In re C.G.

IN THE SUPREME COURT OF NORTH CAROLINA

2022-NCSC-123

No. 308A21

Filed 16 December 2022

IN THE MATTER OF C.G.

Appeal pursuant to N.C.G.S. § 7A-30(2) from the decision of a divided panel of

the Court of Appeals, 278 N.C. App. 416, 2021-NCCOA-344, affirming an order

entered on 7 February 2020 by Judge Doretta Walker in District Court, Durham

County. On 27 October 2021, this Court allowed respondent’s petition for

discretionary review to consider an additional issue. Heard in the Supreme Court on

20 September 2022.

Joshua H. Stein, Attorney General, by James W. Doggett, Deputy Solicitor
General, and South A. Moore, General Counsel Fellow, for the State.

Glenn Gerding, Appellate Defender, by Katy Dickinson-Schultz, for respondent-
appellant.

Disability Rights North Carolina by Lisa Grafstein, Holly Stiles, and Elizabeth
Myerholtz for Disability Rights North Carolina, National Association of Social
Workers, Promise Resource Network, and Peer Voice North Carolina, amici
curiae.

ERVIN, Justice.

¶1 This case and its five companions raise an important issue regarding the

constitutional rights of those who face the prospect of involuntary commitment as a

result of mental illness. More specifically, these cases require us to address the
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question of whether a trial court presented with a petition to have an individual

involuntarily committed for additional inpatient treatment pursuant to N.C.G.S.

§ 122C-261 et seq. violates that person’s due process rights by conducting a hearing

concerning the petition in the absence of counsel representing the State on the

grounds that the use of such procedures violates the respondent’s right to an

impartial tribunal. In addition, respondent argues that, even if no due process

violation occurred in this case, the trial court’s written findings of fact failed to

support its conclusion that respondent was mentally ill and posed a danger to himself

so that he could be involuntarily committed pursuant to N.C.G.S. § 122C-268(j).

¶2 A majority of the Court of Appeals held that the proceedings, as conducted, did

not result in a due process violation and that the trial court’s findings were sufficient

to support a prima facie inference that respondent could not care for himself. In re

C.G., 278 N.C. App. 416, 2021-NCCOA-344, ¶¶ 25, 36. The dissenting judge

disagreed with his colleagues’ decision with respect to the due process issue without

directly commenting upon the sufficiency of the trial court’s findings. Id. ¶ 46

(Griffin, J., dissenting). After careful consideration of the arguments advanced in the

parties’ briefs, we affirm the decision of the Court of Appeals with respect to the due

process issue for the reasons set forth in In re J.R., ___ N.C. ___, 2022-NCSC-127, but

reverse the Court of Appeals’ decision to affirm the trial court’s order to have
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respondent involuntarily committed on the grounds that the record evidence and the

trial court’s findings did not support that determination.

I. Background

A. Involuntary Commitment Statutory Scheme

¶3 Any person “who has knowledge of an individual who has a mental illness and

is either (i) dangerous to self, as defined in [N.C.G.S. §] 122C-3(11)a., or dangerous to

others, as defined in [N.C.G.S. §] 122C-3(11)b., or (ii) in need of treatment in order to

prevent further disability or deterioration that would predictably result in

dangerousness,” may file an affidavit delineating the facts upon which the affiant’s

opinion is based and seeking the entry of an order to have the respondent taken into

custody for examination. N.C.G.S. § 122C-261(a) (2021). If, after reviewing the

affidavit, a clerk or magistrate “finds reasonable grounds to believe that the facts

alleged in the affidavit are true” and that the respondent appears to satisfy one of the

three relevant statutory criteria, the clerk or magistrate shall order that the

respondent be taken into custody. N.C.G.S. § 122C-261(b).

¶4 After the respondent has been taken into custody, a commitment examiner has

twenty-four hours within which to determine if the respondent “has a mental illness”

and “is dangerous to self . . . or others” so as to warrant inpatient commitment.
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N.C.G.S. § 122C-263(c), (d)(2).1 In the event that the examiner concludes that

inpatient commitment is justified, the respondent will be admitted for treatment to a

mental health unit known as a “24-hour facility,” N.C.G.S. §§ 122C-3(14)(g), -262(d)

(2021), with the examiner being required to prepare a report that specifically

recommends that the respondent receive inpatient treatment and having the option,

if no one has already sought to have the respondent involuntarily committed, to file

an involuntary commitment petition after completing the examination, N.C.G.S.

§ 122C-261(d). Within twenty-four hours after the respondent’s arrival at a 24-hour

facility, a physician, other than the one that conducted the initial examination, must

examine the respondent and, upon determining that the respondent is mentally ill

and constitutes a danger to himself or others, hold the respondent at the facility

pending a hearing before the district court, with the second examiner also being

required to prepare a report containing his or her commitment recommendation.

N.C.G.S. § 122C-266(a), (c).

¶5 Within ten days after the respondent has been taken into custody, the district

court must hold a hearing for the purpose of determining whether the respondent

should remain involuntarily committed. N.C.G.S. § 122C-268(a). At this hearing,

1 The commitment examiner must be a physician, eligible psychologist, or other
health, mental health, or substance abuse professional certified to perform evaluations by
the Secretary of the Department of Health and Human Services. N.C.G.S. §§ 122C-
3(8a), -263.1.
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the respondent is entitled to be represented by counsel of his own choosing or

appointed by the trial court, N.C.G.S. §§ 122C-268(d), -270(a); to have the

commitment reports filed in support of the decision to commit the respondent and

other relevant documents shared with the trial court, N.C.G.S. §§ 122C-

263(3), -266(c), -269(b); and to have the right to confront and cross-examine witnesses,

including the commitment examiners, N.C.G.S. § 122C-268(f). As a prerequisite for

the respondent’s continued involuntary commitment, the trial court must find “by

clear, cogent, and convincing evidence” that the respondent is mentally ill and

presents a danger to himself or others and make written findings of fact in support

of that determination. N.C.G.S. § 122C-268(j). If the trial court makes the necessary

findings, it is authorized to order that the respondent continue to be involuntarily

committed in an inpatient facility for a period not to exceed ninety days. N.C.G.S. §

122C-271(b)(2).

B. C.G.’s Case

¶6 On 30 January 2020, Dr. Phillip Jones, a physician practicing at Duke

University Medical Center, signed an affidavit and petition requesting that

respondent be involuntarily committed on the grounds that he was mentally ill and

presented a danger to himself. According to the affidavit, respondent had arrived at

the emergency department earlier that day while exhibiting “psychotic and

disorganized” behavior, with his Assertive Community Treatment team having been
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“unable to stabilize his psychosis in the outpatient environment.”2 According to Dr.

Jones, respondent needed to be hospitalized “for safety and stabilization” given that

he was “so psychotic [that] he is unable to effectively communicate his symptoms and

[he] appears to have been neglecting his own self-care,” with his difficulties having

included a failure to take his prescribed medication. In addition, Dr. Jones completed

a “First Examination for Involuntary Commitment” report that contained the same

findings. Based upon this affidavit, a magistrate concluded that there were

reasonable grounds to believe that respondent was mentally ill and a danger to

himself and ordered that respondent be taken into custody for inpatient treatment at

Duke.

¶7 On 31 January 2020, Dr. Miles Christensen completed a second examination,

during which he observed that respondent had “talk[ed] to other people in the room

during [the] interview,” claimed that “god[’]s people [were] putting voices in [his]

head,” and repeatedly stated that he was “[b]lessed and highly favored.” According

to Dr. Christensen, respondent would begin crying intensely without any apparent

cause and, when asked to identify the goals that his hospitalization was intended to

2An Assertive Community Treatment team is “a community-based group of medical,
behavioral health[,] and rehabilitation professionals who use a team approach to meet the
needs of an individual with severe and persistent mental illness.” Assertive Community
Treatment, N.C. Dep’t of Health and Hum. Servs., https://www.ncdhhs.gov/divisions/mental-
health-developmental-disabilities-and-substance-abuse/adult-mental-health-
services/assertive-community-treatment (last visited Nov. 15, 2022).
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accomplish, replied, “I don’t know, 90, 40, 50 pounds probably?” and stated that he

wanted to gain weight. Dr. Christensen diagnosed respondent with schizoaffective

disorder and concluded that respondent was a danger both to himself and to others.

¶8 On 7 February 2020, the trial court held a hearing for the purpose of

determining whether respondent should be released or remain in the custody of Duke

for further inpatient treatment. Although an assistant public defender was present

to represent respondent, no counsel appeared on behalf of the State or Duke. At the

outset, respondent’s trial counsel objected to proceeding with the hearing in the

absence of counsel for the State or Duke, arguing that the trial court could not “on its

own initiat[ive]—or volition . . . conduct the business of the State.” In overruling

respondent’s objection, the trial court noted that, while the district attorney’s office,

the attorney general’s office, and Duke had all declined to participate, it did not

believe that it could ignore its own statutory obligation to conduct the required

hearing “as a result of people failing to do their duty[.]” In addition, respondent’s

trial counsel unsuccessfully sought dismissal of the involuntary commitment petition

on the grounds that the findings contained in the first and second commitment

examination reports were nothing more than conclusory statements that did not

suffice to sustain an involuntary commitment order.

¶9 After the completion of these preliminary proceedings, the trial court called Dr.

Max Schiff, a physician who was involved in respondent’s treatment, to inform the
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court concerning “whether or not [he could] give [the trial court] enough evidence on

this to go forward.” Although respondent’s trial counsel objected to the calling of Dr.

Schiff as a witness on the grounds that Dr. Schiff had not performed either of the

examinations that had resulted in respondent’s commitment, the trial court overruled

respondent’s objection, explaining that, “if he doesn’t know anything about this case,

you can keep making your objection and we will go from there.”

