In Re the Detention of: M.B.

IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
DIVISION II
In the Matter of the Detention of: No. 59613-0-II
M.B.
UNPUBLISHED OPINION
Appellant.
CRUSER, C.J.—MB appeals from the superior court order imposing 90 days of involuntary
mental health treatment based on a jury’s finding that MB was gravely disabled. MB argues that,
although he has already completed his 90 days of involuntary treatment, his appeal is not moot.
And MB argues that the evidence was insufficient to establish that he was gravely disabled.
We hold that MB’s appeal is not moot and that sufficient evidence supported the jury’s
finding that MB was gravely disabled under either RCW 71.05.020(25)(a) or (b).1 Accordingly,
we affirm.
FACTS
I. CHARGES AND DISMISSAL OF CHARGES
In 2023, the State charged MB with second degree assault and third degree possession of
stolen property. Following a competency evaluation and restoration, MB was deemed incompetent
1 RCW 71.05.020 has been amended since the events of this case transpired. Because the
amendments do not affect our analysis, we cite to the current version of the statute. Compare
former RCW 71.05.020 (2023), with LAWS OF 2025, ch. 226, § 1.
Filed
Washington State
Court of Appeals
Division Two
December 16, 2025

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to stand trial. The State dismissed the charges against MB, and the trial court ordered MB
committed to Western State Hospital for a civil commitment evaluation.
II. PETITION FOR INVOLUNTARY TREATMENT AND JURY TRIAL
MB’s treatment providers, Dr. Vanessa Kieu and Dr. Mehrban Goshtaseb Pour Parsi,
petitioned on behalf of the State for an involuntary treatment order under RCW 71.05.280(3) and
(4). The petitioners alleged that MB was “gravely disabled” and that he “has been determined to
be incompetent and criminal charges have been dismissed pursuant to RCW 10.77.086(4), has
committed acts constituting a felony, and as a result of a behavioral health disorder, presents a
substantial likelihood of repeating similar acts.” Clerk’s Papers (CP) at 21. The matter proceeded
to a jury trial where the petitioners sought 90 days2 commitment on the basis that MB was gravely
disabled.
A. Dr. Parsi’s Testimony
Dr. Parsi, MB’s treating psychologist, testified at trial. Dr. Parsi diagnosed MB with
“[s]chizophrenia spectrum disorder and other psychotic disorders.” Verbatim Rep. of Proc. (VRP)
(Apr. 24, 2024) at 106. This diagnosis was based on disorganized behavior (a reaction to internal
stimuli), delusions, disorganized (illogical) speech, lack of motivation, and flat affect. One of
MB’s delusions was that he had a “higher MCAT score” than Dr. Parsi. Id. Dr. Parsi stated that
MB lacked insight into his own mental illness because he thought he had “defeated all the ultra[-
]hallucinations” and that he is either no longer mentally ill or “only has ADHD,” depending on the
person with whom he was speaking. Id. at 107.
2 The petitioners initially requested a 180-day involuntary treatment order but eventually reduced
the request to 90 days. The record does not explain the reason for the shift. The length of the period
of commitment is not challenged on appeal.

No. 59613-0-II
3
Dr. Parsi prescribed antipsychotic medication for MB. Dr. Parsi found that MB was better
able to converse and had fewer reactions to internal stimuli while he was medicated. According to
Dr. Parsi, MB has a greater chance of relapsing and resistance to treatment if he discontinues his
medications. He believed that MB would not continue taking antipsychotics on his own because
he has only asked providers for ADHD medications in the past and “he believes there are robots
in the pills that are harming him.” Id. at 114. Dr. Parsi stated that he believes MB would not be
able to “ensure that his basic health and safety needs are met” as a result of his behavioral health
disorder because he “has a difficulty advocating for himself in an effective and safe way.” Id. For
example, instead of speaking with Dr. Parsi about his dosage being titrated up, MB threatened to
stab Dr. Parsi and made a stabbing motion. MB does not believe that he is mentally ill, and called
the patient advocacy hotline, stating that “he has a higher MCAT score than [Dr. Parsi] . . . and
that he’s going to start knifing [him] until things change.” Id. at 129. MB also would not shower
or otherwise care for his hygiene without being told to do so and did not permit providers to
complete medical care like lab work, a physical examination for a visible rash on his face or any
other medical conditions, or a neuro assessment after he was attacked by another patient.
Additionally, Dr. Parsi opined that MB was incapable of providing for his own health and
safety because he relied heavily on his social workers for tasks like acquiring an ID and completing
social security paperwork. Dr. Parsi believed that MB was incapable of making rational decisions
concerning his treatment. MB also had altercations with other patients and Dr. Parsi worried that
if he were released, he would be at risk of physical harm by misconstruing interactions with others
due to his delusions. Dr. Parsi stated that MB had harmed someone unprovoked on March 8, 2024,
and another time on April 6, 2024; as a result, he had a “mental health technician or therapist [ ]

