Clarifying Least Restrictive Alternatives in Involuntary Commitment: In the Matter of L.G.

Introduction

In April 2025, the Alaska Supreme Court considered an appeal from Lawrence G. (“L.G.”), who was involuntarily committed for 30 days at the Alaska Psychiatric Institute (API) after repeatedly threatening to kill his mother and exhibiting delusional behavior. The superior court found by clear and convincing evidence that Lawrence was mentally ill, gravely disabled, and posed a danger to himself and others, and that no less restrictive alternative was available. On appeal, Lawrence challenged only the court’s finding that no less restrictive alternative existed—arguing that the risk of harm was limited to his mother and that medication-based treatment should not be dispositive. The Supreme Court affirmed, refining how courts should analyze “least restrictive alternatives” (LRA) under AS 47.30.735(c).

Summary of the Judgment

The superior court initially authorized Lawrence’s evaluation and hospitalization after threats to his mother. At API, psychiatric nurse practitioner Josh Bearden testified that Lawrence suffered from schizoaffective disorder marked by delusions about his family and poor insight into his condition. Lawrence expressed plans to live in a shelter in Anchorage or with his father in Oregon, but refused to acknowledge his illness or the need for medication. The superior court master and later the judge found by clear and convincing evidence that:

Lawrence was mentally ill and gravely disabled.
He posed a risk of serious harm to others, based on threats to his mother, frustrations expressed toward API staff and his outpatient provider, and delusional insistence that strangers were following him.
No less restrictive alternative (outpatient treatment with medication, living with his father or in a shelter) was feasible given his lack of insight, past non-compliance, and inability to self-manage in the community.

The Supreme Court, applying de novo review to statutory questions and clear-error review to factual findings, held that the superior court did not err or plainly err in concluding that commitment was the least restrictive alternative under Alaska law.

Analysis

Precedents Cited

In re Hospitalization of Jacob S., 384 P.3d 758 (Alaska 2016) – established that involuntary commitment requires proof by clear and convincing evidence of mental illness plus danger or grave disability and no feasible LRA.
In re Hospitalization of Connor J., 440 P.3d 159 (Alaska 2019) – reaffirmed de novo review of statutory questions and clear-error review of factual findings in commitment appeals.
In re Hospitalization of Mark V., 375 P.3d 51 (Alaska 2016) – underscored the vital importance of carefully examining less restrictive alternatives to protect individual liberty interests.
In re Hospitalization of Sergio F., 529 P.3d 74 (Alaska 2023) & In re Hospitalization of Declan P., 538 P.3d 318 (Alaska 2023) – held that the State must explore alternatives beyond the respondent’s plan, but did not require the trial court to sua sponte consider every imaginable option.

Legal Reasoning

The Court’s opinion rests on three key legal pillars:

Scope of “Danger to Others”: The statutory definition of “likely to cause serious harm” extends beyond immediate family. Threats during the commitment hearing and low frustration tolerance supported a finding of general risk to public safety, not merely to the mother.
Least Restrictive Alternative (LRA) Analysis: Under AS 47.30.735(c), a person may only be committed if no less restrictive alternative is available to provide adequate treatment and protection. The court must examine proposed alternatives (outpatient medication, living with relatives, shelter placement), assess feasibility and safety, and articulate why each alternative fails. The superior court did so, relying on expert testimony that Lawrence lacked insight, would not comply with medication on an outpatient basis, and would be unable to navigate community resources safely.
Role of Medication in LRA: The Court clarified that when treatment depends on consistent medication compliance, unwillingness to take medication may render less restrictive care inadequate. The superior court did not err by finding that medication was essential to prevent deterioration and that Lawrence’s non-compliance made community placement unsafe.

Impact

This decision provides guidance for lower courts and practitioners in involuntary commitment hearings:

Affirmation that risk assessments must consider threats within and beyond family relationships when evaluating public safety.
A clear blueprint for LRA analysis: courts must identify each alternative, elicit and weigh evidence on feasibility, and record findings on why each alternative fails.
Confirmation that medication compliance is a valid factor in LRA determinations when non-compliance poses a substantial risk of harm or grave disability.

The ruling balances individual liberty against the State’s duty to protect vulnerable persons and the community, ensuring commitment remains a last resort.

Complex Concepts Simplified

Clear and Convincing Evidence: A medium-high standard of proof requiring the court to be reasonably certain of the facts. It sits between “preponderance” (more likely than not) and “beyond a reasonable doubt.”
Gravely Disabled: A condition in which, due to mental illness, a person cannot provide for basic personal needs (food, shelter, safety) even if they want to.
Least Restrictive Alternative: The obligation under the statute to choose the intervention that infringes least on personal liberty while still providing adequate treatment and protecting health and safety.

Conclusion

The Supreme Court’s memorandum opinion in In the Matter of the Necessity for the Hospitalization of L.G. reaffirms and refines Alaska’s framework for involuntary commitment. It underscores that courts must conduct a thorough, documented LRA analysis, consider the full scope of risk, and may legitimately weigh medication compliance in choosing between inpatient and outpatient care. By doing so, the decision strengthens procedural safeguards for individuals with mental illness while preserving public safety and the integrity of the commitment process.