¶ 10 According to Dr. Schiff, respondent “has a long-standing history of mental

illness with psychosis” and “currently carries a diagnosis of schizoaffective disorder,

for which he’s been treated since his late teens.” In addition, Dr. Schiff stated that

respondent’s ACT team had initially brought him to the emergency room “in order to

evaluate him for an acute change in his mental status with increasing

disorganization, hallucinations, delusions, [and] abnormal psychomotor behavior,”

including reports that respondent had been “wandering around the streets” and

throwing away the medication that he needed in order to remain stable. At the time

that he examined respondent following the latter’s arrival in the psychiatric unit, Dr.

Schiff asserted that respondent “continued to demonstrate very profound

disorganization of thought and behavior responding to hallucinations or internal

stimuli,” that it was “very difficult to elucidate a narrative from [respondent],” and

that respondent claimed that “thoughts were being inserted into his head and

occasionally controlling him, as well as containing derogatory content that was quite
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disturbing to him.” After the trial court asked for clarification about this aspect of

his testimony, Dr. Schiff explained that respondent “was complaining of feeling that

thoughts were being inserted into his head, that he could hear other people’s thoughts

or voices in his head,” and that these thoughts or voices provided respondent “with

derogatory content that was quite disturbing to him and made it difficult for

[respondent] to attend to a normal interview.”

¶ 11 According to Dr. Schiff, while respondent had been compliant with the

treatment that had been provided to him at Duke, he had informed the hospital staff

that he did not believe that he really needed medication or hospitalization and that

he did not have any longstanding mental health problems. Dr. Schiff expressed

concern that, despite respondent’s improvement while under Duke’s care, “if he were

to be discharged, . . . there would be an immediate decompensation, given his

continued level of disorganization and the hallucinations which are disturbing to him

and, in the past, have led him to have aggressive behaviors in the community.” In

addition, Dr. Schiff informed the trial court that, during his time at Duke, respondent

had “been the victim of assaults on a number of occasions as well as in the context of

both his substance use and decompensated primary psychotic disorder.” In response

to the trial court’s inquiry concerning how long Duke wished to retain respondent in

involuntary commitment and what treatment plan Duke had in mind for respondent,

Dr. Schiff indicated that Duke was seeking an additional thirty-day period of
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involuntary commitment and that Duke would continue to administer the

medications that had been provided to respondent since his arrival.

¶ 12 On cross-examination, Dr. Schiff testified that, while he had not conducted

either of the evaluations that had been performed in connection with respondent’s

commitment or signed either of respondent’s evaluations, he had attended

respondent’s second evaluation and currently served as respondent’s attending

physician. After acknowledging that respondent’s ACT team would be able to assist

respondent outside the hospital, Dr. Schiff pointed out that, at the time that it had

brought respondent to the emergency room, respondent’s ACT team had concluded

that “they could no longer support him in the community based on his level of

disorganization and decompensation.” Dr. Schiff said he had no knowledge of any

efforts that respondent might have made to harm himself but noted that “there has

been some aggression and aggressive behavior before” while stating that “[respondent

has] put himself in situations that would place him in danger and could place him in

danger again.”

¶ 13 After the completion of Dr. Schiff’s testimony, respondent’s trial counsel called

respondent to testify. When asked if he lived with anyone, respondent replied that

he lived with “[my] brother and my friend. My—he’s my brother first, but he’s my

friend second. I was in a relationship with him for 8, 9, 10 years. But it wasn’t be

nothing sexually wise like that with him again.” In addition, respondent testified
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that, in the event that he was released, he would continue living with this man.

Respondent denied having had any thoughts of self-harm or that he posed a threat to

others but admitted that he sometimes got into arguments with a friend named

“William,” who would sometimes get angry with him. In such instances, respondent

said that he would just acquiesce in whatever William wanted in order to avoid

further trouble. Although respondent could not tell whether the medication that he

was taking had provided him with any relief, he committed to continue to take that

medication in the event that he was released. At that point, respondent had the

following colloquy with his trial counsel:

[Counsel]: What kind of assistance or help do you have
in accessing medical help?

[Respondent]: My ACT team, Easterseals.

[Counsel]: And do you cooperate with them?

[Respondent]: Easter and seals. Yes, I do, yes.

[Counsel]: And if they ask you to take medications,
would you take them?

[Respondent]: Yes.

[Counsel]: And if they ask you to go see a doctor, would
you go see a doctor?

[Respondent]: They have. They have tried to get me
to take care of my teeth more. They wanted me to go do
that, but I didn’t want to do that. I just disregarded it.

[Counsel]: Why didn’t you want to take care of your
teeth?
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[Respondent]: I brush my teeth at least once or twice
a day. You are supposed to brush it three times and have
three meals. I don’t get three meals a day, but they have
started to give me at least breakfast, a meal for breakfast,
but he’s been working on losing weight, and I’m trying to
work with him, but I’m gonna have to eat more.

After claiming that his mother, who lived about fifteen or twenty minutes away,

would help him remember to take his medications, respondent answered his trial

counsel’s question concerning whether he would like to be released by stating that, “I

see her ankles and Amy—the Amy at [Duke]—[Duke] remind me of my mom’s ankles,

and she takes her water pills in the morning. I remind her.”

¶ 14 In response to questions posed by the trial court, respondent stated that he had

contact with his ACT team on Mondays, Wednesdays, and Thursdays and that he

attended a substance abuse group meeting on Friday “here and there, once in a blue.”

Respondent told the trial court that he was provided with a bus ticket every time that

he went to a group meeting and that he received a weekly check from Easterseals

that he used to buy groceries. Respondent answered the trial court’s question

concerning what had happened right before his ACT team brought him to the hospital

by stating, “I don’t—I don’t—I was—everything was the same, you know. It’s just

probably one of my first family or my second family just probably wanted me there,”

and reiterated that he did not know why he had been taken to the hospital except

“just to eat and drink.”
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¶ 15 In response to the trial court’s questions concerning the hallucinations that Dr.

Schiff had described, respondent said, “I see—I see angels, white dots. I see angels”

and “they just be like, white dots, different white dots floating in the air. I see them

some, like not as much. I see black dots, but I see white dots more than the white

dots.” Respondent said that he knew that the white dots were angels, but that “[t]he

black[ ] one just might be hallucinations or—that is negativity.” When the trial court

asked him whether he felt better inside or outside of the hospital, respondent

answered that he had “bad habits,” including smoking cigarettes and marijuana, and

that he would pick up cigarette butts by his apartment “so nobody can slip and fall

on it.”

¶ 16 After respondent’s counsel made her closing argument, during which she

requested that respondent be released from involuntary commitment, the trial court

announced, based upon “clear, cogent, and convincing evidence,” that respondent had

a mental illness, that he posed a danger to himself and to others, and that he was

unable to care for himself. As a result, the trial court ordered that respondent remain

involuntarily committed for another thirty days. On the same date, the trial court

entered a written order that incorporated the examination reports prepared by Dr.

Jones and Dr. Christensen and found “by clear, cogent, and convincing evidence” that

respondent

has [a] mental illness[,] that being schizoaffective disorder
[and] has [a] long-standing [history] of mental illness
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which goes back to his late teens[,] he is 33 [years old] now.
[Respondent] suffers from hallucinations, disorganized
thoughts[, and] is noncompliant with medications when not
in [the] hospital. His active psychosis causes him to be a
danger to himself and others. His ACT team initially had
him committed as they were unable to see to his needs due
to his decompens[ation]. [Respondent] [is] unable to
sufficiently [take] care of [his] needs[,] that being dental
[and] nourishment needs. [Respondent] lives with [a]
person who has anger issues [and respondent] has been
[the] victim of assaultive [behavior and] disturbing
thoughts which cause deterioration [and] leaves him
unable to perceive dangers to himself.

Based upon these findings, the trial court concluded that respondent was mentally ill

and posed a danger to himself and others. Respondent noted an appeal to the Court

of Appeals from the trial court’s order.

C. Court of Appeals Decision

¶ 17 In seeking relief from the trial court’s order before the Court of Appeals,

respondent began by arguing that the trial court’s written findings of fact lacked

sufficient evidentiary support and did not support its conclusion that respondent

posed a danger to himself and others. Among other things, respondent contended

that the trial court had violated his right to confront and cross-examine the witnesses

against him when it admitted the examination reports of Dr. Jones and Dr.

Christensen into evidence even though neither of them had testified at the hearing

and that there was “no other clear, cogent, and convincing record evidence that

[respondent] was dangerous to himself or others.” In addition, respondent argued
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that the trial court had violated respondent’s due process right to an impartial

tribunal by “assuming the role of prosecutor by presenting the entirety of the State’s

case.”

