The Britney Thing

My job is to do mental health crisis assessments in the local emergency rooms.  Anytime someone shows up with severe depression, suicidal or homicidal thoughts, psychosis, or any number of other ailments of the psychiatric kind, I can be called in to help decide whether this person can safely go home, or needs to be hospitalized.  Sometimes, that hospitalization is a voluntary process.  Sometimes, not so much.

I've been asked a few times lately, "So what do you think about this whole Britney Spears situation?  Is she really going over the edge, or is it all some sort of weird publicity stunt?"  The simple answer is, I have no idea.  It's happening way over there, to someone I've never met, in an entirely different state.

And state matters.  There are huge differences between the laws and philosophies just on either side of the Massachusetts/New Hampshire state line; a person that I could involuntarily commit to a psychiatric facility in Massachusetts can walk the streets and supermarkets and campaign offices of New Hampshire without any interference.  Just hypothetically, mind you.

And then there's the question of resources.  New Hampshire operates with, as a rough guess, perhaps 25% as many inpatient psychiatric beds as it really needs.  That means that mental hospitals around here have become crisis stabilization units, not long-term care facilities.  Your average length of stay, whether voluntary or kicking-and-screaming, will be about three days.  That's not long enough to even be sure if you might be allergic to a medication, much less to see if that medication is actually helping at all.  The days of several-month hospital stays are over. 

Most of the time, this is a good thing.  Studies have supported hospitalization for crisis stabilization, in the short term, but in most cases it's better for people to live in their own homes and be as normal as possible, whatever that means.  Though it seems to me that there might be a happy medium between three days and a year and a half, that maybe the ideal length of stay is actually somewhere in the middle.

So I don't know about California.  Maybe the legislators there, in a frenzy of unchecked intelligence, have allocated sufficient funds to provide adequate mental health care for everyone who needs it, for as long as they need it.  Stranger things have happened.  But I doubt it.  I suspect that the mental health crunch is nationwide, because those with serious illnesses are simply too easy to brush aside and ignore in favor of cute, publicly acceptable, photogenic causes. 

And with this in mind, I suspect that Britney's troubles might actually be real.  It's very difficult, in the legal sense, to hospitalize someone against their will; even though I do it several times a week, I send lots more people home.  Even when it's against the wishes of their family, or against my better judgment, because the law trumps mental health.   Particularly in recent months, because that power was abused by a nurse at a local hospital not too long ago, and since then everyone's a bit more sensitive to the possibility of vengeance as grounds for hospitalization. 

In New Hampshire, I can only force you to go to an inpatient facility under three basic circumstances:  (1) You've attempted or threatened suicide, (2) You've attempted or threatened homicide as the result of a mental illness (not from a bar fight or domestic argument), or (3) You are so blatantly incapacitated by your mental illness that you are no longer able to meet the basic daily needs of life, like eating and bathing and dressing appropriately for the weather.  Anything else is considered legal, or at least non-committable.  I've seen people who are stalkers, petty thieves, unpleasant or confusing or disturbing in personality, self-mutilating, living in horrifying circumstances... all manner of things that lower their quality of life, but don't rise to the level of an involuntary admission.

I haven't researched California's commitment laws, because frankly my brain is already filled with a billion details and tidbits and I just don't need to add to it with some idle, celebrity-fueled curiosity.  But assuming that they're at least vaguely similar, then she really might be falling apart at the seams. 

Comments

[Fairly Odd Mother]

This was really interesting to read. It must be incredibly frustrating to have to let someone go who you feel like should be committed for a long time.

I was also shocked to hear that when Brit was taken away in an ambulance the first time, she tested negative for drugs---I had really thought that her troubles were drug related. It seems much scarier to me that they are probably totally mental.

[Manic Mommy]

Thanks for the informed view. I think she meets the third criterion you mentioned as she seems to forget her panties everywhere she goes.

Seriously? It's sad to see her without a real support system, even if it is partially self-induced.

[Paul is a Hermit]

Since funds are not an issue, either she is convinced or is being convinced that she does not need care. She obviously is not submitting. I wonder who runs her life.

Maybe she knows not where to turn. Picking a name for successful psychiatric care can not be easy, even for her. I would just like to know where she comes from as far as the kids are concerned.