## Facts

- Police found Catherine Lake, age 60, wandering and took her to a public hospital.
- Lake petitioned for habeas corpus; she was transferred to Saint Elizabeths Hospital for observation during commitment proceedings, and the petition was initially dismissed without a hearing.
- After Lake appealed, she was adjudicated of unsound mind and committed to Saint Elizabeths based on psychiatric testimony diagnosing chronic brain syndrome associated with aging and inability to care for herself.
- The court of appeals remanded for a return and hearing; after an evidentiary hearing, the district court again denied habeas relief and suggested Lake could reapply if she secured an alternative placement.
- At the hearing, the psychiatric testimony indicated Lake was not dangerous to others and would not intentionally harm herself, but she was prone to wandering, nighttime exposure, and vulnerability.
- Lake had previously wandered away from the hospital, was missing for about 32 hours, and was returned by police with a minor injury.
- Lake’s husband and sister opposed continued hospitalization but lacked resources to provide adequate care; Lake was indigent.
- A new District of Columbia mental-health statute took effect, directing consideration of a range of services beyond full-time hospitalization, including outpatient care and less restrictive residential settings.

## Issues

1. Whether continued involuntary confinement in a mental hospital was justified where the patient was not dangerous to others and only marginally dangerous to herself due to wandering and self-neglect.
2. Whether, in habeas review of ongoing confinement, the court must investigate and consider less restrictive alternatives to full-time institutionalization before approving continued hospitalization.

## Decision

- The court did not order immediate release.
- The court remanded to the district court to conduct an inquiry into available alternative treatments or facilities suitable for Lake, rather than defaulting to continued confinement at Saint Elizabeths.
- The court directed that the remand inquiry reflect the statutory requirement to consider the full range of available services and placements.

## Legal Principles

- Because involuntary hospitalization is a severe deprivation of physical liberty, courts must consider whether less restrictive arrangements can meet the patient’s needs and protect safety before continuing full custodial confinement.
- Under the governing statutory framework, judicial decisionmaking in commitment-related matters must address the “entire spectrum” of available mental-health and supportive services, not treat hospitalization as the presumptive option.
- Where a patient is not dangerous to others and presents mainly risks of disorientation, wandering, or vulnerability, non-institutional options (e.g., outpatient care, nursing homes, supervised residential placement) must be seriously examined.
- For indigent patients lacking practical ability to secure placements, the government must participate in identifying and assessing feasible less restrictive alternatives; the burden cannot rest solely on the patient.
- Habeas corpus may be used to challenge the legality of continuing confinement, not only the legality of the initial commitment, when statutory standards governing continued detention are not satisfied.

## Conclusion

The court required a remand for factfinding and evaluation of less restrictive alternatives, holding that continued involuntary hospitalization of a non-dangerous, indigent patient cannot be sustained without a meaningful judicial inquiry into available community-based or less restrictive placements consistent with the patient’s welfare and public safety.


Lake v. Cameron, 364 F.2d 657 (D.C. Cir. 1966)