. The court-appointed psychiatrist testified that he is "very, very concerned" that, without his medications, the respondent will become psychotic and engage in assaultive behavior.

         The respondent testified that he is not schizophrenic and does not need medication or therapy. According to the respondent, he was last admitted to the psychiatric hospital because he was experiencing symptoms of Attention Deficit Hyperactivity Disorder (ADHD). Following the hearing, the trial court found in favor of the petitioner, and ordered that the respondent be involuntarily admitted to New Hampshire ...


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