Appeal from the Appellate Court for the First District; heard
in that court on appeal from the Circuit Court of Cook County,
the Hon. Cornelius J. Collins, Judge, presiding.
MR. JUSTICE UNDERWOOD DELIVERED THE OPINION OF THE COURT:
The Cook County grand jury returned indictments charging that defendant, Charles Stephenson, murdered two persons. Subsequent proceedings resulted in a January 3, 1974, finding that he was unfit to stand trial, and his confinement in a State institution pending recovery. On January 10 a petition alleging defendant to be in need of mental treatment was filed accompanied by the certificates of two psychiatrists, both stating defendant was in need of hospitalization on an emergency basis because he was, in the words of one doctor, a "[p]ossible danger to self if depression increases in severity" and, as stated by the other, was "likely to physically harm others unless hospitalized." Following a February 15 evidentiary hearing defendant was found to be in need of mental treatment and committed to the Department of Mental Health for care and treatment in the Manteno State Hospital.
Defendant appealed and the Appellate Court for the First District affirmed. (36 Ill. App.3d 746.) We allowed defendant's petition for leave to appeal, and now consider whether the due process requirements of the Federal and State constitutions in involuntary commitment proceedings are satisfied by a standard of proof less demanding than the proof beyond a reasonable doubt standard applicable to criminal trials. The trial judge in this case believed proceedings for the commitment of the mentally ill were civil in nature, thus permitting the use of the ordinary preponderance of the evidence standard. The appellate court disagreed, holding that the indefinite loss of personal liberty which could result necessitated the more stringent standard of clear and convincing evidence. That court held, however, that the evidence before the trial court clearly and convincingly established defendant's need for mental treatment and accordingly affirmed the judgment.
While it could be argued the issue is moot since defendant is no longer subject to the judgment being reviewed, the issue is a constantly recurring one upon which judicial opinions diverge. It has been thoroughly briefed and argued, and its resolution will relieve existing uncertainties and contribute to the efficient operation of our system of justice. We therefore consider it. In re Estate of Brooks (1965), 32 Ill.2d 361, 364-65; People ex rel. Wallace v. Labrenz (1952), 411 Ill. 618, 622-23.
Civil commitments are governed by the Mental Health Code of 1967 (Ill. Rev. Stat. 1973, ch. 91 1/2, pars. 1-1 through 20-1). Section 1-11 defines a "Person in Need of Mental Treatment" as "any person afflicted with a mental disorder, not including a person who is mentally retarded, as defined in this Act, if that person, as a result of such mental disorder, is reasonably expected at the time the determination is being made or within a reasonable time thereafter to intentionally or unintentionally physically injure himself or other persons, or is unable to care for himself so as to guard himself from physical injury or to provide for his own physical needs. This term does not include a person whose mental processes have merely been weakened or impaired by reason of advanced years." (Ill. Rev. Stat. 1973, ch. 91 1/2, par. 1-11.) Other sections provide extensive safeguards clearly intended to minimize the possibility of confinement of persons for whose protection, or the protection of others, confinement is unnecessary. Among those are: sections 3-8 and 3-9 (Ill. Rev. Stat. 1973, ch. 91 1/2, pars. 3-8, 3-9), requiring an explanation of the status and rights to be given every hospitalized patient in a language he understands within 12 hours of his admission; section 9-2 (Ill. Rev. Stat. 1973, ch. 91 1/2, par. 9-2) providing for jury trials on the question of the need for mental treatment if such trial is requested by the patient, his spouse, relative, friend or an attorney for any of them; section 9-4 (Ill. Rev. Stat. 1973, ch. 91 1/2, par. 9-4), providing for counsel and requiring the presence of the patient at any court hearing unless waived by counsel or the court finds such attendance would cause the patient serious risk of physical or emotional injury in which event the court or jury must personally observe and confer with the patient; sections 9-6 and 9-7 (Ill. Rev. Stat. 1973, ch. 91 1/2, pars. 9-6, 9-7), limiting the authority of custodians; section 9-11 (Ill. Rev. Stat. 1973, ch. 91 1/2, par. 9-11), providing that commitment as in need of mental treatment is not an adjudication of, and creates no presumption of, legal incompetency and does not deprive the patient of his civil rights (although the efficacy of the latter provision is questioned by defendant, who cites other statutory provisions authorizing revocations or suspensions of licenses, etc., following a finding that the holder is in need of mental treatment (e.g., Ill. Rev. Stat. 1973, ch. 91, par. 55.13-6)); section 10-1 (Ill. Rev. Stat. 1973, ch. 91 1/2, par. 10-1), permitting patients to file requests for discharge accompanied by a physician's certificate; and section 10-2 (Ill. Rev. Stat. 1973, ch. 91 1/2, par. 10-2), providing:
"The superintendent of any hospital in which any patient is hospitalized as in need of mental treatment or as mentally ill under this Act or any prior Act shall, as frequently as practicable but not less than every 6 months, review the need for continued hospitalization of the patient, and make the results of such examination a part of the patient's record. At least once during the first year of a patient's hospitalization and once during each 2-year period thereafter, the superintendent shall file with the Department a written report, on a form which it prescribes, setting forth the reasons supporting the need for further hospitalization of the patient. At the same time this written report is filed, the superintendent shall give notice of such report to the patient, his attorney, his nearest relative, 2 other persons designated by the patient, and to the court which conducted the consultation or ordered the patient's hospitalization or continued hospitalization, whichever was later. Such notice must set forth the right which the patient or any person on his behalf shall have to secure a hearing on the need for continued hospitalization of the patient, by sending a request for hearing to the superintendent, the Department, or the court. Such request must be made to the court, Department, or hospital within 10 days, excluding Saturdays, Sundays and holidays, after the notice is received by the person who makes such request for hearing. If the request is made to the hospital or Department, such recipient shall notify the court of such request forthwith."