¶ 18 The Court of Appeals began by addressing respondent’s due process argument,

with a majority of the Court of Appeals having concluded that “the trial court only

elicited evidence that would otherwise be overlooked as no counsel for the State was

present,” that “[t]he trial court did not ask questions meant to prejudice either party

or impeach any witness,” and that, as a result, “the trial court did not violate

[r]espondent’s right to an impartial tribunal.” C.G., ¶ 25. Judge Griffin dissented

from his colleagues’ conclusion with respect to the due process issue on the grounds

that respondent had been “deprived of his liberty by an officer of the court who, after

expressing some reluctance, offered and admitted evidence against that individual,

called an adverse witness to testify on his adversary’s behalf, and examined that

witness to elicit the State’s evidence.” C.G., ¶ 46 (Griffin, J., dissenting).3

¶ 19 Next, the Court of Appeals evaluated whether the trial court’s written findings

of fact were supported by competent evidence and supported its determination that

respondent should be involuntarily committed for additional inpatient treatment. As

an initial matter, the Court of Appeals held that the trial court had erred by

3As a result of the fact that we have addressed respondent’s due process claim in
detail in our opinion in a companion case, we will refrain from further discussion of the Court
of Appeals’ evaluation of that issue in this opinion.
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incorporating the commitment examination reports into its written findings of fact

given that, even though such reports are generally admissible in involuntary

commitment proceedings, respondent had been deprived of the right to confront and

cross-examine the persons who had prepared those reports. Id. ¶¶ 27–28 (citing

N.C.G.S. § 122C-268(f) (2019)). According to the Court of Appeals, neither Dr. Jones

nor Dr. Christensen had been present at respondent’s involuntary commitment

hearing, so that the trial court had violated respondent’s confrontation rights by

incorporating the contents of those reports into its written findings of fact. Id. ¶ 28.4

¶ 20 Nevertheless, the Court of Appeals concluded that the testimony provided by

Dr. Schiff and the trial court’s remaining findings of fact were sufficient to support

its decision to involuntarily commit respondent, so that the trial court’s error in

incorporating the examiners’ reports into its findings of fact constituted harmless

error. Id. ¶ 29 (citing State v. Ferguson, 145 N.C. App. 302, 307 (2001)). More

4 Although Judge Griffin appeared to agree with his colleagues that the trial court had
erred by incorporating the relevant reports into its written findings, he seems to have reached
this conclusion on the grounds that, in light of the trial court’s failure to formally admit the
relevant reports into evidence, it had violated respondent’s due process rights when it
incorporated those reports into its written findings. C.G., ¶ 54 (Griffin, J., dissenting). Judge
Griffin did not, however, address the issue of whether the evidence and the trial court’s
written findings sufficed to support the trial court’s decision to involuntarily commit
respondent for additional inpatient treatment. As a result of the fact that the State did not
note an appeal based upon this aspect of Judge Griffin’s dissent or seek discretionary review
of the Court of Appeals’ decision with respect to this issue, the question of whether the Court
of Appeals erred by holding that trial court improperly incorporated the contents of the
examination reports into its written findings of fact is not properly before us for decision. See
N.C. R. App. P. 10(a) (providing that issues not raised in a party’s brief are deemed
abandoned).
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specifically, the Court of Appeals held that the record contained sufficient evidence,

consisting of respondent’s own testimony, to support the trial court’s determination

that respondent was a danger to himself because of his “inability to care for his own

nourishment and dental needs.” Id. ¶ 34. In addition, the Court of Appeals held that

the trial court’s finding that respondent’s ACT team was unable to adequately ensure

that his needs for nourishment and dental care would be met “created the [required]

nexus between [r]espondent’s mental illness and future harm to himself.” Id. ¶ 35.

Finally, the Court of Appeals concluded that “[a] showing of behavior that is grossly

irrational, of actions that the individual is unable to control, . . . or of other evidence

of severely impaired insight and judgment shall create a prima facie inference that

the individual is unable to care for himself or herself.” Id. ¶ 36 (quoting N.C.G.S.

§ 122C-3(11)(a)(1)(II) (emphasis added by Court of Appeals). In the Court of Appeals’

view, Dr. Schiff’s testimony concerning respondent’s hallucinations and disturbed

thinking, his description of the assaults that had been previously perpetrated upon

respondent, and his concern that respondent would decompensate following

discharge sufficed to support an inference that respondent would be unable to care

for himself. Id. As a result, the Court of Appeals concluded that the trial court did

not err by determining that respondent posed a danger to himself. Id.5 Respondent

5As a result of its conclusion that the evidence supported a finding that respondent
posed a danger to himself, the Court of Appeals did not reach the issue of whether the trial
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noted an appeal to this Court from the Court of Appeals’ decision with respect to the

due process issue based on Judge Griffin’s dissent, and we allowed respondent’s

request for discretionary review of the Court of Appeals’ determination that the

record evidence and the trial court’s written findings sufficed to support the trial

court’s decision to have respondent involuntarily committed for additional inpatient

treatment.

II. Analysis

A. Standard of Review

¶ 21 According to well-established North Carolina law, this Court reviews decisions

of the Court of Appeals for errors of law. N.C. R. App. P. 16(a); State v. Melton, 371

N.C. 750, 756 (2018). “When constitutional rights are implicated, the appropriate

standard of review is de novo.” In re Adoption of S.D.W., 367 N.C. 386, 391 (2014);

see also Dorsey v. UNC-Wilmington, 122 N.C. App. 58, 66 (1996) (utilizing a de novo

standard of review in determining whether the trial court had violated a party’s due

process right to an “impartial decisionmaker”). In addition, as the Court of Appeals

has correctly held, an involuntary commitment order is reviewed on appeal for the

purpose of determining whether the trial court’s findings of fact are supported by

sufficient evidence and whether the trial court’s findings support its determination

court’s determination that respondent posed a danger to others had sufficient support in the
record evidence and the trial court’s findings of fact. C.G., ¶ 33.
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that the respondent should be involuntarily committed for additional inpatient

treatment, In re N.U., 270 N.C. App. 427, 430 (2020), with the latter of these

determinations also being subject to de novo review on appeal. “Under a de novo

review, the court considers the matter anew and freely substitutes its own judgment

for that of the lower tribunal.” State v. Williams, 362 N.C. 628, 632–33 (2008)

(cleaned up). Although the involuntary commitment order at issue in this case has

long since expired, respondent’s appeal is not moot. See In re E.D., 372 N.C. 111, 114

n.8 (2019) (concluding that “[t]he possibility that [the] respondent’s commitment in

this case might likewise form the basis for a future commitment, along with other

obvious collateral consequences, convinces us that this appeal is not moot” (quoting

In re Hatley, 291 N.C. 693, 695 (1977))).

B. Due Process

¶ 22 In his first challenge to the Court of Appeals’ decision, respondent argues that

the trial court violated his due process right to an impartial tribunal when it “called

the case, elicited all the evidence in favor of involuntarily committing [respondent],

and then, based on the evidence [that] the [trial court] introduced, decided to

involuntarily commit [respondent].” For the reasons set forth in our opinion in In re

J.R., ___ N.C. ___, 2022-NCSC-127, we hold that no due process violation occurred in

this case given that nothing about the manner in which the trial court conducted

respondent’s involuntary commitment hearing tended to cast doubt upon the trial
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court’s impartiality. “The trial court simply presided over the hearing, asking

questions to increase understanding and illuminate relevant facts to determine

whether respondent met the necessary conditions for commitment.” Id. ¶ 24. As a

result, we affirm the decision of Court of Appeals with respect to the due process

issue.

C. Sufficiency of Written Findings Supporting Commitment

¶ 23 In his second challenge to the trial court’s involuntary commitment order,

respondent argues that the trial court’s findings of fact were not supported by

competent evidence and that those findings were not sufficient to support a

determination that respondent posed a danger to himself. As we have already noted,

in order to involuntarily commit an individual for inpatient treatment, the trial court

must “find by clear, cogent, and convincing evidence that the respondent is mentally

ill” and that he or she is either “dangerous to self” or “dangerous to others.” N.C.G.S.

§ 122C-268(j).6 A respondent poses a danger to himself when, “[w]ithin the relevant

past,” he or she has (1) acted in a manner that presents a reasonable probability that

6As a result of the fact that respondent has not contested the validity of the trial
court’s finding that he was mentally ill, that determination is binding for purposes of
appellate review. See State v. Fuller, 376 N.C. 862, 2021-NCSC-20, ¶ 8 (holding that “[a] trial
court’s finding of an ultimate fact is conclusive on appeal if the evidentiary facts reasonably
support the trial court’s ultimate finding”). In addition, we conclude that the trial court’s
determination concerning respondent’s mental illness is supported by Dr. Schiff’s testimony
that respondent suffers from a schizoaffective disorder and has a “long-standing history of
mental illness with psychosis” and by respondent’s admission that he had been diagnosed
with a mental illness.
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he or she will suffer serious physical debilitation in the near future; (2) attempted or

threatened suicide and there is a reasonable probability of suicide; or (3) mutilated

or attempted to mutilate himself or herself and there is a reasonable probability of

serious self-mutilation, absent intervention and treatment. N.C.G.S. § 122C-3(11)(a).

With respect to the first of these three scenarios, which is the only one that appears

to be relevant for purposes of this case, the relevant statute provides that an

individual poses a danger to himself if:

I. The individual would be unable, without care,
supervision, and the continued assistance of others not
otherwise available, to exercise self-control, judgment, and
discretion in the conduct of the individual’s daily
responsibilities and social relations, or to satisfy the
individual’s need for nourishment, personal or medical
care, shelter, or self-protection and safety.

II. There is a reasonable probability of the individual’s
suffering serious physical debilitation within the near
future unless adequate treatment is given pursuant to this
Chapter. A showing of behavior that is grossly irrational,
of actions that the individual is unable to control, of
behavior that is grossly inappropriate to the situation, or
of other evidence of severely impaired insight and
judgment shall create a prima facie inference that the
individual is unable to care for himself or herself.

N.C.G.S. § 122C-3(11)(a)(1). In addition, the relevant statutory language provides

that “previous episodes of dangerousness to self, when applicable, may be considered

when determining reasonable probability of physical debilitation, suicide, or self-

mutilation.” N.C.G.S. § 122C-3(11)(a). A trial court must make findings of fact that
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support both prongs of this test in order to support an involuntary commitment order.

N.C.G.S. § 122C-268(j).

