Britney's Law? Not so crazy

The pop singer's recent episode could prompt a much-needed critique of California's mental healthcare policies.
Wouldn't it be something if the giants of mental healthcare reform in California turned out to be three men named Lanterman, Petris and Short -- and a pop singer by the name of Britney Spears?
The first three were state legislators. More than 40 years ago, impelled by film and fiction horrors such as "The Snake Pit" and "One Flew Over the Cuckoo's Nest," and even more by true-to-life mental hospital outrages, they drafted what they called a Magna Carta for mental patients.For good and ill, treatment of the mentally disturbed in California has not been the same since. And Spears may just turn out to be a sad enough and famous enough Hollywood head case to get some changes going on that Magna Carta's flaws. Last week, Spears barricaded herself in her bathroom for three hours in a custody dispute, until police had her hustled off for physical and psychological evaluations. Now the entire gossip blogosphere knows about California's Welfare and Institutions Code Section 5150, which allows someone who's a danger to herself or others, or both, to be held involuntarily for up to three days. Section 5150 is one piece of a set of mental health laws that make it very hard to commit people against their wishes, if not their needs -- maybe too hard.The tale of modern mental healthcare in California is one of good intentions sometimes one awry, of public money gone elsewhere, of hope too often simply ... gone.In the 1950s and '60s, care for the mentally ill gave off a Dickensian vibe. People were locked away in state hospitals for months, years, for life. Too many times, they weren't insane -- just old and dotty, or inconvenient, or different and difficult. For just acting up and acting out, actress Frances Farmer was locked in the madhouse and subjected to treatment that wouldn't pass muster at Gitmo. Those three legislators decided to stop it. Frank Lanterman, Nick Petris and Alan Short made seminal laws that give mental patients rights and make it much harder to lock them up for long periods against their will. The laws ended the "warehousing" of the mentally ill and encouraged more humane, individual, local care. California's mental health dollars were supposed to follow patients back home, to clinics and board-and-care residences. It didn't always work that way. Gov. Ronald Reagan famously used the new rules to close state hospitals and whack the mental health budget, a combination that turned the streets and sometimes the jails into de facto mental institutions as people, left untreated, crossed the line from irrational to illegal.In 2004, Californians voted for Proposition 63, a 1% tax on millionaires to expand mental health services. Richard Scheffler, a professor at the UC Berkeley School of Public Health, calls it "a kind of Robin Hood tax" for a "starved" mental health system. Spears might be the first person who both pays the tax and benefits from it. But even taxing all of California's millionaires can't remedy the flaws in the well-intentioned Magna Carta for the mentally ill. Before those reforms were passed, Petris was rightly appalled by how casually someone could be locked away after a five-minute hearing before a judge."A guy walking down the street, talking to himself, could be thrown in a hospital," he said years ago. Acting irrationally -- say, whacking a car with your umbrella or shaving your head, as Spears has done -- could have gotten her committed for years. Yet, as Petris himself later found, "we moved from a stage where people were being railroaded and there were no standards to a situation where people [are] not getting treated because [commitment] standards are rigid."Which brings us back to Spears. Did she check herself out of Cedars-Sinai too soon? It's the Catch-22 of California law: Can the mentally ill always know what's best for them? Do the mentally ill have the right to self-destruct? There's a Mad Pride movement among some mental patients who say they have a right to be crazy. And there are heartbroken families begging the courts time and again to intervene on behalf of loved ones who won't take medicine, won't see doctors. Spears' family's frustration, if the tabloids are to be believed, is the same: How can we get help for her if she refuses?Proposition 63, which is generating upward of $2 billion since the law passed, can accomplish a lot -- but it can't change that conundrum. Laura's Law was passed to try to strike a balance. It's named for honor student Laura Wilcox, who was working in a California mental health center when she was killed by a delusional man who couldn't be forced to take medication. Thanks to the law, judges now can order outpatient treatment for people after medical and legal hearings.What, I wonder, would a Britney's Law look like? Would it make it easier to require treatment, especially if the outburst gets 100,000 hits on YouTube?