What #FreeBritney Can Tell Us About Mental Health and the Law

In a June testimony to the  Los Angeles Superior Court, Britney Spears spoke out against her 13-year conservatorship, asking that it be disbanded. In the 23-minute long statement, she described being medicated against her will, barred from seeing her friends, forced into work without break, and denied the right to remove her birth control to have a baby, among other abuses.

This testimony marked the culmination of a months-long #FreeBritney movement that has made headlines and sparked protests around the world.

Though Spears's diagnosis has never been formally disclosed, she was involuntarily hospitalized for psychiatric evaluation in early 2008. At the same time, she was dealing with divorce, a child custody battle, and increased media attention. Finally, in early 2009, her father James P. Spears and team petitioned to be appointed conservators of the singer's estate, "based on allegations that she is unable to provide for her personal needs."

Since then, Spears's father has had absolute control over her personal decisions, work schedule, and finances. But as early as 2014, the singer has spoken out about suffering abuses under the conservatorship.

With an estimated 1.5 million adults under guardianship in the U.S., some of the trauma Spears speaks of may be familiar to many.

A Last Resort

Although the terms "conservatorship" and "guardianship" vary by state, they are often used to distinguish between financial assistance and personal assistance.

The former mostly deals with the management of the conservatee's finances, whereas the latter deals with everyday care, such as help around the home, with medical care, etc. Spears's conservatorship allows for both.

To obtain a conservatorship, a couple of requirements must be met. First, the conservatee must be judged in some way to be unable to deal with their finances or personal matters. This could be the case due to disabilities related to old age, dementia, stroke, and mental health disorders such as schizophrenia, depression, and bipolar disorder. There also has to be no other viable option, which holds true for involuntary commitment, too.

Robert A. Brooks, JD, PhD, who teaches courses at the intersection of law and psychology at Worcester State University, tells Verywell that involuntary commitment should be the "last resort."

"We should try everything else first. We should try to get people in voluntarily," he says. But at the end of the day, he adds, "we should provide better care for people so that they don't spiral into conditions where they need to be committed involuntarily."

Understanding the Modern Conservatorship

Psychiatrist Paul S. Appelbaum, MD, who directs the division of psychiatry, law, and ethics at Columbia University, tells Verywell that if you want to understand the modern conservatorship, you have to go back in time—at least half a millennium.

"These provisions go back to medieval England," he explains, to when the Crown took over the estates of noblemen who were unable to manage them.

"That early institution then transforms into this system we have today," he adds, where people who are unable to manage their affairs or make certain decisions for their wellbeing, can be the subject to a process that involves a judicial hearing.

But before a hearing, many states require that an independent guardian do an investigation to determine whether the allegations of incapacity are supported. If supported, then they're appointed a guardian.

According to the California Handbook for Conservators, that guardian could be a relative, domestic partner, or friend. If no one in these roles can serve, a public guardian can be hired from a professional agency. Conservator compensation is also negotiated with the court.

Once the conservator or guardian is appointed, Appelbaum says, their appointment is usually reviewed on an annual basis. They're also required to file reports about the money they've handled.

Lastly, Appelbaum adds, conservatorships have changed in scope over the years. Whereas they have historically been all-encompassing, more limited conservatorships are becoming an option.

"The idea is that the court is charged with determining exactly what your incapacities are and tailoring a guardianship with those powers to make decisions for you in those areas of specific incapacity while leaving the rest of your life untouched," he says.

Overall, Appelbaum adds, "[conservators] are charged by the court to act in the best interest of the person."

What are the Dangers and Benefits?

When anyone is put in charge of another's wellbeing, there's a risk for abuse. This risk is particularly heightened in Spears's case, given her fame and fortune.

But Spears's case is just one among many, Lisa Zammiello, a student at the Texas Tech University School of Law, tells Verywell.

"Whenever there are everyday, average people who can't afford legal teams, or who don't have support in the media, there's really not a lot that can be done," she says.

For example, without money or influence, the conservatee may struggle to prove that they are being abused by their conservator. Once you're deemed "mentally unfit," anything you say or do can be questioned. And when a conservatorship is granted, it can be very hard to undo.

It's also important to keep in mind that conservators are paid for providing care. Because of this payment, she says, some "are going to try to push to keep the conservatorship in place."

Spears's father is estimated to have made more than $5 million before taxes during the 13 years as her guardian. The singer said in her testimony, "considering my family has lived off my conservatorship for 13 years, I won’t be surprised if one of them has something to say [against ending my conservatorship]."

Conservatorships Can Still Be Good

Still, Brooks adds, conservatorships are there for a reason. They provide care for people who cannot care for themselves.

Think of someone with severe dementia who, without a conservator, might forget that they left the stove on, or who might not be able to bathe themselves.

Also, conservatorships aren't necessarily easy to obtain. In general, Brooks says, since the late 1960s, it has become more difficult to commit someone against their will.

This is great in some aspects, he says, because it does away with certain abusive tactics, notably through involuntary hospitalization, or involuntary commitment.

"If we look back to the Victorian era, men who couldn't get divorced would commit their wives, based on one signature of one doctor, not even a psychiatrist, and just kind of put them away and move on," he says.

In general, Brooks adds, "it is troubling when someone has control over someone's decisions to marry and to have children, when the person is a fully-grown adult and seems to be functioning," such as in Spears's case. "At the same time, I understand the need for conservatorships more generally."

How Can Conservatorships Be Improved?

If Spears's highly-publicized case inspires any change, both Zammiello and Brooks say that it's not going to come in law-making.

Rather, they say, change needs to happen in how the laws are regulated, and how officials are trained to deal with the nuances of conservatorships.

"I think the law itself is sufficient. What's written in the books is sufficient in order to make sure we have conservatorships," Zammiello says. "It's the oversight, enforcement, and the tools used in order to carry out a helpful conservatorship that are the issue."

Specifically, Zammiello proposes various adjustments that could reduce conservatorship-related risks:

• Providing all judges, regardless of state, with universal guidance on what it means to be "incapacitated"
• Registering all conservators/guardians, regardless of state, in an online database
• Requiring that all conservators/guardians, regardless of state, go through a certification course

And in the event that the conservatee wishes to end the conservatorship, such as in Spears's case, it might help to place the burden of proof on the conservator. That is, if the conservatee provides evidence of abuse, the conservator will then also have to provide evidence of the absence of abuse.

"Dissolving a guardianship is extremely difficult—almost impossible," Zammiello wrote for the Estate Planning Journal. "So placing the burden on the certified guardian relieves some of the strife the ward faces when raising the issue of an abusive guardian."

Providing judges with more training on psychiatry, too, could promote more nuanced understanding. For example, if the son of a conservatee with dementia claims that his mother doesn't actually have dementia, and is being manipulated by her conservator, there should be no harm in getting an outside, independent opinion.

Brooks tells a story about a nurse he knew in Virginia. She worked at a hospital that held public hearings so that patients didn't need to be transported. "Every day before the hearing, [the judge] would come by her desk and say, 'Who should I keep and who should I let out?'"

This story is a clear example, Brooks says, of the need for an interdisciplinary approach.

"On paper, it looks great. You get a hearing, you get an attorney appointed for you," he says. "But in this particular case, a decision's been made before the hearing even takes place." What would have happened if that judge had a deeper understanding of the patients' conditions?

Spears speaks to some of the fear and trauma that can be brought on by these decisions and involuntary commitment in her testimony.

"This conservatorship is doing me way more harm than good," Spears said. "I feel ganged up on, and I feel bullied, and I feel left out and alone. And I'm tired of feeling alone."