A Therapist Speaks: Conservatorships and the #FreeBritney Movement

Many of us remember when the beloved pop princess Britney Spears publicly shaved her head in February of 2007 — and most who don’t have likely seen photos of the incident. Although we had (and still have) no idea why she did it, two things were clear: She was both in pain and desperate.

A year later, Britney Spears was根据保守主义，据The New York Times,这意味着她的个人和金融事务would be managed by someone else — in this case, largely by her father, Jamie Spears.

Court documents detailing parts of the conservatorship, including mandated drug tests and treatment with锂（通常用于的药物treat bipolar disorder) were leaked in 2016, but the exact reasons for the conservatorship are still unknown to the public.

Although we don’t know exactly why this arrangement is in place for Spears, certain aspects of her case are concerning to many — including the fact that the conservatorship remains in effect 13 years later, against Britney’s wishes, a situation she has become increasingly vocal about.

正如她说话的那样，她的粉丝已经注意到了。#freebritney hashtag和与它关联的竞选活动于2019年5月起飞Los Angeles Timesreported, afterfans protestedthe conservatorship outside the West Hollywood City Hall in California.

Now #FreeBritney has resurged in 2021, withSpears herself using the hashtag在一个课程邮寄后，在七月统治后，矛队可以雇用自己的律师，因为她寻求结束她的保护统一体。

All this raises questions for people who are less acquainted with what a conservatorship means. Here are some answers.

What Is a Conservatorship?

保守党 - 也被称为监护人 - 是一种法律安排，其中一个人或一个人团队（称为“保守派”）由一名法官任命，以帮助照顾另一个人（称为“保守”），他们是谁被认为无法照顾自己。这种安排旨在帮助无法理解其决策的重要性和后果的人，以便他们不会做出造成重大的身体或财务危害的决定。一旦法院授予了保护统治，只有一个法院可以解除它。

Typically, when judges grant a conservatorship, they specify both the duration and scope of the conservatorship. In other words, they will say how long the arrangement will likely last and what types of decisions the conservator is allowed to be involved in.

A conservatorship is an extreme and relatively rare arrangement and should be used only as a last resort. Importantly, a conservatorship is not meant to be a complete loss of rights. The purpose of a conservatorship is to prevent someone from making dangerous decisions — not to take away all their decision-making power.

什么时候通常使用保护律师？

Conservatorships are typically put in place for people with significant cognitive impairment — or issues with memory, learning new things, concentration, or decision-making.

As a physician, I have mostly seen conservatorships used for older people with severe dementia or severe cognitive impairment related to neurological trauma, such as a stroke. In some cases, I have also seen a conservator assigned to younger people with severe developmental and intellectual disabilities.

Although mental health conservatorships do exist, they’re not common. As apsychiatrist, I have only seen them used a few times throughout my career for people with a mental illness. In most of the cases I’ve seen, the conservatees had intellectual disabilities in addition to their mental illnesses. On rare occasions, other conservatees experienced long-term impairment related to a severe, chronic mental illness.

In all these cases, the conservatees either lived in assisted-living facilities or with their conservators because they were unable to live alone at that time — and they did not oppose the conservatorship.

适当的保护统统是什么样的？

适当使用保护统治的具体例子包括确保保守的时间按时支付账单，不会冲动地花费所有的储蓄，进入公平合同（并没有利用），并理解他们可能需要的任何医疗选择制作。

Ultimately, a conservatorship is meant to help someone, not control them. As long as conservatees are not choosing to do something that causes themselves significant harm, their personal wishes should be taken into account and guide the conservator’s decision-making.

Similarly, although it’s ultimately the court’s decision who the conservator is, the conservatee’s wishes should be taken into account when assigning a conservator.

Why Is a Conservatorship Rare for Mental Illness?