Section 10-3 (Ill. Rev. Stat. 1973, ch. 91 1/2, par. 10-3) requires the court to appoint physicians to examine those patients who are indigent and file requests for discharge under section 10-1, and establishes the procedures for court hearings on such requests, including the appointment of counsel and jury trials for hearings under both sections 10-1 and 10-2. The continued use of writs of habeas corpus is expressly recognized by section 10-6. (Ill. Rev. Stat. 1973, ch. 91 1/2, par. 10-6.) Section 10-8 (Ill. Rev. Stat. 1973, ch. 91 1/2, par. 10-8) incorporates a 1969 amendment requiring review within 6 months by the superintendent of each hospital of all unrestored patients committed as mentally ill prior to January 1, 1964, for the purpose of determining their current competence and whether they might be adequately cared for outside the hospital; that amendment further required a petition and physician's certificate to be filed with the court in the cases of the pre-1964 committed patients and a determination by the court of the patients' competence, and, if still incompetent, appointment of conservators of the person and, if appropriate, of the estate. Sections 12-2 and 12-3 (Ill. Rev. Stat. 1973, ch. 91 1/2, pars. 12-2, 12-3) contain specific provisions for the rights of patients to have visitors, telephonic communication and uncensored correspondence with attorneys and public officials, with any restriction upon visitation and telephonic communications and the reasons therefor to be made a part of the patient's clinical record. Inspection of hospital records or divulging information regarding clinical or clerical data is severely limited. Section 10-4 (Ill. Rev. Stat. 1973, ch. 91 1/2, par. 10-4) authorizes the hospital superintendents to grant patients absolute or conditional discharges or temporary releases.
These provisions of Illinois' comprehensive Mental Health Code are stated in some detail, not because we regard them as dispositive of the issue before us, but because we regard them as relevant in our consideration of the consequences attendant upon involuntary commitments. Those consequences are of primary concern in a determination of the required standard of proof.
Defendant contends that the reasonable doubt standard of proof is constitutionally required because the loss of individual liberty is at stake, and permanent and substantial stigmatization results from a civil commitment. Due process, however, is a flexible concept and depends, at least in part, on the circumstances of the particular matter in issue. Morrissey v. Brewer (1972), 408 U.S. 471, 481, 33 L.Ed.2d 484, 494, 92 S.Ct. 2593, 2600.
Our society places an especially high but not completely unlimited value upon personal liberty and freedom, and, in criminal cases, the conviction of an innocent person is regarded as a greater encroachment upon those values than is the acquittal of one who is guilty. To minimize the possibility of the former, proof beyond a reasonable doubt is required to sustain a criminal conviction. (In re Winship (1970), 397 U.S. 358, 364, 25 L.Ed.2d 368, 375, 90 S.Ct. 1068, 1073.) In contrast, the decision in the ordinary civil case only determines which party must bear an economic loss. Because there are no sound reasons for favoring one party over another, a preponderance of the evidence standard is used. (In re Winship (1970), 397 U.S. 358, 371, 25 L.Ed.2d 368, 379, 90 S.Ct. 1068, 1076 (Harlan, J., concurring).) The case we deal with here, like many others, does not fit easily into either category. Thus, although commitments of the mentally ill are usually regarded as civil proceedings, analogies may be drawn to criminal proceedings. The most obvious, of course, is the potential loss of liberty which may well be of substantial duration. In our judgment, however, the application of labels or use of simplistic analogies is of little real assistance. More to the point, we believe, is an appraisal of the interests of the allegedly mentally ill individual and the society of which he is a part. Those interests are, in part, competing.