¶ 24 In seeking to persuade us to overturn the trial court’s involuntary commitment

order, respondent argues that the Court of Appeals’ decision in this case

“dramatically changed the test for what constitutes ‘danger to self’ ” by “essentially

[holding] that a person may be found to be dangerous to himself based solely on

current self-care issues without any forward-facing showing of ‘serious physical

debilitation.’ ” According to respondent, the trial court was required to make specific

findings concerning the probability that respondent would experience serious

physical debilitation if released given that the Court of Appeals has previously held

that “courts may not disregard the second prong of the definition of ‘danger to self,’ ”

citing In re Monroe, 49 N.C. App. 23, 29 (1980), superseded on other grounds by

statute, An Act to Recodify the Mental Health, Mental Retardation, and Substance

Abuse Laws of North Carolina, ch. 589, §§ 1–2, 1985 N.C. Sess. Laws 670, 672, as

recognized in In re J.P.S., 264 N.C. App. 58 (2019); In re W.R.D., 248 N.C. App. 512,

516 (2016); In re Whatley, 224 N.C. App. 267, 273 (2012). In respondent’s view,

“[u]nder Monroe, Whatley, W.R.D., and the plain language of the involuntary

commitment statutes, being mentally ill and exhibiting symptoms of that mental

illness, without more, are insufficient to support a finding of dangerous to self.”
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¶ 25 According to respondent, “none of the trial court’s findings specifically

addressed the future harm prong” of the statute. In addition, respondent contends

that the record contains insufficient record evidence to support the trial court’s order,

with the Court of Appeals having erred by relying on Dr. Schiff’s testimony that

respondent “was still experiencing symptoms of his mental illness and that

[respondent] told [Dr. Schiff] that he didn’t think he needed his medication or had a

long-standing mental illness,” citing C.G., ¶ 36. In respondent’s view, “this evidence

reflected the trial court’s ultimate finding that [respondent] had a mental illness and

described [respondent’s] condition and symptoms at the time of the hearing, [but it

does] not indicate that [respondent] presented a threat of ‘serious physical

debilitation’ in the near future.”

¶ 26 Finally, respondent argues that a “prima facie inference” that he lacked the

ability to care for himself, which the trial court was entitled to make in the event that

respondent displayed certain behaviors or actions, see N.C.G.S. § 122C-3(11)(a)(1)(II),

did not relieve the trial court of its obligation to make a finding that respondent would

have likely experienced serious physical debilitation in the event that he was not

involuntarily committed. Respondent argues that a person’s inability to take care of

his or her daily needs is not equivalent to facing a reasonable possibility that he or

she would sustain serious harm and that the Court of Appeals’ conclusion to the

contrary “erodes the constitutional assurance that we don’t involuntarily commit
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someone for having a mental illness,” citing O’Connor v. Donaldson, 422 U.S. 563,

575 (1975). As a result, for all these reasons, respondent urges us to reverse the Court

of Appeals’ holding that the trial court’s findings of fact sufficed to support its

determination that he posed a danger to himself.

¶ 27 In seeking to persuade us to uphold the trial court’s order, the State begins by

arguing that respondent “does not contest the [trial] court’s finding that he was not

able to satisfy his basic needs and exercise self-control” and that, even if he had done

so, those findings had sufficient record support. In addition, the State contends that

the trial court “properly found that there was a reasonable probability of

[respondent’s] physical debilitation in the near future absent treatment.” After

acknowledging that the trial court is required to find that respondent would likely

suffer physical debilitation in the near future in the event that he was released from

involuntary commitment, the State argues that the trial court “need not say the

magic words ‘reasonable probability of future harm’ ” in order to make the required

determination, quoting J.P.S., 264 N.C. App. at 63.

¶ 28 According to the State, the trial court “specifically found that [respondent’s]

current psychosis will persist and endanger him in the near future” and “that [he]

was likely to repeat his previous self-endangering conduct.” First, the State contends

that the trial court found that respondent had “ ‘active psychosis’ ” that “ ‘causes him

to be a danger to himself and others’ ” and that, “unless committed, [respondent] was
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likely to continue to experience self-endangering psychosis, hallucinations, and

disorganized thoughts.” (emphasis added in brief). In addition, the State argues that

the trial court found that respondent “was noncompliant with his medicine when he

was not in inpatient treatment,” a fact that “indicate[s] that, if released, there was a

reasonable probability that the symptoms causing [respondent’s] physical

debilitation would continue.” The State contends that these findings are supported

by Dr. Schiff’s testimony that respondent had “very profound disorganization of

thought and behavior responding to hallucinations,” that his thoughts “contain[ed]

derogatory content that was quite disturbing to [respondent],” and that respondent

had thrown away his medications.

¶ 29 Second, the State argues that the trial court “made findings that indicate that,

absent treatment, [respondent] was likely to engage in conduct that had harmed him

in the past.” More specifically, the State asserts that the trial court found that

“[respondent] lives with a person who has anger issues . . . and that [he] has, in fact,

become a victim of assaultive behavior and disturbing thoughts, which caused

deterioration and leaves him unable to perceive dangers to himself resulting in his

being assaulted.” (emphasis added in brief). According to the State, these findings

“indicate that, absent treatment, [respondent’s] disturbing thoughts would have

persisted and there was a reasonable probability that [respondent] would both behave

in ways that instigated others to violence and been unable to perceive the danger of
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being assaulted” given that respondent “lived with a roommate who struggled with

anger management and with whom [respondent] had previously gotten into fights,

and because, before he was committed, [respondent] had started wandering the

streets.”

¶ 30 Finally, the State argues that “the inference that [respondent] was unable to

care for himself provides further support for the conclusion that there was a

reasonable probability that [respondent] would suffer serious physical debilitation

absent treatment,” citing N.C.G.S. § 122C-3(11)(a)(1)(II). In the State’s view,

respondent’s behavior warrants such an inference in light of the trial court’s finding

that respondent “suffers from hallucinations” and “disorganized thoughts” and the

testimony presented at the hearing both by Dr. Schiff and by respondent. In addition,

the State argues that the trial court’s other findings, including its determination that

respondent’s ACT team had been unable to care for him, “combined with the inference

that [respondent] was unable to care for himself, further indicate that [respondent]

was likely to suffer physical debilitation in the near future.”

¶ 31 After carefully reviewing the record, we hold that the trial court’s written

findings were insufficient to support its ultimate finding that respondent constituted

a danger to himself. As we have already noted, the involuntary commitment statutes

provide that “the court shall find by clear, cogent, and convincing evidence that the

respondent is mentally ill and dangerous to self.” N.C.G.S. § 122C-268(j) (emphasis
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added). For that reason, the required finding “must actually be made by the trial

court” and “cannot simply be inferred from the record.” State v. Morgan, 372 N.C.

609, 616 (2019) (holding that, “when the General Assembly has inserted the phrase

‘the court finds’ in a statute setting out the exclusive circumstances under which a

defendant’s probation may be revoked, the specific finding described in the statute

must actually be made by the trial court and cannot simply be inferred from the

record”). However, “[t]hese ultimate findings, standing alone, are insufficient to

support the trial court’s order,” since “the trial court must also ‘record the facts upon

which its ultimate findings are based.’ ” In re N.U., 270 N.C. App. at 430 (quoting In

re Collins, 49 N.C. App. 243, 246 (1980)). As a result, our review of the sufficiency of

the trial court’s order in this case must begin with an examination of its written

findings.

¶ 32 As we have already noted, the trial court found in its written order that

Respondent has [a] mental illness[,] that being
schizoaffective disorder [and] has [a] long-standing
[history] of mental illness which goes back to his late
teens[,] he is 33 [years old] now. [Respondent] suffers from
hallucinations, disorganized thoughts[, and] is
noncompliant with medications when not in [the] hospital.
His active psychosis causes him to be a danger to himself
and others. His ACT team initially had him committed as
they were unable to see to his needs due to his
decompens[ation]. [Respondent is] unable to sufficiently
[take] care of [his] needs[,] that being dental [and]
nourishment needs. [Respondent] lives with [a] person
who has anger issues [and respondent] has been [the]
victim of assaultive [behavior and] disturbing thoughts
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which cause deterioration [and] leaves him unable to
perceive dangers to himself.

As an initial matter, we observe that, contrary to the State’s assertion, the trial court

never found that “[respondent] was unable to satisfy his basic needs and exercise self-

control.” On the contrary, the trial court found that respondent could not take care

of his “dental” and “nourishment” needs, rather than his “basic” needs, and said

nothing about respondent’s ability to exercise self-control. In addition, we note that

the trial court did not find that, in the event that respondent was released from

involuntary commitment, he would immediately decompensate or place himself in

danger or that respondent’s ACT team could not manage respondent’s level of

functioning in an outpatient environment. As a result, under the applicable legal

standard, we are required to take the trial court’s findings as they stand without

reference to any other information that might be contained in the record, including

Dr. Schiff’s testimony that “there would be an immediate decompensation” upon

discharge; that, in the absence of inpatient treatment, respondent “would

immediately decompensate, be into a hospital,” or “into a situation placing himself or

others in danger;” and that respondent’s ACT team could not support respondent in

an outpatient environment.

¶ 33 The trial court’s findings, as written, cannot be deemed sufficient to support a

determination that respondent posed a danger to himself given its failure to find that

there was “a reasonable probability of [respondent] suffering serious physical
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debilitation within the near future” unless he was involuntarily committed. N.C.G.S.

§ 122C-3(11)(a)(1)(II). As the Court of Appeals has consistently held for several

decades, the relevant statutory provision “mandates a specific finding of a probability

of serious physical debilitation resulting from the more general finding of lack of self-

caring ability.” Monroe, 49 N.C. App. at 29; see also W.R.D., 248 N.C. App. at 515

(holding that, in order to support a determination that the respondent posed a danger

to himself, the trial court must find that the respondent cannot care for himself or

herself and that there is a reasonable probability that the respondent will experience

serious physical debilitation in the absence of continued inpatient treatment);

Whatley, 224 N.C. App. at 273 (holding that “the trial court’s findings reflect [the]

[r]espondent’s mental illness, but they do not indicate that [her] illness or any of her

aforementioned symptoms will persist and endanger her within the near future”).