No. 59613-0-II
4
with him to reduce the chances of damage to others or unpredictable psychotic behavior.” Id. at
115. Dr. Parsi believed that MB “would benefit from continued hospitalization, but with increase
of privileges incrementally to allow him to gain more freedom.” Id. at 116. Continued treatment,
in Dr. Parsi’s view, was necessary to ensure MB stays out of the hospital in the future.
B. Dr. Kieu’s Testimony
Dr. Kieu, a forensic psychologist who conducts civil commitment evaluations, also
testified at trial. She had observed MB, interacted with him, treated him, and reviewed his hospital
records. Dr. Kieu opined that MB suffered from schizophrenia because he exhibited all the
symptoms of the illness; a diagnosis requires that a patient exhibit at least two or three. These
symptoms include delusion, hallucination, and disorganized thoughts and behaviors. She
concluded that he suffered from delusions because he had told her that “he owns McDonald’s [and]
Jack in the Box.” Id. at 149. MB had also told Dr. Kieu that he hears voices that tell him to “cut a
piece of body,” and that it is unclear if he meant his own body or someone else’s because his
communication is so disorganized. Id. at 150. Dr. Kieu also observed that MB rarely engaged with
others on the ward. Dr. Kieu noted on cross-examination that MB has some level of awareness in
communicating with her—for example, he remembers her name—but that he answers some
questions in such a way that indicates he is “aware, but not fully aware.” Id. at 172. For example,
when she asked about his birthday, he started listing multiple dates.
Dr. Kieu also noted that after consulting with MB’s treatment teams, she learned that he
went for long periods of time without showering or changing into clean clothes. Dr. Kieu noted
that she had observed MB pacing aimlessly and speaking to himself, which lead her to believe that
he is “unable to control his function.” Id. at 153. Dr. Kieu also interviewed MB, and noted that he

No. 59613-0-II
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was “disheveled,” was wearing food-stained clothes, and that it seems as though he had not been
“attending to his personal care” at that time. Id. She stated that MB made disjointed and delusional
statements to her, for example that the president and the district attorney were trying to harm him
and that he needed to cut a piece of his body to die and go to a kingdom called “Aztec.” Id. at 154.
To her knowledge, MB has never tried to harm himself.
Dr. Kieu testified regarding MB’s prior history of deterioration, commitment, and release.
MB had been civilly committed to Western State Hospital on one prior occasion after a court found
him to be incompetent to stand trial. Through treatment, MB was able to stabilize and discharge
from the hospital. According to MB’s records, during periods of decompensation, MB made
statements that he wanted to harm others, assaulted peers, and spat on hospital staff.
Dr. Kieu noted that in every interaction she has had with MB, he has not committed to
continuing to take his medication; he did not believe that he needed medication because he did not
believe that he is mentally ill. This attitude demonstrated poor judgment, in her opinion. She
posited that MB would not continue treatment if released, and if he did not continue treatment, she
worried that he would decompensate, he would harm others and thereby put himself in danger.
This determination of MB’s risk of harm was based on her review of records.
Dr. Kieu believed that MB’s statements exhibited poor judgment and misperception of
reality; for example, he told her that he believed Dr. Parsi was telling staff to harm him. She stated,
similarly to Dr. Parsi, that MB’s misperception of reality could put him in danger outside of the
hospital setting. Dr. Kieu stated that MB “cannot make insightful decision[s]” regarding his own
well-being. Id. at 165. She stated that “inpatient hospitalization is the best placement for him at
this time.” Id. at 166.

