What's Wrong With Britney?

What's wrong with Britney Spears? The troubled pop singer was hospitalized Thursday night in Los Angeles after she reportedly refused to hand over one of her kids during a child-custody exchange with ex-husband Kevin Federline. People magazine, among other media outlets, reported that Spears, 26, had been taken to Cedars-Sinai Hospital and placed on an involuntary 72-hour hold for medical evaluation. Los Angeles Police Department spokeswoman April Harding would not comment on whether Spears had been sent to the hospital against her will, saying only that the officers sent the star to the hospital in an ambulance "for her own welfare." "The officer determined she needed medical treatment and called an ambulance," Harding told NEWSWEEK. "She has been taken to the hospital." At a hearing Friday afternoon, a court granted Federline sole custody of the children until another hearing, scheduled for Jan. 14. (On Saturday, several celebrity Web sites reported that Spears had left the hospital.)

Bruce Spring, M.D., an assistant professor of clinical psychiatry at the University of Southern California's Keck School of Medicine, has participated in hundreds of examinations of patients brought to his hospital under similar circumstances. In an interview with Jenny Hontz, Spring explained how patients are brought in, the variety of tests and evaluations they undergo and the possible outcomes. Excerpts:

NEWSWEEK: When police are called, what can they do if they believe a person needs to be sent to the hospital?
Bruce Spring: There are certain legal powers they can use. When police are concerned about someone's health and well-being, they can sometimes convince them to seek help voluntarily. If they believe the person needs help, and they will not go willingly--let's say someone has a medical condition, and police are concerned about that--there are ways people can get involuntarily treated, with respect to medical, not psychiatric conditions. If it's for psychiatric reasons, they have to meet certain criteria to put them on an involuntary hold. Unless the criteria apply, police are not legally able to take them involuntarily for observation and possible treatment.

Can you explain what a 72-hour involuntary detention in California is?
There is a section of the California code, section 5150, which allows a person to be held in a psychiatric facility against their will, involuntarily, if there is reason to believe they are a danger to themselves, a danger to others or unable to care for themselves on the basis of a mental disorder.

Who is authorized by the court to make that determination?
It could be the cop. It could be there are psychiatric mobile teams. Many hospitals have facilities or a person authorized by law to write a 5150.

We hear in this instance the police sent Britney to Cedars-Sinai Medical Center. Would they have a psychiatrist on staff that could evaluate her?
The police, actually, are authorized to write 5150s themselves, and they then bring the person on the 5150 hold to an authorized facility. And they present the patient and the hold. Then, it's the responsibility of the hospital or the admitting physician to determine that the hold is valid. I don't know anything about Britney Spears, so I can't tell you anything about her. But most likely the police put her on 5150 hold, or a psychiatric mobile-emergency team put her on 5150 hold and brought her to the hospital and said, "Here's a patent we think is a danger to herself, a danger to others or gravely disabled, and please take care of her."

Is there an instance in which the police would not make that determination, but just bring her to the hospital?
Yes, that's possible. Sometimes the cops don't really know what's going on. They don't feel confident or they don't even necessarily think a person is a danger to themselves or others, but they feel the person is not doing well and needs an evaluation by a competent mental-health professional. They will take them to the hospital and ask them to be evaluated, and the evaluating people will determine, "Yeah this person meets the criteria for a 5150," so they will put them on a hold.

What happens during a 72-hour hold? What kinds of tests are performed to determine if you can be held?
During the 72 hours, it's a time specifically designed for evaluating the patient to determine: are they truly a danger to themselves, a danger to others or gravely disabled? It's an observation time to determine what the person's difficulties are, what the real situation is, and, also, treatment is generally instituted in that time. For example if someone is suicidal, they will be talked to. The situation will be looked into, and they will generally be given medication--appropriate medication. They would often be taken to a treatment facility, so other types of treatment can be instituted, including caring for their safety and protection so they are not able to commit suicide or hurt someone else. Or that food, clothing and shelter is provided for. But the 72-hour time period is a time of evaluation and treatment.

What is involved in evaluating the person?
It's a complete psychiatric evaluation. Does this person have a psychiatric diagnosis? What's going on, and what needs to be done about it? It also involves an evaluation of their medical status. Is there a medical problem that's contributing here that needs to have attention paid to it? And then, the full interview, laboratory work … it can involve other types of medical studies like X-rays or scans. It just depends on the patient and the situation. Well, actually, any competent evaluation would inquire and probably test for [alcohol or substance abuse].

So it could be, for instance, that while you're under the influence, you are a danger to yourself. But when you are no longer under the influence, you are not, and you can then be released?
That's correct. Many people get drunk and recognize how bad they feel, how bad things are, and they talk about suicide. Those people have the police called on them. And the police don't want someone killing themselves so they bring them to the hospital. The person is kept in the hospital. They sober up and say, "I never said I was suicidal." Or, "Gee, that was a dumb thing for me to say." They are then usually kept a little while longer to make sure that's it's really true they are not suicidal, and then they can be discharged.

If the person wants to challenge the legal hold, what are the patient's rights, and how can lawyers challenge the hold?
I've been involved with hundreds, if not thousands, of 72-hour holds, and I have never, ever seen a legal challenge even mounted.

What happens at the end of the 72-hour-hold period?
One of three things happens: either the person is released because the treaters don't believe they are a danger to themselves or others, the person is placed on another hold because they do believe they meet the criteria for a hold or the patient will sometimes be changed to a voluntary status and remain in the hospital under their own will, as a voluntary patient.

Under the 72-hour period, is a patient allowed to be medicated against his or her will?
In California, you're only allowed to be medicated against your will if there is reason to believe you are a danger somehow. There are procedures that allow people to be medicated against their will.

How often is the 72-hour hold invoked in Los Angeles?
Oh, boy. I would guess in Los Angeles, probably a low number would be 30. A high number would be 100 in a day.

How often do you think it is used in a child-custody dispute?
It would be an inappropriate use of a 5150 to deal with a child-custody dispute, as far as I know. It's not around custody issues. It's about the behavior of the person.