¶ 34 In Monroe, the respondent’s brother sought to have the respondent

involuntarily committed on the grounds that he posed a danger to himself and others.

49 N.C. App. at 24. At the conclusion of the involuntary commitment hearing, the

trial court determined that respondent was mentally ill and a danger to himself and

others7 based upon the following findings of fact:

7The statutory definition of “dangerous to self” at the time that the Court of Appeals
decided Monroe was, for all relevant purposes, identical to the one that applies in this case.
Compare N.C.G.S. 122-58.2(1) (1979) with N.C.G.S. 122C-3(11)(a) (2021).
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1. The Respondent has been hospitalized at Dorothea
Dix Hospital two times since 1975 prior to his current
admission.

2. At the time of his last discharge from the hospital
the Respondent’s physician prescribed medicine for him to
take, and his brother purchased the medicine for him. The
Respondent took the medicine for only three weeks. The
Respondent then refused to take any more of his medicine
and stated to his brother, “You might as well give me the
money because I will not take that. I don’t need it.”

3. As long as Respondent was taking his medicine he
was in control of himself; but, once he stopped taking his
medicine he started going down.

4. He has become uncontrollable at times.

a. During the night he is irregular in his
sleeping. He is up from three to six times a night.

b. At other times he is in his front yard or on his
porch making all kinds of loud noises or calling
inappropriately to anyone passing by and telling
them to hold their head up or telling them how they
should do.

....

5. Respondent disregards his nutritional needs by
fasting for some periods and then eating a whole chicken
or a whole loaf of bread. Respondent eats about five pounds
of sugar every two days. He will sometimes consume five
or six glasses of sweet water.

....

8. Respondent has the paranoid and delusional belief
that his family is sexually seducing him and he has accused
them of that. He believes that all of his relatives are
against him.
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9. On a previous hospital admission, Respondent was
noted to be lying in bed all day staring up at the ceiling.
He wouldn’t move. This same type of behavior has been
exhibited on his present admission.

10. Respondent has refused medication on this
admission.

Id. at 26–27. On appeal, the Court of Appeals held that “neither the facts recorded

by the trial court nor the record supports a conclusion or ultimate finding of

dangerousness to self” on the basis that, “even if indicative of some danger, the facts

do not support the finding that there is a reasonable probability of serious physical

debilitation to the [r]espondent within the near future.” Id. at 29 (cleaned up). The

Court of Appeals also noted that, while the respondent’s disregard of his nutritional

needs “may be evidence of mental illness” or even characteristic of an “inability to

‘exercise self-control, judgment, and discretion in the conduct of his daily

responsibilities,’ ” the record evidence did not show a “reasonable probability of

serious physical debilitation to [the respondent] within the near future,” with the

State having failed to elicit any evidence “showing the present or future effect of these

irregular dietary habits on respondent” and with the existence of “[u]nusual eating

habits alone [ ] do not amount[ing] to danger as contemplated in the controlling

statute.” Id. (quoting N.C.G.S. 122-58.2(1)(a)(1)(I) (1979))
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¶ 35 In Whatley, the trial court involuntarily committed the respondent for

additional treatment after finding “by clear, cogent, and convincing evidence” that

she

was exhibiting psychotic behavior that endangered her and
her newborn child. She is bipolar and was experiencing a
manic stage. She was initially noncompliant in taking her
medications but has been compliant over the past 7 days.
Respondent continues to exhibit disorganized thinking
that causes her not to be able to properly care for herself.
She continues to need medication monitoring. Respondent
has been previously involuntarily committed.

224 N.C. App. at 271. On appeal, the Court of Appeals held that “none of the [trial]

court’s findings demonstrate that there was ‘a reasonable possibility of [the

respondent] suffering serious physical debilitation within the near future’ absent her

commitment” and that, while “[e]ach of the trial court’s findings pertain to either [the]

[r]espondent’s history of mental illness or her behavior prior to and leading up to the

commitment hearing,” they “do not indicate that these circumstances rendered [the]

[r]espondent a danger to herself in the future.” Id. at 273. In addition, the Court of

Appeals held that, even though the trial court had determined that the respondent

“needed medication monitoring and that she did not plan to follow up as an

outpatient,” the trial court had made “no finding that connect[ed] these concerns with

the court’s ultimate finding of ‘dangerous to self’ as defined in [N.C.G.S.] § 122C-

3(11)(a)(1).” Id.
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¶ 36 In W.R.D., the Court of Appeals determined that the trial court’s involuntary

commitment order contained only two findings that could reasonably be construed as

relevant to the issue of whether the respondent posed a “danger to self.” 248 N.C.

App. at 515.

First, the trial court found that “it is not medically safe for
Respondent to live outside of an inpatient commitment
setting” because “Respondent maintains a belief that
another doctor is his treating physician and will not be
treated by Dr. Weigel”; “Respondent is diagnosed
with paranoid schizophrenia, for which Respondent has
refused treatment”; and “Respondent has heart health
related issues, for which he is not compliant with
prescribed medical treatment.” Second, the trial court
found that Respondent was “unable to take [sic] maintain
his nutrition.” The trial court did not include any
additional findings of fact concerning Respondent's
nutrition.

Id. at 515–16. After concluding that the record did not contain any evidence tending

to show that the respondent’s “refusal to acknowledge his mental illness” or his

“refusal to take his prescription medication” created a “reasonable probability of his

suffering serious physical debilitation within the near future” in the absence of

immediate involuntary commitment, the Court of Appeals determined that the trial

court’s findings with respect to the respondent’s “inability to ‘maintain his nutrition’

[were] not supported by competent evidence.” Id. at 516.
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¶ 37 Most recently, in J.P.S., the Court of Appeals vacated an involuntary

commitment order in which the trial court had found that the respondent posed a

danger to himself based on evidence tending to show that

(1) Respondent maintained grandiose thoughts that he had
a military staff providing him with intelligence
information; (2) Respondent ingested a large number of
pills in an apparent suicide attempt; (3) Respondent had “a
high dose of Adderall [and] Valium meds”; (4) Respondent
presented with an agitated manner and required forced
medication and restraints; (5) Respondent refused
medication for mania and psychosis; and (6) Respondent
suffered from post-traumatic stress disorder as a result of
prior military service.

264 N.C. App. at 63. In declining to uphold the trial court’s involuntary commitment

order “because of the trial court’s failure to include a finding of reasonable probability

of some future harm,” the Court of Appeals explained that, “[a]s in Whatley, the trial

court’s findings in this case ‘reflect [the] [r]espondent’s mental illness, but they do not

indicate that [the] [r]espondent’s illness or any of [his] aforementioned symptoms will

persist and endanger [him] within the near future.’ ” Id. (quoting Whatley, 224 N.C.

App. at 273). According to the Court of Appeals, while “the trial court need not say

the magic words ‘reasonable probability of future harm,’ it must draw a nexus between

past conduct and future danger.” Id. (emphasis added) (quoting Whatley, 224 N.C.

App. at 273).

¶ 38 The consistent theme in each of these decisions is that trial court’s findings

that an individual suffers from a mental illness, exhibits symptoms associated with
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that mental illness, and may not be able to take care of his or her needs are not

sufficient to satisfy the second prong of the statutory test for the presence of a “danger

to self.” In this case, the trial court found that respondent suffered from

schizoaffective disorder, hallucinations, and disorganized thoughts; that his ACT

team had initially had respondent committed because “they were unable to see to his

needs due to his decompensating;” that he was “noncompliant with medications”

when he was not in the hospital; and that he was not able to sufficiently attend to his

“dental [and] nourishment needs.” A critical analysis of these findings and the

underlying record evidence shows that they “[do] not demonstrate a ‘reasonable

probability of [respondent] suffering serious physical debilitation within the near

future’ without immediate, involuntary commitment,” W.R.D., 248 N.C. App. at 516,

with the trial court having failed to couple its findings concerning respondent’s past

and current condition with any findings regarding the extent to which respondent

faced a risk of “serious physical debilitation” in the event that he did not remain in

inpatient care.

¶ 39 In seeking to persuade us to reach a different result, the State contends that

the trial court’s findings “show that [respondent’s] symptoms were likely to persist”

given that those findings use “present tense verbs” to describe respondent’s symptoms

and indicate that respondent “has an active psychosis’ that makes him ‘a danger to

himself.’ ” (emphasis added in brief). We do not find this argument persuasive. As
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an initial matter, the trial court findings in each of the Court of Appeals’ decisions

described above were also written in the present tense, but that fact did not convince

the Court of Appeals to uphold the challenged orders. In addition, and more

importantly, the fact that a respondent had significant mental health difficulties in

the past and currently exhibits symptoms of mental illness, standing alone, does not

tend to establish that these symptoms will necessarily occur or persist in the future

or that he or she will suffer serious physical debilitation in the near future in the

absence of additional inpatient treatment. See J.P.S., 264 N.C. App. at 62 (stating

that “[a] trial court’s involuntary commitment of a person cannot be based solely on

findings of the individual’s ‘history of mental illness or . . . behavior prior to and

leading up to the commitment hearing’ ” (quoting Whatley, 224 N.C. App. at 273)).8

In addition, the trial court’s finding that respondent’s “active psychosis causes him to

be a danger to himself” fails to explain how respondent’s psychosis precludes him

from attending to his physical needs or causes him to face a risk of serious physical

debilitation in the near future. Simply put, findings or evidence that one has been or