No. 59613-0-II
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C. MB’s Testimony
When asked about his plans if he were to leave the hospital, MB stated that he planned to
“do whatever you do as a homeless person and, like, run through the city and collect groceries and
things.” VRP (Apr. 25, 2024) at 178. He stated that he eats well, but that he did not know where
groceries came from. He testified that you can “walk around the corner” and “pick them up,” and
that “[y]ou [ ] spin a circle and you hold them. It’s magic. They’re magic food.” Id. He said that
he planned to return to a city called “Soto,” which he stated that he had lived in before, but that he
does not “have any friends in the state as the State killed them to rape them at the hospital before
I got here.” Id. at 178-79.
The jury found that MB suffered from a behavioral health disorder, that he is gravely
disabled as a result of that disorder, and that a less restrictive alternative to confinement at Western
State Hospital was not in his best interest. Accordingly, the trial court granted the petition and
ordered MB to be detained at to Western State Hospital for 90 days of involuntary treatment. MB
appeals.
ANALYSIS
I. MOOTNESS
MB argues that his appeal is not moot, although his period of involuntary commitment is
over, because his commitment order carries collateral consequences in subsequent petitions and
hearings. The State does not respond to this argument. We agree with MB.
While an appeal is generally moot where the appellate court can no longer provide effective
relief, release from detention does not render an appeal moot where collateral consequences flow
from the initial determination authorizing the detention. In re Det. of M.K., 168 Wn. App. 621,

No. 59613-0-II
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626, 279 P.3d 897 (2012). This court has held that civil commitment orders under chapter 71.05
RCW carry such collateral consequences because they can be used as part of the evidence against
a person seeking denial of a subsequent petition for commitment in the three years following the
initial commitment. Id. Accordingly, MB’s appeal is not moot, and we address MB’s appeal on
the merits.
II. SUFFICIENCY OF THE EVIDENCE
MB argues that substantial evidence did not support the jury’s finding that MB was gravely
disabled under either prong of RCW 71.05.020(25). The State contends that the evidence was
sufficient to support a finding that MB is gravely disabled on either prong. We agree with the State.
A. Legal Principles
If a trial court or jury finds that a person is gravely disabled and “that the best interests of
the person or others will not be served by a less restrictive treatment” the court may order that that
person be involuntarily committed to the custody of the department of social and health services
for up to 90 days. RCW 71.05.280(4); .320(1). Grave disability is defined as
a condition in which a person, as a result of a behavioral health disorder: (a) Is in
danger of serious physical harm resulting from a failure to provide for his or her
essential human needs of health or safety; or (b) manifests severe deterioration in
routine functioning evidenced by repeated and escalating loss of cognitive or
volitional control over his or her actions and is not receiving such care as is essential
for his or her health or safety.
RCW 71.05.020(25).
Under the first definition of “gravely disabled” a petitioner
must present recent, tangible evidence of failure or inability to provide for such
essential human needs as food, clothing, shelter, and medical treatment which
presents a high probability of serious physical harm within the near future unless
adequate treatment is afforded. Furthermore, the failure or inability to provide for

No. 59613-0-II
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these essential needs must be shown to arise as a result of mental disorder and not
because of other factors.
In re Det. of LaBelle, 107 Wn.2d 196, 204-05, 728 P.2d 138 (1986).
Under the second definition of gravely disabled the petitioner must provide evidence that
reveal[s] a factual basis for concluding that the individual is not receiving or would
not receive, if released, such care as is essential for his or her health or safety. It is
not enough to show that care and treatment of an individual’s mental illness would
be preferred or beneficial or even in his best interests. To justify commitment, such
care must be shown to be essential to an individual’s health or safety and the
evidence should indicate the harmful consequences likely to follow if involuntary
treatment is not ordered.
Id. at 208. RCW 71.05.020(25)(b) requires that the petitioner establish “that the individual is
unable, because of severe deterioration of mental functioning, to make a rational decision with
respect to his need for treatment.” Id. (interpreting former RCW 71.05.020(1)(b) (1979)). In other
words, the individual’s failure to receive care must be the result of the individual’s inability to
make a rational decision regarding his need for treatment.
A trial court must consider a person’s historical behavior when determining if the person
is gravely disabled. RCW 71.05.245(1). “Symptoms or behavior which standing alone would not
justify civil commitment may support a finding of grave disability” when the symptoms “are
closely associated with symptoms or behavior which preceded and led to a past incident of
involuntary hospitalization, severe deterioration, or one or more violent acts;” and when “without
treatment, the continued deterioration of the respondent is probable.” RCW 71.05.245(2).
At trial, the State must prove that the person is gravely disabled “by clear, cogent[,] and
convincing evidence.” LaBelle, 107 Wn.2d at 209; RCW 71.05.310. The appellate court considers
whether substantial evidence supports the findings of fact and whether the findings of fact support
the conclusions of law. In re Det. of A.F., 20 Wn. App. 2d 115, 125, 498 P.3d 1006 (2021).

