A year later, Britney Spears was placed under a conservatorship, according to The New York Times, meaning that her personal and financial affairs 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 lithium (a medication typically used to 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. As she speaks up, her fans have taken note. The #FreeBritney hashtag and the campaign associated with it took off in May 2019, the Los Angeles Times reported, after fans protested the conservatorship outside the West Hollywood City Hall in California. Now #FreeBritney has resurged in 2021, with Spears herself using the hashtag in an Instagram post after a court ruled in July that Spears could hire her own attorney as she seeks to end her conservatorship. All this raises questions for people who are less acquainted with what a conservatorship means. Here are some answers.
What Is a Conservatorship?
A conservatorship — also known as a guardianship — is a legal arrangement in which one person or a team of people (called the “conservator”) is appointed by a judge to help care for another person (called the “conservatee”), who is deemed unable to care for themselves. This arrangement is meant to help someone who cannot understand the importance and consequences of their decisions so that they don’t make decisions that cause themselves significant physical or financial harm. Once a court grants a conservatorship, only a court can lift it. 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.
When Is a Conservatorship Usually Used?
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 a psychiatrist, 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.
What Does an Appropriate Conservatorship Look Like?
Some specific examples of appropriate use of a conservatorship include ensuring a conservatee pays their bills on time, does not impulsively spend all of their savings, enters into fair contracts (and is not taken advantage of), and understands any medical choices they may have to make. 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?
Conservatorships are rarer in cases of severe mental illness than in situations such as severe neurological disease like dementia because of the nature of mental illnesses. For starters, many psychiatric illnesses are episodic — meaning that someone spends much of their time in their usual state (either unaffected or minimally affected by the symptoms of their mental illness) and only some of their time significantly impacted by symptoms. Some mental illnesses — most often, more severe forms of schizophrenia and bipolar disorder — 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. In addition to involuntary hospitalization, there are other forms of mandated mental health treatment that can take place outside the hospital. For example, assisted outpatient treatment (AOT) is a type of treatment in which a judge orders an eligible person to adhere to a certain mental health treatment plan in order to live in the community (rather than being inside a hospital, for example). 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. From the outside, it seems her desire to at least have a different conservator has been denied for a long time. It also seems that the decisions her conservator is involved in are beyond the realm of ensuring basic safety. For example, court documents obtained by the New York Times indicated 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. Additionally, why she has had an ongoing conservatorship 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.
A Therapist’s Parting Thoughts on #FreeBritney
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. Going back to the definition of a conservatorship, this type of arrangement is meant to help, not control. It is important for both those with and without mental illness to know that the goal of any intervention is always to help people maintain independent, satisfying, joyful lives — whatever that means to them 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. *On August 12, 2021, Jamie Spears agreed to step down as the conservator of Britney Spears’s estate.