8The State relies on Carr v. United States, 560 U.S. 438, 448 (2010), for the proposition
that “words used in the present tense include the future as well as the present.” Carr involved
the interpretation of a federal sex offender registration statute, with the quoted language
having come directly from 1 U.S.C. § 1, which provides guidance for “determining the
meaning of any Act of Congress.” Id. We are unable to see how Carr has any relevance to
the issue that is before us in this case, which involves the interpretation of a state court’s
handwritten factual findings contained in an involuntary commitment order.
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currently is mentally ill, or has, in the past, “decompensat[ed],”9 without more, does

not make one dangerous to himself or others, with the trial court’s findings to that

effect and the underlying record evidence failing to account for the fact that the

second prong of the relevant statutory test requires proof that future physical harm

is probable in the absence of involuntary commitment. See O’Connor, 422 U.S. at 575

(holding that “[a] finding of ‘mental illness’ alone cannot justify a State’s locking a

person up against his will and keeping him indefinitely in simple custodial

confinement”).10

¶ 40 We are equally unpersuaded by the State’s claim that respondent’s involuntary

commitment was justified by the trial court’s finding that respondent lived with a

roommate who had anger problems and that respondent had previously been

assaulted by others. As respondent points out, these facts “[do] not justify his

9 In our understanding, “decompensation” is a term of art within the psychiatric
profession that Dr. Schiff never defined during his testimony. Although the American
Psychological Association defines “decompensation” as “a breakdown in an individual’s
defense mechanisms, resulting in a progressive loss of normal functioning or worsening of
psychiatric symptoms,” American Psychological Association Dictionary of Psychology,
https://dictionary.apa.org/ decompensation (last visited December 6, 2022), neither the trial
court’s order nor Dr. Schiff’s testimony demonstrates specifically how a likelihood of
“decompensation” tended to show the existence of a “reasonable probability of [respondent]
suffering serious physical debilitation within the near future” absent treatment in an
inpatient facility.
10 More specifically, while the record does contain evidence tending to show that

respondent suffered from active psychosis, was at a risk of decompensation, and had shown
a level of decompensation in the recent past, that generalized evidence, without more, does
not tend to show that respondent is at a risk of substantial debilitation in the near term in
the event that he is released from involuntary commitment.
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commitment” against his will, with the Court of Appeals having rejected a virtually

identical argument more than forty years ago in the course of considering the

sufficiency of psychiatric testimony that the respondent “was imminently dangerous

to herself and others” because the respondent’s mental health difficulties might cause

others to engage in assaultive behavior. See In re Hogan, 32 N.C. App. 429, 434

(1977). As the Court explained,

it is abundantly clear from his testimony given at the
hearing that [the psychiatrist] arrived at his opinion that
[the] respondent was imminently dangerous to herself or
others solely because he felt that her persistence in trying
to convert someone on the street might cause that person
to resist the idea, so that “they could become physically
aggressive toward her.” If so, it would seem more
appropriate to commit her aggressor rather than the
respondent.

Id.; see also Monroe, 49 N.C. App. at 29–30 (holding that “[t]he chance that someone

will harm [the] respondent in response to [his] action[s] cannot be found to be

evidence of danger to self”). As a result, we hold that a risk that someone else might

engage in unlawful conduct by assaulting respondent cannot support a determination

that respondent poses a danger to himself sufficient to support the respondent’s

involuntary commitment for inpatient mental health treatment.

¶ 41 Finally, the State argues that “the inference that [respondent] was unable to

care for himself provides further support for the conclusion that there was a

reasonable probability that [respondent] would suffer serious physical debilitation
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absent treatment,” citing N.C.G.S. § 122C-3(11)(a)(1)(II). Admittedly, the record in

this case could support a determination of “grossly irrational” or “grossly

inappropriate” behavior on the part of respondent and contains “other evidence of

impaired insight and judgment” on respondent’s part that is sufficient to “create a

prima facie inference that [respondent] is unable to care for himself.”11 N.C.G.S.

§ 122C-3(11)(a)(1)(II). As the State acknowledges, however, “an inference that

respondents are unable to care for themselves cannot alone satisfy the second prong”

of the statutory definition of “danger to self.” In addition, as we have already

explained, an inference that someone is “unable to care for himself” does not

necessarily mean that that person is at risk of “suffering serious physical debilitation

within the near future” in the absence of inpatient mental health treatment, with the

fact that the respondent is “unable to care for himself” being insufficient to obviate

the need to “draw a nexus between [the respondent’s] past conduct and future

danger.” J.P.S., 264 N.C. App. at 63.

¶ 42 Thus, for all these reasons, we hold that the Court of Appeals erred by

concluding that the trial court’s findings and the record evidence were sufficient to

support a determination that respondent posed a danger to himself and that

11Interestingly, it was the Court of Appeals that first drew this inference. There is
no indication in the record that the trial court did so.
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Opinion of the Court

respondent’s involuntary commitment could be justified on that basis. 12 As a result,

we reverse the trial court’s involuntary commitment order and remand this case to

the trial court for further proceedings not inconsistent with this opinion.13 We take

this action with the understanding that, as the Court of Appeals observed in W.R.D.,

12 An examination of the sufficiency of the evidence concerning the extent to which
respondent posed a danger to himself is necessary in order to permit the Court to determine
whether this case should be remanded to the trial court for the purpose of allowing the trial
court to consider whether, in the event that the trial court had made proper findings of fact
that were supported by the evidence, respondent should have been involuntarily committed.
13 Although the trial court also found that respondent was a danger to others, the

Court of Appeals did not review the sufficiency of this finding or whether the evidence
supported it in light of its determination that the trial court had properly found that
respondent posed a danger to himself. C.G., ¶ 33. Although the State made a relatively brief
argument in the Court of Appeals that the trial court’s findings and the record evidence would
have supported a determination that respondent posed a danger to others, it made no effort
to present any such argument before this Court and has not requested that, in the event that
we did not uphold the trial court’s involuntary commitment order on the grounds that
respondent posed a danger to himself, we remand this case to the Court of Appeals for the
purpose of allowing it to determine whether the trial court’s involuntary commitment order
could be upheld on the basis that respondent posed a risk to others. Aside from the issue of
whether the remand approach remains viable as a matter of appellate procedure, we note
that the relevant statute provides that a respondent is “dangerous to others” if, “[w]ithin the
relevant past, the individual has inflicted or attempted to inflict or threatened to inflict
serious bodily harm on another, or has acted in such a way as to create a substantial risk of
serious bodily harm to another, or has engaged in extreme destruction of property; and that
there is a reasonable probability that this conduct will be repeated.” N.C.G.S. § 122C-
3(11)(b). The trial court made no written findings that tend to suggest that respondent’s
conduct would satisfy this statutory definition, and nothing in the record evidence appears
to us to be sufficient to support such a determination. Dr. Schiff’s assertion that respondent’s
hallucinations have in the past “led him to have aggressive behaviors in the community,”
without explaining what those behaviors were, and respondent’s vague statement that he
and William had “gotten into it” are hardly “clear, cogent, and convincing evidence” of the
infliction, attempted infliction, threatened infliction, or creation of a substantial risk of
“serious bodily harm on another.” As a result, we decline to remand this case to the Court of
Appeals for consideration of the extent to which, if at all, the trial court’s involuntary
commitment order should be upheld on the basis of a determination that respondent posed a
danger to others.
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Opinion of the Court

our decision “does not mean that [r]espondent is competent, or that he cannot

properly be committed at some future hearing.” 248 N.C. App. at 513. Instead, “[w]e

simply hold that the trial court’s findings and the evidence in the record are

insufficient to satisfy the statutory criteria for involuntary commitment,” id., with a

firm adherence to the relevant statutory requirements in these cases being essential

given the “massive curtailment of liberty” and “stigmatizing consequences” that

accompany involuntary commitment. Vitek v. Jones, 445 U.S. 480, 491–92 (1980).

III. Conclusion

¶ 43 Thus, for the reasons set forth in In re J.R., ___ N.C. ___, 2022-NCSC-127, we

affirm the Court of Appeals’ decision with respect to the due process issue while

holding that the record evidence and the trial court’s written findings of fact do not

suffice to support the trial court’s involuntary commitment order. As a result, we

reverse the Court of Appeals’ decision, in part, and remand this case to that Court for

further remand to the District Court, Durham County, for further proceedings not

inconsistent with this opinion.

AFFIRMED, IN PART; REVERSED, IN PART; AND REMANDED.
 Chief Justice NEWBY concurring in part and dissenting in part.

¶ 44 I agree with the majority’s conclusion that respondent’s due process right to an

impartial tribunal was not violated for the reasons stated in In re J.R.,

2022-NCSC-127. I write separately, however, because the trial court did make

forward-looking findings of fact that draw a nexus between respondent’s past conduct

and a reasonable probability of future harm. Because the trial court’s findings of fact

are supported by competent evidence and are sufficient to indicate a reasonable

probability of respondent suffering future harm without adequate treatment, the

Involuntary Commitment Order should be affirmed. Accordingly, I respectfully

concur in part and dissent in part.

¶ 45 On 30 January 2020, respondent was taken to the emergency department by

his outpatient care team, the Assertive Community Treatment (ACT) team. An ACT

team consists of various mental health care providers who assist respondent when he

is not in the hospital and monitor him weekly to ensure that he is taking his

medication and that his dental and nourishment needs are met. Phillip Jones, M.D.

first examined respondent when he arrived at the hospital and reported that

respondent was “so psychotic [that] he [was] unable to effectively communicate his

symptoms.” Dr. Jones completed a commitment report, concluding that respondent

was dangerous to himself, and petitioned for respondent’s involuntary commitment.

The next day, Miles Christensen, M.D. conducted a second examination of respondent
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Newby, C.J., concurring in part and dissenting in part

and completed a second commitment report. He observed that respondent was

hearing voices, experiencing hallucinations, and “crying intensely.” Dr. Christensen

diagnosed respondent with schizoaffective disorder and recommended that

respondent be committed.

¶ 46 The trial court held an involuntary commitment hearing on 7 February 2020.