No. 59613-0-II
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“[W]here the State must prove its case by clear, cogent[,] and convincing evidence, the evidence
[supporting the trial court’s findings] must be more substantial than in the ordinary civil case in
which proof need only be by a preponderance of the evidence.” LaBelle, 107 Wn.2d at 209.
Instead, “the ultimate fact in issue must be shown by evidence to be ‘highly probable.’ ” Id.
(quoting In re Interest of Pawling, 101 Wn.2d 392, 399, 679 P.2d 916 (1984)). We “view the
evidence in the light most favorable to the petitioner.” A.F., 20 Wn. App. 2d at 125. We do not
review the trier of fact’s assessment of witness credibility or the persuasiveness of the evidence.
Id.
B. Application
1. Failure to Provide for Essential Human Needs
MB contends that the evidence was insufficient to support a finding of grave disability
under definition (a) because (1) there was no evidence in the record that MB was unable to secure
food or that he was malnourished, (2) MB’s poor hygiene during confinement likely was caused
by his history of homelessness rather than his mental illness, (3) research does not support the
concern that MB would act violently or be a victim of violence because of his schizophrenia, and
(4) refusal to take medication does not support a finding that MB is gravely disabled because it
was MB’s right to refuse such medication. The State argues that substantial evidence supported a
finding that MB was gravely disabled under prong (a) because the record established that MB
cannot care for his physical health, will not allow needed medical attention, does not understand
where food comes from, and his symptoms make him likely to be involved in violent altercations.
We agree with the State.

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First, MB contends that the evidence was insufficient to establish that MB was unable to
acquire food or that he was malnourished while he was unhoused. But MB’s testimony at trial
indicated that his symptoms would likely interfere with his ability to acquire food. MB testified
that food “appears” and “[i]t’s magic” and that “[y]ou like spin a circle and you hold them. It’s
magic. They’re magic food.” VRP (Apr. 25, 2024) at 178. This evidence supports a conclusion
that MB is gravely disabled.
Next, MB argues that MB’s poor hygiene during commitment was likely caused by a
tolerance built up during the time he was homeless rather than his mental illness. But we “view
the evidence in the light most favorable to the petitioner.” A.F., 20 Wn. App. 2d at 125. And we
do not review the trier of fact’s assessment of witness credibility or the persuasiveness of the
evidence. Id.
MB also contends that several studies refute the petitioners’ conclusions that if MB were
released back into an unhoused environment his schizophrenia would create a risk that he would
be violent or the victim of an assault. These articles were not submitted at trial. Generally, we do
not accept additional evidence on appeal unless
(1) additional proof of facts is needed to fairly resolve the issues on review, (2) the
additional evidence would probably change the decision being reviewed, (3) it is
equitable to excuse a party’s failure to present the evidence to the trial court, (4) the
remedy available to a party through postjudgment motions in the trial court is
inadequate or unnecessarily expensive, (5) the appellate court remedy of granting
a new trial is inadequate or unnecessarily expensive, and (6) it would be inequitable
to decide the case solely on the evidence already taken in the trial court.
RAP 9.11(a). Here, MB makes no argument that any of these six criteria are met. Seeing no basis
to consider this new evidence, we decline to do so. The testimony at trial was that, as a consequence
of MB’s schizophrenia, MB suffered delusions and was detached from reality in a way that made