The fundamental liberty interest of the person facing commitment is self-evident. The Mental Health Code of 1967, as earlier noted, reflects a concern for that interest and, in its present form, represents a serious attempt to provide beneficial treatment and care for the mentally ill with the minimum ostracism and confinement consistent with protection of the public. Our free society's interest in prospectively protecting itself from dangerous or harmful conduct, standing alone, suffices to justify only minimal infringements upon an individual's personal liberty. A high value has also been placed, however, on our society's obligation to protect and care for those of its members unable to protect or care for themselves. It is important to a concerned and humane society that the margin of error be held to a minimum in denying such protection and care. Moreover, the individual involved, as well as society, has a strong interest in getting needed care or treatment which will enable him to function normally, and it seems to us that neither the interests of society nor the mentally ill are well served by a standard requiring proof so conclusive that many persons will be denied needed treatment, care and protection. Additionally, the release of an individual who is unable to control his conduct and likely to injure or endanger himself or others jeopardizes the interest of society in the protection of its members. In contrast, of course, a standard of proof which tends to favor erroneous commitments infringes upon personal liberty, and this consideration persuades us, as it has the State, of the necessity for a standard more nearly conclusive than a mere preponderance of the evidence. But, in our judgment, the degree of infringement here is not so great as to require the proof beyond a reasonable doubt rule applicable in criminal cases. There are substantial differences. The line between guilt and innocence is, in an abstract sense, clear, i.e., either defendant did or did not commit the offense, but the boundary between those persons who are dangerously mentally ill and those who are not is less well marked. It is a matter of the degree of disturbance, an appraisal of which is dependent upon subjective determinations and predictions. It is not unlikely that the mental health of a person erroneously committed will nevertheless be close to a point of serious illness, and that such persons might well benefit from the treatment accorded them while committed. In contrast, it is difficult to imagine any corresponding benefit accruing to an imprisoned innocent person. A further difference is to be found in that, even if the alternatives provided by section 9-6 are not utilized by the court and the individual is hospitalized, section 10-1 provides an opportunity for the speedy release of one no longer in need of mental treatment upon his own application; and the required periodic review and report by the superintendent of the hospital (section 10-2) is unparalleled in the laws controlling release of those serving criminal sentences.
On balance we believe that proof beyond a reasonable doubt is an inappropriate standard for use in involuntary civil commitment proceedings. Predictions of dangerousness can hardly be beyond a reasonable doubt in the undeveloped framework of the science of psychiatric diagnosis and prediction, for the subjective determinations therein involved are incapable of meeting objective certainty. (Tippett v. Maryland (4th Cir. 1971), 436 F.2d 1153, 1165 (Sobeloff, J., concurring in part and dissenting in part), cert. dismissed as improvidently granted sub nom. Murel v. Baltimore City Criminal Court (1972), 407 U.S. 355, 32 L.Ed.2d 791, 92 S.Ct. 2091; Doremus v. Farrell (D. Neb. 1975), 407 F. Supp. 509, 516-17; Bartley v. Kremens (E.D. Pa. 1975), 402 F. Supp. 1039, 1052, prob. juris. noted (1976), 424 U.S. 964, 47 L.Ed.2d 731, 96 S.Ct. 1457; Lynch v. Baxley (M.D. Ala. 1974), 386 F. Supp. 378, 393; and In re Valdez (1975), 88 N.M. 338, 342-43, 540 P.2d 818, 822-23.) See also Ennis & Litwack, Psychiatry and the Presumption of Expertise: Flipping Coins in the Courtroom, 62 Calif. L. Rev. 693 (1974); Diamond, The Psychiatric Prediction of Dangerousness, 123 U. Pa. L. Rev. 439 (1974); Rosenhan, On Being Sane in Insane Places, 179 Sci. 250 (1973); Scheff, Being Mentally Ill: A Sociological Theory 130-53 (1966).
Finally, we deem undesirable any additional steps which might erode the differences between mental health commitment proceedings and traditional criminal trials. (See McKeiver v. Pennsylvania (1971), 403 U.S. 528, 29 L.Ed.2d 647, 91 S.Ct. 1976; In re Winship (1970), 397 U.S. 358, 375-76, 25 L.Ed.2d 368, 90 S.Ct. 1068, 1079 (Burger, C.J., dissenting).) Mental illness is not a crime, and a person in need of mental treatment is not by reason thereof a criminal. But proof beyond a reasonable doubt is ...