Least Restrictive Alternative Requirement in Involuntary Psychiatric Commitment

Introduction

This commentary examines the Supreme Court of the State of Alaska’s decision in In the Matter of the Necessity for the Hospitalization of Alonzo G. issued on May 21, 2025. The case addresses a 90-day involuntary psychiatric commitment under Alaska law and challenges whether the State properly considered “less restrictive alternatives” before ordering continued hospitalization at the Alaska Psychiatric Institute (API). The principal parties are:

Petitioner/Respondent: Alonzo G., a man diagnosed with paranoid schizophrenia who attacked his uncle.
Respondent State: The State of Alaska, represented by the Attorney General’s Office and the local public defender.

The key legal issue is whether the superior court erred in finding—by clear and convincing evidence— that no feasible less restrictive treatment options were available to meet Alonzo’s needs and protect the public.

Summary of the Judgment

The superior court master held a hearing on a petition for a 90-day commitment order. The examiner from API testified to Alonzo’s ongoing delusions, partial medication compliance, inability to engage in discharge planning, and risk of violent behavior. Despite attempts to secure outpatient providers and coordinate care, Alonzo refused to sign releases of information or identify a viable alternative to API. The master recommended, and the superior court approved, continued commitment. On appeal, the Supreme Court affirmed, holding that:

The State had considered specific outpatient and familial alternatives and explained why they were not feasible.
API remained the least restrictive environment consistent with Alonzo’s treatment needs and public safety.
There was no reversible error in the court’s clear-and-convincing-evidence finding on less restrictive alternatives.

Analysis

Precedents Cited

In re Hospitalization of Naomi B. (435 P.3d 918, 2019): Reaffirmed the due process and least restrictive environment requirements under Alaska’s constitution and statute.
In re Hospitalization of Declan P. (538 P.3d 318, 2023): Clarified that the State must identify which less restrictive alternatives it considered and explain why each was infeasible.
In re Hospitalization of Sergio F. (529 P.3d 74, 2023): Confirmed that the State need not disprove every conceivable alternative but must address specific ones.
Wetherhorn v. Alaska Psychiatric Institute (156 P.3d 371, 2007): Categorized involuntary commitment as a “massive curtailment of liberty” requiring heightened due process.

Legal Reasoning

The Court’s reasoning rests on two pillars:

Statutory Requirement: Under AS 47.30.655(2), civil commitment must occur in the “least restrictive environment consistent with treatment needs.” AS 47.30.915(11) defines “gravely disabled” to include a person who cannot meet basic needs due to mental illness.
Constitutional Due Process: The Alaska Constitution protects liberty interests in avoiding involuntary confinement. When the State petitions to confine a mentally ill person, it must show by clear and convincing evidence that no less restrictive treatment plan can adequately address the individual’s disability or dangerousness.

Applying these principles, the Court held that the State had:

Solicited and documented attempts to engage outpatient providers (including API’s efforts to locate “Fiona” and coordinate with Alaska Behavioral Health),
Recorded Alonzo’s refusal to sign releases and his ongoing delusional hostility, and
Confirmed that the structured environment of API was necessary for medication compliance and monitoring of violent risk.

Impact

This decision reinforces the Alaska judiciary’s insistence on a thorough, documented “least restrictive alternative” analysis in involuntary commitment cases:

Trial courts and masters must elicit testimony about specific outpatient or familial alternatives and explain why they are infeasible.
Commitment orders absent such analysis may be vulnerable to reversal under independent review of legal conclusions.
Clinicians will feel procedural pressure to exhaust coordination efforts and obtain releases of information before seeking extended inpatient commitment.

The ruling thus provides practitioners and judges with a clear roadmap for structuring commitment hearings and writing findings that will withstand appellate scrutiny.

Complex Concepts Simplified

Clear and Convincing Evidence: An intermediate standard of proof—higher than “preponderance of the evidence” but lower than “beyond a reasonable doubt”—used in civil commitment to protect liberty interests.
Gravely Disabled: A statutory term meaning a mentally ill person who, due to the illness, cannot care for their basic needs (food, shelter, clothing) or protect their safety.
Least Restrictive Alternative: The requirement that the State use the treatment option that imposes the smallest intrusion on individual liberty while still providing effective care and protecting the public.
Parens Patriae vs. Police Power: Parens patriae is the State’s power to protect individuals who cannot care for themselves; police power is the authority to protect society from dangerous individuals.

Conclusion

The Supreme Court of Alaska’s decision in In the Matter of the Necessity for the Hospitalization of Alonzo G. affirms that involuntary psychiatric commitment must be preceded by a concrete, well-documented evaluation of less restrictive alternatives. By requiring the State to identify which outpatient or familial options were considered and why each proved infeasible, the Court ensures that commitment orders rest on a robust due process foundation. This ruling will guide future practitioners in meeting the dual imperatives of effective mental health care and protection of personal liberty.