Capping months of increasingly bizarre and troubling behavior, pop superstar Britney Spears had to be rushed to the hospital early Thursday morning for an involuntary mental health evaluation. Paramedics assisted by a line of Los Angeles Police Department motorcycle cops broke through the crowd of 100 paparazzi surrounding her hillside home to transport her to UCLA Medical Center. It was the second time in a month that authorities forced Spears to be involuntarily hospitalized; she spent two days at a medical facility in early January after she refused to hand over her two children to ex-husband Kevin Federline and barricaded herself in her bathroom with her one-year old son. Since then, she has lost custody of her children and seemingly accelerated her downward spiral, occasionally speaking in a faux British accent.
The latest episode began when Spears' psychiatrist and family members alerted the LAPD about their concerns for her mental health and gathered at the star's home late Wednesday evening, according to a report in the Los Angeles Times. By 11 p.m., her neighborhood was teeming with photographers and camera crews, prompting an extensive police presence to manage the crowd and finally escort her to the hospital at 1 a.m. The scope and purpose of the police effort—as well as its reported (cops dispute it) $25,000 price tag—have sparked a debate: How should public resources be managed when dealing with celebrities? And, when it comes to Britney Spears, when is enough, enough?
Spears' case is especially notorious, but it's only one of about 100 cases a day when Los Angeles authorities dispatch a two-person SMART (Systemwide Mental Assessment Response Team) to the scene of a police call involving mental health. Typically, a cop and mental health worker evaluate the person's mental status, then decide whether to send the person to the hospital for an involuntary three-day evaluation, called a 5150, says LAPD Lt. Rick Wall, who heads the crisis response team that handles mental illness issues. Privacy laws prevented him from commenting on Spears' health, but Wall discussed his team's work and the added problems the paparazzi with NEWSWEEK's Katie Paul. Excerpts:
NEWSWEEK: How was your unit involved in the handling of the Britney Spears case?
Lt. Rick Wall: I can't confirm that we were there for that particular case, but I oversee what's called the Crisis Response Support Section, which consists of a few different units. [One of those] is the SMART team, where we have an officer paired up with a person—a doctor, nurse or licensed clinical social worker—from the Los Angeles Department of Mental Health, who ride out to investigate when LAPD receive a call about a mental health problem. I have between 18 and 20 teams.
If a unit calls and says, hey we've got this patient, a 5150 [the California Mental Health code number for placing a person on an involuntary 72-hour hold], then we'll arrange, when we can, to have a SMART team respond, and what they do is relieve the patrol officers of that responsibility. Then we'll arrange for the hospitalization, to refer them to the appropriate follow-up entity with various mental health agencies. In LA right now, we average about 100 calls a day that are identified on the front-end as mental health calls.
What is the response sequence when you get a call involving a mental health case?
First, a patrol unit would be dispatched, hopefully one that's been trained [to handle mental illness]. If they identify that there is a mental health issue, they would then call the Mental Evaluation Unit and request a SMART team. We would then dispatch a SMART team that would provide an assessment to see if the person indeed meets the criteria for 5150. If they do, then we would arrange transportation, either by police car or ambulance to the appropriate psychiatric emergency hospital.
When the SMART team gets out there and the officers contact the triage desk and tell them what's going on, we keep track of all these calls, maintain profiles and databases. If during their investigation, they identify that this is just one in a series of episodes, or, if when they contact the Mental Evaluation Unit, they identify that this is a person that has generated a number of calls in recent weeks or months, then those cases automatically get flagged, and we make contact with the family to develop a strategy about how we're going to ensure this patient gets the treatment he or she needs.
Was that how it happened in the recent Britney Spears case?
We respond to about 100 calls a day that we know involve mental illness. Of those 100 calls, we place 20 to 25 persons a day on involuntary holds. They happen exactly as this case has been reported to have happened. Family members contact authorities, the police respond, an assessment is conducted, and the patient is transported to the hospital. And that happens 20 to 25 times a day in the city of Los Angeles.
Now, that being said, there's been some heat over the large police presence, what with all the motorcycles and all the units that responded. The only thing I can say about that is that we do this 20 to 25 times a day, but we don't usually have to deal with 100 paparazzi trying to jump on the hood of the police car to prevent that person from getting to the hospital. That particular situation required a different kind of police response only because there was a crowd-control issue. That case was handled exactly as any other case we come across. We respond, we do the best we can, we make contact with the hospital, we transport the patient to the hospital.
And having a high-profile person involved wouldn't change the number of people deployed with the SMART team?
No, as a rule. We would probably dispatch a supervisor, which we wouldn't dispatch necessarily to a regular call, only because of the high-profile issues that come into play. Depending on the level of the high-profile individual, I would also probably respond. I can think of, off the top of my head, five celebrities in 2007 that were placed on 5150 holds by the Los Angeles Police Department, and I was at four of them. And I guarantee, you've never heard of any of [those cases]. If we do our job right, no one ever knows about it, because we work very hard to protect the patient's right to confidentiality. If we do our job right, we get in there, we meet with a family member, we get the person, we transport them, and no one is the wiser.
Then what broke down with this specific case?
The only reason anyone knew the police were at that particular residence was because there were 100 paparazzi out front. They're staked out there all the time. Most celebrities we encounter don't have that. Truly, this case was only different from a case we would handle with any other citizen because of the crowd issue. Everybody saw it, just go back to Jan. 4. People were literally climbing on the ambulance. Standing in front of the police cars and the ambulance, so it couldn't move. That's a huge issue for anyone, celebrity or not. If a person is suffering from any medical condition and you can't get the ambulance through, you have to bring in crowd control, and unfortunately that's going to result in additional police resources being drained.
Was Britney suicidal?
I can't comment on the specifics of the case, but if you look at some of the things about the diagnosis that have been published, or just look up mania and some of the associated behaviors, one of the issues with people who are manic is that they are not cognizant of the consequences of their actions. They don't realize that their actions are placing other people in danger or placing them at high risk. Whether it's the fact that they're not eating, or engaged in dangerous behaviors as a result of their manic state. Just because a person is a danger to themselves as a result of a manic episode doesn't mean the person is suicidal, or in any way harboring a suicidal thought.
[State regulation] 5150.05 allows us to use information from a credible third party to establish what's going on. Say, if a person is manic and hasn't slept for three days; my officer will not have seen that. If the person says, 'No, I'm fine, I just had a nap a little while ago,' how do we establish that this is indeed the case? We have credible witnesses who can say these are the activities the person has engaged in.
The bottom line is, if we're dealing with a patient who suffers from a mental illness and we're putting them on involuntary hold, then we are absolutely firm in our belief that that person is a danger to themselves, a danger to others or gravely disabled.