From the Newsletter.
There’s no question that Britney Spears is a tragic figure. Dancing in a pink leotard, she’s an ATM machine for family in the swamps of Louisiana. She has no control over her $60 million dollar fortune, career, children, or even her own reproductive decisions. Placed under a conservatorship in 2008 by family who say they are saving her from predators and bad decisions, she is perpetually “not a girl, not yet a woman.”
Over time, Spears has spoken out against her conservatorship and has accrued an army of supporters on social media who frequently tweet: #FreeBritney. Adding weight to the faceless twitter mob, The New Yorker’s Ronan Farrow and Jia Tolentino question the motives of her father, Jamie Spears, and the over reach of the legal system that has in effect enslaved an adult woman. They insinuate that Britney’s mental health issues can be chalked up to run-of-the-mill issues, like postpartum depression, and to a very normal reaction to amoral bands of unprincipled paparazzi. (That being said, a family judge would never have taken away Britney’s custody of her children without serious cause.)
Because drunk fans at Las Vegas are willing to drop $100 per ticket to see a middle aged woman lip-sync 20-year old songs, Britney is in a world of her own. She could lose all her money on GameStop stock and bitcoins, and simply regenerate her fortune with more millions the next week.
Most people with severe mental health issues do not have Britney’s self-destruction proof source of income. They hurt their parents and their children. They hurt themselves, ending up in prison, on the streets, or in the morgue. In reality, it’s very hard for family to gain guardianship of vulnerable family members, and efforts to “Free Britney” could undermine efforts to make important health and political reforms. ✓
Beginning in the 1950s, the hospitals and institutions that housed America’s individuals with severe mental health issues, like schizophrenia, began shutting their doors. People were released into the community as the public became aware of inhumane conditions in some of those hospitals. New antipsychotic medications offered the promise for a cure. And not a few politicians liked that taking the expense of those hospitals off the state’s ledger. The hoped that those individuals could be integrated into communities with regular visits at local clinics for their medication.
That plan didn’t work out. When they were removed from a reliable and regular source of medication, individuals unraveled. Because hospitals and institutions closed without adequate community supports, these individuals were stranded.
According to the National Institute of Mental Health (NIMH), 5.2 percent of the population — 13.1 million people — suffers from severe mental illness, “defined as longstanding mental illnesses, typically psychosis, that cause moderate-to-severe disability of prolonged duration.” Without support, these individuals are disproportionately represented amongst the homeless. One in five inmates in jail have severe mental health issues. Drug addiction and mental health issues are considered co-occurring disorders. It leads to early death. With those grim outcomes, there’s no question that deinstitutionalization was a major failure in public policy.
Without any real government or medical support for people with mental health issues, the only guardrail from a homeless shelter in the Bronx or an early death is a caring family member. A parent can gain guardianship over the individual, which enables them some control over medical and financial decisions. A parent, who would really, really like to be drinking a Pina colada at a retirement village in Florida, instead pays his daughter’s bills and drives her to the therapist for anti-psychotic medication. Family, if they even exist, are the permanent, unpaid caretakers of adults with mental health issues.
In reality, it’s really hard to get guardianship of young adult with mental health issues or other challenges. I know, because we went through the legal hoops to gain guardianship of my son with autism last spring. Although he’s smart, his disability means that he’s social naive, susceptible to Tom Selleck-type reverse mortgage deals. He would not know what to do with a summons to report for jury duty. We would like to help him make decisions. At that time, he was also suffering from intense medical issues, and guardianship meant that we could more easily talk to his doctors. If in the future, he doesn’t need our help, we’ll whoop with delight and tear up the document.
It was not easy or cheap to gain guardianship. We had to hire a lawyer for ourselves and pay for a court appointed lawyer for Ian. That barrier is so expensive that I know people who have not been able to gain guardianship of their highly disabled adult-children. We had to provide boxes of documents about his disability. The whole process took almost a year.
So, the state has put the burden of caring for Americans with mental health issues on families, but at the same time, doesn’t really trust parents to do it properly. 99.9% of people with severe mental health issues are not able to get a Vegas residency, so there’s little chance that the parent will benefit financially from a guardianship, but the law cares more about preventing a situation like Jamie Spears than in supporting the average parent.
Why have guardianships? Should people be allowed to screw up their own lives without protections from a parent or a state-run institution? Britney’s supporters argue that she should have the right to make bad decisions just like any other adult. After all, all adults are free to make bad financial decisions, including me who made an ill-advice purchase from an ad on Facebook last week.
Of course, no one would suggest that they take over my financial rights, because I got suckered into buying a dress from a scam company on Facebook. But what if the bad decisions were more serious? Like what if I was endangering the welfare of a baby? What if in the effort to control the voices in my head, I started shooting up heroin in a porta-John outside a Starbucks? What if I stole money from an elderly aunt to pay for a ticket to Miami to dance at a rave club? What if I spent two years following Phish and smoking crack with waist-length dreadlocks covered in lice?
Britney’s situation is unique in so many ways. Britney’s dad, who I’m quite sure is an asshole, should not benefit financially from the arrangement; few people with severe mental health issues are cash-producers for their family. No matter how many bad decisions that Britney made, she wouldn’t be homeless and broke. She may have too many people overseeing her life, but most people with issues like hers do not have a team of professionals keeping them afloat.
Talking about Britney, without the consideration of the situation of the vast majority of people with mental health issues, is silly and unproductive. Making any changes to guardianship rules, because of the publicity behind her case, would be catastrophic. Rather than focusing attention on the unusual situation of one celebrity, we should reexamine our laissez-faire policies on mental health and find ways new ways to support individuals and families.
Pictures: Scenes from last weekend’s trip to Chinatown. They really don’t have anything to do with mental health.