由于精神疾病的性质，在严重的精神疾病的情况下，保守党在严重的精神疾病的情况下比在痴呆症等严重神经疾病等痴呆症等情况下。

对于初学者来说，许多精神病疾病都是剧目的 - 意思是有人在他们通常的状态下花费大部分时间（未受他们的精神疾病症状的影响或最低影响），并且只有一些时间受到症状的影响。

Some mental illnesses — most often, more severe forms ofschizophreniaand躁郁症— may impact a person’s ability to make safe decisions and think through the consequences of those decisions during a period of exacerbation, or temporary worsening of symptoms. Someone may need help with decisions while in one of these episodes, but outside these periods, they are more than capable of living safely and independently.

Furthermore, although psychiatric treatment is far from perfect, a combination of therapy, rehabilitation services, and medication can really help someone manage — and even sometimes prevent — these more severe episodes.

Because of the episodic nature and ability to manage many of the more severe symptoms of mental illness, something that takes away someone’s rights broadly and continuously like a conservatorship is typically not appropriate.

How Does a Conservatorship Differ From Involuntary Treatment?

When someone is in the middle of a psychiatric episode and needs temporary help with decision-making, they might choose to turn to a trusted friend, family member, or mental health professional. They may run their ideas by them to make sure they’re not making impulsive choices or decisions as a result of a delusion — a fixed belief not rooted in reality.

In other cases, someone won’t accept help with decisions, including the decision to get mental healthcare. In these cases, someone may be hospitalized — sometimes involuntarily (or against the person’s wishes) — to protect them from making harmful decisions during the episode.

If someone does need to be hospitalized, the goal is to treat them, typically with a combination of medication and therapy, and to get them back to their usual self and able to live safely and independently as quickly as possible.

除了非自愿住院外，还有其他形式的授权精神健康治疗，可以在医院外进行。例如，辅助门诊治疗（AOT）是一种治疗类型，其中法官命令符合条件的人遵守某种心理健康治疗计划，以便住在社区（而不是在医院内部）。

Any form of involuntary treatment infringes on someone’s rights, and it should be a last resort and used only when needed for imminent safety. Still, mandated mental health treatment is very different from a conservatorship.

For starters, involuntary treatment mandates treatment of the illness and does not restrict a person’s rights otherwise. In addition, the goal of mandated treatment is to treat a person so that they can continue being independent and making their own decisions.

Why Is Britney Spears’s Case Unique?

Putting all this together, it’s easy to see why Spears’s case is concerning to so many.

从外面来看，似乎她至少有一个不同的保险柜已经被拒绝了很长时间。似乎，她的保护商涉及的决定超出了确保基本安全的领域。

For example,court documents obtained by theNew York Timesindicated that Britney Spears reported being forced to perform and being denied funds to make cosmetic changes to her home, like re-staining her kitchen cabinets, despite continuing a lucrative career.

此外,她有一个持续的conservat的原因orship since its establishment in 2008 is also an important question. Having not evaluated Spears myself, I cannot answer questions regarding the need for this type of arrangement. But I can certainly relate to those who feel confused by her case, since Spears has been capable of continuing a successful performing career — which her conservator profits from — and at the same time is considered unable to make basic decisions related to her daily life.

一个治疗师的# FreeBritney分开的想法

As a psychiatrist, I find Spears’s case troubling. It highlights a lot of issues related to the way people with mental illness are sometimes treated. There is so much stigma related to mental illness, including misconceptions that those with mental illness are dangerous, lack insight, and are unable to live full, independent lives.

Although we don’t know the details of the case, there is something about Spears having a 13-year conservatorship against her wishes that reinforces these misconceptions. This case also risks sending the message that those with mental illness need to be controlled, which is both wrong and harmful.

回到保护统统的定义，这种类型的安排意味着帮助，不控制。对于那些有没有精神疾病的人来说，重要的是，任何干预的目标都是帮助人们保持独立，令人满意，快乐的生活 - 无论这意味着什么他们personally. No matter how severe a person’s mental illness may be, their personhood should always be respected and their wishes always considered important.

For Spears, an appropriate conservatorship — if needed — should help with the pain and desperation we saw in 2007, not create more.

* 2021年8月12日，杰米矛agreed to step downas the conservator of Britney Spears's estate.