Max Schiff, M.D., respondent’s attending physician, testified. Dr. Schiff explained

that respondent’s ACT team brought respondent to the hospital because the team

“could no longer support him in the community” as an outpatient due to “an acute

change in his mental status with increasing disorganization, hallucinations,

delusions, abnormal psychomotor behavior, . . . [and] wandering around the streets.”

Dr. Schiff described that respondent was still demonstrating “very profound

disorganization of thought and behavior responding to hallucinations” during his

evaluation of respondent. According to Dr. Schiff, respondent had not taken his

medications, “which had previously stabilized him[,]” and respondent informed him

that “thoughts were being inserted into his head and [were] occasionally controlling

him.” Dr. Schiff expressed concern that, if respondent was discharged, he “would

immediately decompensate . . . into a situation placing himself or others [in] danger.”

¶ 47 Respondent also testified at the hearing. Respondent explained that he sees

black dots and angels, which he described as white dots. Respondent stated that he

had been taking his medication and would continue to do so, but he could not “tell a
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Newby, C.J., concurring in part and dissenting in part

difference” if the medication was helping him.

¶ 48 At the close of the hearing, the trial court concluded that respondent was

mentally ill and a danger to himself and others. The trial court recorded the following

findings of fact:

Respondent has [a] mental illness that being
schizoaffective [disorder and] has long[-]standing [history]
of mental illness which goes back to his late teens[.] [H]e is
33 [years old] now. Resp[ondent] suffers from
hallucinations, disorganized thoughts[, and] is
noncompliant with medications when not in [the] hospital.
His active psychosis causes him to be a danger to himself
and others. His ACT team initially had him committed as
they were unable to see to his needs due to his
decompensating [and] unable to sufficiently take care of
needs that being dental [and] nourishment needs.
[Respondent] lives with [a] person who has anger issues
[and respondent] has been [a] victim of assaultive
[behavior and] disturbing thoughts which cause
deterioration [and] leaves [respondent] unable to perceive
dangers to himself.

¶ 49 The trial court ordered that respondent be involuntarily committed for thirty

days. Respondent appealed.

¶ 50 On appeal, respondent challenged the trial court’s conclusion that he was a

danger to himself or others under N.C.G.S. § 122C-3(11)(a). The Court of Appeals

concluded that the “trial court properly found Respondent was a danger to himself.”1

In re C.G., 278 N.C. App. 416, 2021-NCCOA-344, ¶ 33. The Court of Appeals reasoned

1Accordingly, the Court of Appeals did not reach the issue of whether the trial court’s
conclusion that respondent is a danger to others was supported by sufficient evidence.
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Newby, C.J., concurring in part and dissenting in part

that the finding that respondent’s ACT team was unable to care for his dental and

nourishment needs “created the nexus between Respondent’s mental illness and

future harm to himself.” Id. ¶ 35. Therefore, according to the Court of Appeals, “the

trial court satisfied the requirement [that] it find a reasonable probability of future

harm absent treatment.” Id. The Court of Appeals thus affirmed the commitment

order. Id. ¶ 37.

¶ 51 Respondent petitioned this Court to consider whether the Court of Appeals

erred in concluding that the trial court’s written findings of fact were supported by

competent evidence and were sufficient to support its conclusion that respondent is

dangerous to himself. This Court allowed respondent’s petition.2

¶ 52 The task here is to determine whether the Court of Appeals properly held that

the trial court’s findings of fact were supported by competent evidence and, in turn,

supported its conclusion that respondent is a danger to himself. This Court reviews

decisions of the Court of Appeals for legal error. State v. Brooks, 337 N.C. 132, 149,

446 S.E.2d 579, 590 (1994). Appellate review of a commitment order “is limited to

determining ‘(1) whether the court’s ultimate findings are indeed supported by the

“facts” which the court recorded in its order as supporting its findings, and (2)

whether in any event there was competent evidence to support the court’s findings.’ ”

2Respondent also appealed to this Court as of right based upon the dissenting opinion
at the Court of Appeals, regarding the due process issue. Because the due process issue was
resolved based upon the holding in the lead case, that issue is not further discussed herein.
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Newby, C.J., concurring in part and dissenting in part

In re Moore, 234 N.C. App. 37, 42–43, 758 S.E.2d 33, 37 (quoting In re Hogan, 32 N.C.

App. 429, 433, 232 S.E.2d 492, 494 (1977)), disc. rev. denied, 367 N.C. 527, 762 S.E.2d

202 (2014).

¶ 53 “To support an inpatient commitment order, the court shall find by clear,

cogent, and convincing evidence that the respondent is mentally ill and dangerous to

self . . . or dangerous to others . . . .” N.C.G.S. § 122C-268(j) (2021). An individual is a

danger to himself if he has acted in a way that shows all of the following:

I. The individual would be unable, without care,
supervision, and the continued assistance of others not
otherwise available, to exercise self-control, judgment, and
discretion in the conduct of the individual’s daily
responsibilities and social relations, or to satisfy the
individual’s need for nourishment, personal or medical
care, shelter, or self-protection and safety.

II. There is a reasonable probability of the individual’s
suffering serious physical debilitation within the near
future unless adequate treatment is given pursuant to this
Chapter. A showing of behavior that is grossly irrational,
of actions that the individual is unable to control, of
behavior that is grossly inappropriate to the situation, or
of other evidence of severely impaired insight and
judgment shall create a prima facie inference that the
individual is unable to care for himself or herself.

N.C.G.S. § 122C-3(11)(a)(1) (2021).

¶ 54 Thus, the trial court must make findings that address both respondent’s

current inability to care for himself and the probability that respondent would suffer

serious physical debilitation in the future without treatment.
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Newby, C.J., concurring in part and dissenting in part

¶ 55 Specifically at issue here is whether the trial court made forward-looking

findings sufficient to support a reasonable probability of respondent suffering serious

harm in the future without adequate treatment. To satisfy this prong, the trial court’s

findings must simply “indicate that respondent is a danger to himself in the future.”

See In re Moore, 234 N.C. App. at 44–45, 758 S.E.2d at 38 (emphasis added). The trial

court “must draw a nexus between past conduct and future danger”; however, it “need

not say the magic words ‘reasonable probability of future harm.’ ” In re J.P.S., 264

N.C. App. 58, 63, 823 S.E.2d 917, 921 (2019) (citing In re Whatley, 224 N.C. App. 267,

273, 736 S.E.2d 527, 531 (2012)).

¶ 56 The majority contends the trial court’s findings of fact are insufficient to

support the conclusion that respondent is dangerous to himself. According to the

majority, the trial court’s findings do not indicate a reasonable probability of

respondent suffering serious physical debilitation in the future. Rather, the majority

contends the trial court’s findings focus on respondent’s behavior prior to the

commitment hearing and fail to draw a nexus to a risk of future harm.

¶ 57 Here the trial court did make findings about respondent’s likely future conduct

and risk of harm without adequate treatment. The trial court found that respondent

“suffers from hallucinations [and] disorganized thoughts” and has “active psychosis”
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Newby, C.J., concurring in part and dissenting in part

which “causes him to be a danger to himself.”3 The trial court’s findings thus indicate

that respondent poses a danger to himself by drawing a nexus between respondent’s

present symptoms—hallucinations, disorganized thoughts, and active psychosis—

and the risk of dangerousness if the symptoms remained untreated.

¶ 58 Dr. Schiff provided forward-looking testimony that supports the trial court’s

findings. Dr. Schiff testified that if respondent were discharged, “there would be an

immediate decompensation, given [respondent’s] continued level of disorganization

and . . . hallucinations.” Dr. Schiff explained that without inpatient treatment,

respondent would “immediately . . . plac[e] himself . . . [in] danger.” See In re Moore,

234 N.C. App. at 44–45, 758 S.E.2d at 38 (affirming a commitment order where the

trial court’s finding of a “high risk of decompensation if released and without

medication” supported the conclusion that respondent posed a danger to himself in

the future). Dr. Schiff’s concerns thus support the trial court’s finding that

3 The majority correctly recognizes that the trial court must actually find that
respondent is a danger to himself; it “cannot simply be inferred from the record.” Yet, the
majority faults the trial court in its order for connecting respondent’s active psychosis and
his present symptoms to the risk that respondent poses a danger to himself but for failing to
explain how respondent’s symptoms lead to such a risk. Additionally, the majority contends
that “the findings or evidence that one has been or currently is mentally ill, or has, in the
past, ‘decompensat[ed],’ without more, does not make one dangerous to himself or others.”
Here, however, the trial court also found that (1) both respondent and the ACT team were
unable to treat respondent’s outpatient needs; (2) respondent is unable to perceive dangers
to himself; (3) respondent is unable to obtain sufficient nourishment; and (4) respondent has
been a victim of assaultive behavior which causes deterioration. These findings demonstrate
how respondent’s present symptoms affect his behavior and cause him to be a danger to
himself.
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Newby, C.J., concurring in part and dissenting in part

respondent’s symptoms caused him to be a danger to himself.

¶ 59 The trial court also found that respondent is noncompliant with his medication

when he is not in the hospital and that respondent’s ACT team brought him to the

hospital because the team was unable to attend to his decompensation and his dental

and nourishment needs. Dr. Schiff’s testimony supports these findings. Dr. Schiff

explained that respondent admitted he was not taking his medication, “which had

previously stabilized him[,]” and that the ACT team was unable to support

respondent’s current “level of disorganization and decompensation” in the outpatient

environment. Respondent’s testimony also supports the trial court’s finding that

respondent and the ACT team were unable to meet respondent’s dental and

nourishment needs. Respondent testified that the ACT team had “started to give

[him] at least breakfast,” but he does not “get three meals a day” when he is not in

the hospital. Thus, respondent was unable to obtain proper bodily nourishment,

which is essential for respondent to sustain himself. Additionally, respondent

testified that he “disregarded” the ACT team’s suggestion that he take care of his

teeth. Therefore, despite the ACT team’s efforts, respondent was unwilling to take

care of his dental needs. Therefore, the trial court’s findings, supported by Dr. Schiff’s

testimony, indicate that respondent’s symptoms, level of active psychosis, and dental
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Newby, C.J., concurring in part and dissenting in part

and nourishment needs could not be treated with outpatient resources. 4 As such,

there is a reasonable probability that respondent’s present symptoms would persist

and increase his risk of suffering physical debilitation and further decompensation

without inpatient care, and thus would cause him to be a danger to himself.

