Tough choice: Who gets committed, who doesn’t

Sam Skolnik

Friday, May 4, 2007 | 7:02 a.m.

They walked - and sometimes were wheeled - in to Civil Commitment Court on Friday with a range of potentially debilitating mental health issues.

Some had exhibited manic, schizophrenic, depressive or even psychotic behaviors. Others appeared stable and rational.

One heavily tattooed man walked out, yelling to those about to enter that it was a "kangaroo court." One woman exited threatening to slap a court worker.

But no one appeared to be the next Seung-Hui Cho, the Virginia Tech gunman who killed 32 people before turning the gun on himself.

After the shootings, there was outrage and second guessing that Cho hadn't been involuntarily committed in 2005 when he was arrested for stalking two female Virginia Tech students. He had been held for 24 hours in a mental facility, and a judge determined that he presented "an imminent danger to himself and others" because of his mental illness. But Cho was released and ordered to seek outpatient treatment.

Clark County's Civil Commitment Court is set up to determine whether someone should be involuntarily committed to a mental institution. It hears about 130 cases each week.

The patients are referred to the court from public hospital emergency rooms and private mental health facilities such as Monte Vista. The cases are referred, and patients are committed, if officials believe that patients appear to be a danger to themselves or others, and that their behavior is caused by mental illness and not drug addiction or a medical condition.

In 2006, according to Family Court statistics, there were 2,548 new court filings, up from 2,164 the year before.

Last year 1,430 additional cases were reopened on people who already had cases referred to the court. The court could not cite specifically what percentage of those patients were issued commitment orders, though many factors point to that number being small.

One-third of the patients admit themselves to those facilities, officials estimate. The others often are brought in by police, or sometimes friends or relatives.

If the hearing master in Civil Commitment Court agrees with the doctors and others on the patient's treatment team, the patient can be civilly, or involuntarily, committed for up to six months at the state Rawson-Neal Psychiatric Hospital or at another mental health facility.

The people who come through this court are not criminal defendants. In some cases the district attorney's office has declined to prosecute them because of their mental state.

But because civil commitments entail detaining someone involuntarily, officials who work in the court - from the hearing master who makes the decision, to the doctors, lawyers, psychologists and social workers who advise him - say they take their responsibilities seriously.

"This is kind of a last resort," said Deputy Attorney General Susanne Sliwa, who represents Southern Nevada Adult Mental Health Services. "We can't hold them there if we're not helping them."

Sliwa sits in on hearings in which the patient may need to be civilly committed and be forced to take medications. She said those orders are signed in a minority of the cases.

Dr. Gregory Brown is a local psychiatrist who acts as one of two independent mental health professionals who review each case for the court and make recommendations to the hearing master.

Brown says the unique nature of the court - the patients aren't criminally guilty of anything - means it's necessary to keep close watch that the patients' civil liberties aren't violated. That's his first priority, he said.

Brown and Family Court Judge William Voy, who oversees Civil Commitment Court, confirmed that the caseload has grown exponentially in the past decade. About a half-dozen cases were on the schedule during any given hearing 10 years ago, they said. That number has risen to as many as 25 to 35 people who show up for each hearing day.

On Friday about 80 people were on the docket, Voy said, although fewer than 20 showed up. Typically, many are released before their hearings because their doctors decide confining them is no longer necessary.

Civil Commitment Court hearings take place every Wednesday and Friday afternoon at Rawson-Neal. The facility, which has 190 beds, opened in August.

The patients are a mix of ethnicities, ages and genders. Some seem coherent and well-spoken. Others are disheveled and agitated, or outright angry, about their circumstances.

The hearing master sits at one end of a rectangular wooden table in the small, makeshift courtroom. The patient and a defense lawyer, Don Williams, sit at the other end. The other participants sit on the sides.

On Friday one man came to the hearing with his wife and parents. He had been yelling and pounding on the door to his room at Rawson-Neal since he was admitted, and Brown concluded that he generally suffers from manic and even psychotic tendencies.

And yet he and Hearing Master Thomas Kurtz said the man would be more likely to stay on his medication, and thus be less of a danger to others, if he was returned home. He was released.

(The Sun was allowed to observe the proceedings on the condition that no patient be publicly identified.)

Another patient was described as severely mentally disabled and had swallowed razor blades twice in two weeks in suicide attempts. He was issued a four-week continuance - a result in many if not most of the cases - to see whether he can be stabilized on medications before being released, instead of being formally committed.

Another, a gentle-sounding, bearded young homeless man, said he believed it was his duty to reprimand others when they committed acts he considered to be religious transgressions. He was first arrested when he interfered with a Las Vegas police officer who was arresting another man.

The man became a danger to himself, some officials concluded, when he started scolding fellow inmates at the Clark County Detention Center for various behaviors.

Defense lawyer Williams argued that the man had a right to state his religious beliefs, and a right to be homeless. He threatened to appeal the case if Kurtz signed a commitment order. Kurtz continued the case for a month.