No. 59613-0-II
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him vulnerable to attack by others and which had actually caused several altercations during
commitment. This evidence supports a conclusion that the symptoms of MB’s schizophrenia
placed him in danger of serious physical harm.
Finally, MB contends that the “main issue preventing release” was MB’s statement that he
would refuse to take antipsychotic medication if he were released. Br. of Appellant at 20. MB
argues that this refusal does not support a finding that he is unable to provide for his own essential
health needs because MB has a right to refuse medication unless the medication is actually helpful.
But the record belies MB’s claim that non-compliance with medication was the “main issue
preventing release.” Id. The evidence demonstrated that MB consistently refused medical care and
struggled to communicate his needs to care providers. Based on the petitioners’ descriptions of
MB’s disorganized speech and detachment from reality, a reasonable jury could conclude that MB
is unable to advocate for his own physical or mental health.
Overall, sufficient evidence in the record demonstrates that MB, as the result of a
behavioral health disorder, “[i]s in danger of serious physical harm resulting from a failure to
provide for his or her essential human needs of health or safety.” RCW 71.05.020(25)(a). Dr. Parsi
and Dr. Kieu diagnosed MB with schizophrenia or schizophrenia spectrum disorder characterized
by disorganized behavior, delusions, and an inability to show emotions. Both doctors opined that,
if released, MB would not be able to provide for his own basic health and safety needs as the result
of his mental illness. Indeed, while committed, MB had poor hygiene, he did not shower without
being told and he appeared disheveled and had food on his clothes. At trial, MB testified that food
would appear by magic. This delusion indicates that MB’s schizophrenia would prevent him from
acquiring food on his own. And MB consistently refused needed medical care. MB demonstrated

No. 59613-0-II
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his inability to advocate for his medical needs when he threatened to stab Dr. Parsi because Dr.
Parsi titrated up MB’s medication.
And both doctors expressed concerns that MB’s symptoms put him at risk of serious
physical harm through altercations with peers. Dr. Parsi believed that MB’s reactions to internal
stimuli and inability to control his actions would make him a target for others. Dr. Kieu opined
that because MB is detached from reality, his reaction to perceived situations could put him at risk
of serious physical harm. MB also told Dr. Kieu that voices told him to “cut a piece of body” so
he could die and go to the kingdom of “Aztec.” VRP (Apr. 24, 2024) at 149-150, 154.
Accordingly, the evidence was sufficient to support a finding that MB was gravely disabled
under definition (a).
2. Severe Deterioration in Routine Functioning
MB also argues that the evidence did not support a finding that MB was gravely disabled
under definition (b) because there was no baseline from which to measure deterioration. But our
supreme court rejected such a literal interpretation of former RCW 71.05.020(1)(b) in Labelle, 107
Wn.2d at 206-207. There the court concluded that a literal reading of the statute would result in
absurd and potentially harmful consequences, for a court would be required to
release a person whose condition, as a result of initial commitment, has stabilized
or improved minimally—i.e., is no longer “escalating”—even though that person
otherwise manifests severe deterioration in routine functioning and, if released,
would not receive such care as is essential for his or her health or safety. Such
consequences could not have been intended by the Legislature in enacting [former]
RCW 71.05.020(1)(b).
Id. at 207. The court clarified that in order to establish the requisite factual basis under prong (b),
the “evidence must include recent proof of significant loss of cognitive or volitional control” and

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“a factual basis for concluding that the individual is not receiving or would not receive, if released,
such care as is essential for his or her health or safety.” Id. at 208.
The record demonstrates that the petitioners presented sufficient evidence of severe
deterioration in routine functioning as evidenced by recent proof of significant loss of cognitive or
volitional control—specifically, MB’s doctors observed that MB exhibits disorganized behavior,
reacts to internal stimuli, and suffers from delusions, illogical speech, and impaired insight. While
committed, MB also was involved in several altercations with peers and pulled the hair of staff
and peers. Moreover, these events occurred after MB had been previously committed based on
similar conduct, stabilized, and released back into the community.
Additionally, the record provides ample support from which a jury could find that MB
would not receive care that is essential for his health or safety if released and that MB was
incapable of making rational decisions about his health care needs. Dr. Kieu and Dr. Parsi testified
that MB had no insight into his mental illness, did not believe that he was mentally ill, and did not
believe that he needed any medication. And MB told Dr. Kieu that he would not continue to take
his medication when discharged because there were robots and bleach in it.
Therefore, even if the evidence was insufficient to support a finding that MB was gravely
disabled under prong (a), the above facts provided substantial evidence of grave disability under
prong (b) that the superior court could have reasonably found to be clear, cogent, and convincing.
CONCLUSION
We conclude that substantial evidence supports the jury’s finding that MB was gravely
disabled under either prong of RCW 71.05.020(25). Accordingly, we affirm.

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A majority of the panel having determined that this opinion will not be printed in the
Washington Appellate Reports, but will be filed for public record in accordance with RCW
2.06.040, it is so ordered.
CRUSER, C.J.
We concur:
LEE, J.
GLASGOW, J.