¶ 60 In sum, the trial court’s findings of fact directly link respondent’s past behavior

and current symptoms to a risk of future harm. Respondent’s history of mental illness

and noncompliance with medication coupled with his current hallucinations,

disorganized thoughts, active psychosis, and decompensation that could not be

treated with outpatient resources indicate a reasonable probability of respondent

suffering serious physical debilitation in the future. The Court of Appeals thus

properly affirmed the commitment order. Accordingly, I concur in part and dissent in

part.

Justice BERGER joins in this concurring in part and dissenting in part

opinion.

4The majority concedes that the record could support a prima facie inference that
respondent is unable to care for himself based on respondent’s “grossly irrational” or “grossly
inappropriate” behavior. The majority acknowledges, though, that such an inference alone
cannot satisfy the second prong of the “dangerous to self” definition. Here, however, such a
prima facie inference does not stand alone and is supported by Dr. Schiff’s testimony that the
ACT team is also unable to support respondent due to his decompensation and treat
respondent’s needs in the outpatient environment. Not only is respondent unable to care for
himself, but the ACT team, the outpatient team specifically designed to assist respondent
when he is not in the hospital, is also unable to see to respondent’s needs. Thus, absent
inpatient treatment, the trial court correctly concluded that respondent is a danger to
himself.
 Justice EARLS concurring in part and dissenting in part.

¶ 61 I dissent from the majority’s holding on the due process issue in this case for

the reasons stated in my dissenting opinion in In re J.R., 2022-NCSC-127.

Justices HUDSON and MORGAN join in this opinion concurring in part and

dissenting in part.

Justice BARRINGER concurring in part and dissenting in part.

¶ 62 Although I agree with the majority’s conclusion that respondent’s due process

right to an impartial tribunal was not violated for the reasons stated in In re J.R.,

2022-NCSC-127 and that the written findings of fact are insufficient to support the

trial court’s determination that respondent posed a danger to himself, I cannot agree

with the conclusion that the evidence in the record in this matter is insufficient to

satisfy the statutory criteria for involuntary commitment. Not only is this issue not

before us, but the record is more than sufficient to satisfy the statutory criteria for

involuntary commitment if proper findings of fact had been made. Therefore, I

respectfully concur in part and dissent in part.
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Barringer, J., concurring in part and dissenting in part

¶ 63 The only issue that respondent petitioned for review1 by this Court is whether

“the Court of Appeals err[ed] by concluding that the trial court’s written findings of

fact were supported by evidence and were sufficient to support its conclusion that

[respondent] was dangerous to himself.” We allowed respondent’s petition for

discretionary review on this issue, and that is the issue respondent briefed. The

majority answered this question in the negative, and I agree with that conclusion.

The trial court’s written findings of fact were as follows:

Respondent has [a] mental illness that being
schizoaffective [disorder and] has long[-]standing [history]
of mental illness which goes back to his late teens[.] [H]e is
33 [years old] now. Resp[ondent] suffers from
hallucinations, disorganized thoughts[, and] is
noncompliant with medications when not in [the] hospital.
His active psychosis causes him to be a danger to himself
and others. His [Assertive Community Treatment (ACT)]
team initially had him committed as they were unable to
see to his needs due to his decompensating [and] unable to
sufficiently take care of needs that being dental [and]
nourishment needs. [Respondent] lives with [a] person who
has anger issues [and respondent] has been [a] victim of
assaultive [behavior and] disturbing thoughts which cause
deterioration [and] leaves [respondent] unable to perceive
dangers to himself.

¶ 64 As identified by my colleagues, the trial court specifically found that

respondent “suffers from hallucinations [and] disorganized thoughts” and has “active

1 Respondent also appealed as of right to this Court on account of the dissenting
opinion at the Court of Appeals. The dissent in the Court of Appeals disagreed with the Court
of Appeals majority with respect to the due process issue.
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Barringer, J., concurring in part and dissenting in part

psychosis” which “causes him to be a danger to himself.” Psychosis is “[a]n acute or

chronic mental state marked by loss of contact with reality, disorganized speech and

behavior, and often by hallucinations or delusions, seen in certain mental illnesses,

such as schizophrenia.” Psychosis, The American Heritage Dictionary (5th ed. 2018).

However, the trial court’s other findings focused on the respondent’s state and his

outpatient team’s (ACT team) inability to care for him at the time of his commitment,

rather than his outpatient team’s ability to care for him and the consequences if

respondent was released out of inpatient care at or around the time of the hearing.

¶ 65 Going further than assessing the findings of fact is neither necessary nor

appropriate under Rule 16 of our Rules of Appellate Procedure. N.C. R. App. P. 16(a)

(“[R]eview in the Supreme Court is limited to consideration of the issues stated in the

notice of appeal filed pursuant to Rule 14(b)(2) or the petition for discretionary review

and the response thereto filed pursuant to Rule 15(c) and (d), unless further limited

by the Supreme Court, and properly presented in the new briefs required by Rules

14(d)(1) and 15(g)(2) to be filed in the Supreme Court.”).

¶ 66 However, if we reach the issue of whether the record is sufficient to satisfy the

statutory criteria for involuntary commitment, specifically the “dangerous to self”

portion of the statute, this Court should conclude that the testimony from

respondent’s attending physician and respondent himself, as reflected in the

transcript, is sufficient to support a conclusion that respondent is dangerous to
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Barringer, J., concurring in part and dissenting in part

himself.

¶ 67 The relevant subsection of the statute is as follows:

a. Dangerous to self. — Within the relevant past, the
individual has done any of the following:

1. The individual has acted in such a way as to show
all of the following:

I. The individual would be unable, without care,
supervision, and the continued assistance of
others not otherwise available, to exercise
self-control, judgment, and discretion in the
conduct of the individual’s daily
responsibilities and social relations, or to
satisfy the individual’s need for nourishment,
personal or medical care, shelter, or self-
protection and safety.

II. There is a reasonable probability of the
individual’s suffering serious physical
debilitation within the near future unless
adequate treatment is given pursuant to this
Chapter. A showing of behavior that is grossly
irrational, of actions that the individual is
unable to control, of behavior that is grossly
inappropriate to the situation, or of other
evidence of severely impaired insight and
judgment shall create a prima facie inference
that the individual is unable to care for
himself or herself.

....

Previous episodes of dangerousness to self, when
applicable, may be considered when determining
reasonable probability of physical debilitation,
suicide, or self-mutilation.
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Barringer, J., concurring in part and dissenting in part

N.C.G.S. § 122C-3(11)(a) (2021) (emphases added).

¶ 68 At the hearing, Dr. Max Schiff testified that he was concerned that “if

[respondent] were to be discharged, that there would be an immediate

decompensation.” He explained that immediate decompensation would lead to

respondent being placed “into a hospital or into a situation placing himself or others

at danger at this point.” Decompensation in psychiatry is “the failure to generate

effective psychological coping mechanisms in response to stress, resulting in

personality disturbance or disintegration, esp[ecially] that which causes relapse in

schizophrenia.” Decompensation, New Oxford American Dictionary (3rd ed. 2010); see

also Decompensation, The American Heritage Dictionary (5th ed. 2018).

¶ 69 Dr. Schiff also testified that just the week prior to the hearing he and

respondent’s Assertive Community Treatment team met with respondent and the

ACT team “felt that [respondent was] quite far from his baseline last week.” Dr. Schiff

explained that he continues to work with the ACT team “in attempting to assess

[respondent’s] baseline and whether or not they are able to support him in the

community.” Dr. Schiff testified that the ACT team felt that “they could no longer

support [respondent] in the community based on his level of disorganization and

decompensation last week.” Dr. Schiff further testified that respondent’s behavior

was “disorganized and psychotic in nature” and that “there has been some aggression

and aggressive behavior before.” While Dr. Schiff has been “pleased with
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Barringer, J., concurring in part and dissenting in part

[respondent’s] response [to treatment] so f[a]r,” Dr. Schiff stated, “[H]e remains with

a high level of psychosis that makes me concerned about his decompensation, were

he . . . to be released and not in the monitored setting.”

¶ 70 Respondent also testified at the hearing. When asked by his counsel with

whom he lived, respondent stated:

My brother and my friend. My — he’s my brother first, but
he’s my friend second. I was in a relationship with him for
8, 9, 10 years. But it wasn’t be nothing sexually wise like
that with him again. And his best friend, which is my
roommate, which is my brother.

¶ 71 When asked whether he would like to be released from commitment,

respondent did not answer the question but instead responded, “I see her ankles and

Amy — the Amy at Williams Ward — Williams Ward remind me of my mom’s ankles,

and she takes her water pills in the morning. I remind her.” Respondent also

acknowledged that he was having hallucinations and explained that he “see[s] angels,

white dots . . . floating in the air” and “black dots,” which “just might be

hallucinations or . . . negativity.”

¶ 72 Given this record, there was more than sufficient testimony to support a

conclusion that respondent is dangerous to himself. The trial court could have made

findings of fact that linked respondent’s past behavior and current symptoms to a

risk of future harm if inpatient treatment was discontinued. Therefore, I concur in

part and dissent in part.