As estimated 1.3 million Americans are living under conservatorships (also known as guardianships): legal arrangements by which a judge takes decision-making power away from a person with disabilities and gives it to a third party. A conservator then determines where a person lives, how to spend their money, and what medical treatment they receive. Despite its scale, America’s conservatorship system was largely invisible until 2021, when a “Free Britney Spears” movement called attention to the pop singer’s thirteen-year-long guardianship at the hands of her father.
In her recent memoir, Spears details how the conservatorship—put into place in 2008 after a ten-minute hearing in which she was not even present—“turned me into a teenager again. . . . The woman in me was pushed down for a long time.” The range of humiliations and abuses she details are stark: from being deprived of the choice of when to go to the bathroom to being forced to take Lithium under the supervision of security guards.
“Conservatorships,” notes Spears, “are usually reserved for people with no mental capacity . . . who can’t do anything for themselves. But I was highly functional. I had just done the best album of my career. I was making a lot of people a lot of money.” Advocates have seized upon her portrayal to argue that conservatorships are far too easy to impose: as Disability Rights California asserted, “While Britney’s fame may be unique, her experience in the current conservatorship system is not.”
Despite its scale, America’s conservatorship system was largely invisible until 2021, when a “Free Britney Spears” movement called attention to the pop singer’s thirteen-year-long guardianship at the hands of her father.
But in my book, Conservatorship: Inside California’s System of Coercion and Care for Mental Illness, I document a different, and seemingly contradictory, set of stories, like that of Mark Rippee. Mark was, according to his sisters, the “worst of the worst [off]” homeless people in Solano County, north of San Francisco. He had schizoaffective disorder and was left blind and missing one-third of his frontal lobe after a motorcycle accident. Over a decade of homelessness, Mark was arrested over one hundred times, mostly for vagrancy and illegal camping. Yet the county repeatedly declined to place him under a conservatorship, even when he refused treatment and left the group home it placed him in.
In 2022, Mark died of an untreated infection, joining thousands of unhoused people—including two thousand in Los Angeles alone—who perished in the last year. From the perspective of Mark’s family, conservatorships are in fact far too hard to get, a conclusion echoed by California politicians, who have concluded that strict conservatorship laws leave the state’s most vulnerable citizens to “die on the streets.”
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So which is it? Are conservatorships an unwarranted and overused form of coercion over people with alleged disabilities or a form of life-saving care too rarely put into place? My book argues that the answer is “both”—and that a common failure of government authority underpins this paradoxical tragedy.
Spears’s memoir points to the root of this failure. She notes that, for her whole life, people seemed to treat “my body as public property, something they could police, control, criticize, or use as a weapon.” Her father, acting as conservator, took this to a new level, forcing her to exercise relentlessly and restricting her diet to push her to lose weight. But, Spears observed, “When my father told me I couldn’t have desert, I felt it was not just him telling me, but . . . [the] state.”
Conservatorship is, indeed, ultimately an exercise of government power, one that takes usually private choices and makes them a public concern. But this power is largely delegated to nongovernmental actors like families or professional guardians (who control $50 billion in assets nationwide). These actors can then use this power largely as they see fit.
Completely destitute people with severe mental illness, like Mark Rippee, are rarely targets of unscrupulous and exploitative private guardians.
For example, while California’s probate system requires a report to the court every two years, until recently conservatees had no guarantee of having the lawyer of their choice. Little surprise that in 2014, when Spears went before a judge to request being freed from the conservatorship, “the case didn’t go anywhere. The judge just didn’t listen.” Later, when Spears’ resisted her father’s order that she go into a mental health facility, he told her, “[You’ll] have to go to court . . . We will make you look like an . . . idiot. . . . You will not win.”
Completely destitute people with severe mental illness, like Mark Rippee, are rarely targets of unscrupulous and exploitative private guardians. Rather, their cases are typically handled by Public Guardians—a county agency that receives no regular state funding and subject to the vagaries of individual counties’ budgets. Since 2012, there has been no state agency that oversees county Public Guardians, establishes best practices for when to implement conservatorships, or requires reporting on outcomes.
Public Guardians thus exercise largely unregulated discretion in deciding who to conserve, meaning that fundamental civil liberties in the state vary depending on which of California’s fifty-eight counties a person with mental illness calls home. When Mark was hit by a car, he went to a hospital in Napa County, which said that he met their county’s standard for conservatorship. But when the application for conservatorship went to Solano, they claimed—improbably—that Mark was capable of making decisions for himself, and sent him back to the street.
But whether poor or super-rich, the most fearsome powers of conservatorship…operate behind closed doors, in institutions that exercise state power largely outside the gaze of state regulators themselves.
Behind this refusal was the county’s unwillingness to assume the cost of placing Mark in a locked facility—the vast majority of which are private and for-profit. They would have charged a sharp premium for someone with Mark’s complex conditions. Spears, for her part, was sent by her father to a $60,000-a-month private rehab center. But whether poor or super-rich, the most fearsome powers of conservatorship—placing someone in a locked facility for months at a time or ordering medication with the threat of being strapped to a gurney and injected for noncompliance—operate behind closed doors, in institutions that exercise state power largely outside the gaze of state regulators themselves.
In my book, I theorize the delegation and discretion in California’s conservatorship system as part of a common process of abdicated authority. The state has responded to the thorny challenges of organizing, funding, and directing the conservatorship system by declining to organize it at all. Thus, while many people, from Britney Spears’s father to the police officers putting Mark Rippee in the back of a police cruiser for the hundredth time, hold power over people with mental illness, no one has responsibility for how that power is exercised.
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Concerns about the abuses of people on conservatorships and the neglect of people off of them have fueled reforms that push California in different directions. In 2022, Governor Gavin Newsom signed legislation that would encourage “supported decision-making”—an arrangement whereby a person with disabilities sets up a network of trusted advisers to help in making decisions that are, ultimately, their own—in lieu of conservatorship, with the goal of ensuring people “maintain control over their lives to the greatest extent possible.” That same year, though, the governor declared himself “disgusted” and “outraged” by “what’s going on the streets” and backed legislation that would loosen the criteria for putting people with mental illness like Mark under conservatorship.
These dueling reforms track national trends by which states have sought to expand involuntary treatment of people with mental illness—who are perceived as otherwise likely to engage in violence or fall into homelessness or incarceration—while limiting guardianships for elderly people and those with developmental disabilities (Britney Spears was, improbably, initially alleged to have dementia).
But policymakers are, in both cases, missing the essential need for a new public infrastructure for the conservatorship system.
But policymakers are, in both cases, missing the essential need for a new public infrastructure for the conservatorship system. The state needs a corps of lawyers specially trained in defending the rights of people with disabilities (modeled after New York’s Mental Hygiene Legal Services). Government should also provide some truly public programs and facilities for conservatees so that access to care is based on need, not profitability. Perhaps most important, the conservatorship system cannot remain rudderless: a dedicated state agency needs to establish a clear set of objectives for conservatorship—protecting life while maximizing someone’s ability to make decisions for themselves—and promote best practices for meeting them.
In her book, Britney Spears rightly recognizes that what is at stake in conservatorship is life itself. As she laments, “A lot of people said, ‘oh, your life was saved [by conservatorship],’ but no, not really. It’s the way you look at it. It’s perspective. My music was my life, and the conservatorship was deadly for that. It crushed my soul.” But while for Spears life meant being free from an unjustified conservatorship, for people like Mark Rippee life depends on being placed in an involuntary guardianship when they are no longer capable of consenting to necessary care. The best guarantee for both is a state engaged in the responsible and accountable use of its own power.