Jan. 30, 2008 -- It is hard for a family to watch someone like Britney Spears implode in public. It is also very difficult emotionally to force a family member to seek treatment involuntarily.
But in Britney's home state of California, once that hard decision is made, it can be as easy as calling a cop to have a loved one committed to a mental hospital.
Under a state statute known as 5150, an individual who is considered by a medical professional to be a danger to herself, others or is known to be gravely disabled can be involuntarily committed to a mental institution by her family or even friends.
"If a family member believes the patient needs psychiatric care and the patient refuses to get it, there are options available," said Keith Valone, a clinical psychologist in Pasadena, Calif., who is not associated with Spears' treatment and declined to comment specifically on her case. "And if that person meets the narrowly determined criteria, they can be put on involuntary hold."
No Spears' family members have stated publicly that they are contemplating such a move.
Involuntary hold, which translates into 72 hours in a locked mental institution, must be approved by trained professionals like a psychiatrist or a nurse. But a police officer can also qualify, according to California law, to evaluate a patient and decide if that person meets the 5150 requirements, said Valone.
After the 72-hour stay is completed, patients can either voluntarily admit themselves to treatment or the family can request another evaluation for a 14-day stay, according to the California Department of Mental Health.
"Getting a 5150 isn't a very hard [process] to do," explained Valone. "Families can either call a hospital, ask if they write holds and then just present at the hospital. Or if the patient is uncooperative, they can call the police."
A spokesperson from the Los Angeles Police Department told ABCNEWS.com that 5150s are so common that they are an almost daily occurrence, and cops are often called upon to help transport unruly patients to hospitals, where they will they be kept on hold.
The reason most families seek involuntary committal is for self destructive behavior, and Spears' behavior over the past year has cost her a great deal.
In just the past few months, Spears was rushed to a Los Angeles hospital after refusing to hand over her children to authorities and then later lost custody of her two kids. She then failed to even make it into the courtroom and subsequent hearings meant to regain custody of her children.
She has shaved her head in public, attacked a car with an umbrella, shoplifted a lighter from a gas station, and most recently sat down in front of paparazzi earlier this week and cried while holding her little Yorkie named London. That latest crying jag was apparently set off by her sometime manager Sam Lutfi telling ABC's "The View" that Spears has mental issues that are treatable.
Her behavior has become so alarming that last week it was revealed that The Associated Press is working on the 26-year-old Spears' obituary, just in case.
The Road to Commitment
Nevertheless, forcing a family member into treatment is not an easy call.
"Sometimes it's very hard for family members to do because you're torn between the love for your family member and the fear of the patient," said psychiatrist Valone. "The whole idea of psychiatric hospitalization is a great unknown, and there is a stigma. It's terrifying, and understandably so."
Involuntary holds often involve extremely regimented environments, said Valone. Often patients won't be able to bring in shoelaces or sharp objects.
According to Nancy Kincaid, the spokeswoman for the California Department of Mental Health, the 5150 statute -- and the lockdown that comes with it -- has resulted in a noticeable difference in the number of people who decide to seek treatment voluntarily rather than getting committed against their will.
"Fewer patients are being pursued by the 5150," said Kincaid. "The majority are ordered to the mental facilities because they have violated the law, and before they were there because of voluntary or involuntary committal because people didn't know how to get help or family members wanted to 'put that relative away.'"
Kincaid estimates that only 500 of the 5,000 beds in the five different facilities in California are patients who are committed voluntarily or involuntary -- as opposed to those people there for violated the law -- which is a tremendous shift from 10 years ago.
Kincaid attributes the shift to much more direct-to-consumer advocacy by manufacturers of products like anti-depressants as well as society's increased willingness to talk openly about mental health issues such as depression.
5150 Isn't the Only Option
"Most people who are in relationships with family members or friends if they're approached and spoken to with sincerity will choose to voluntarily see their physician or a health worker," said David Shern, president and CEO of Mental Health America, the largest advocacy and public education organization devoted to mental health issues.
"Try to develop a common understanding of what's going on and provide the individual with a hopeful path about how things might get better within the family relationships [if they get help]," suggests Shern. "You want to try to place it in the context that they're doing something for you, rather than doing something for them."
Shern also suggests that family members seek out medical professionals, such as a psychiatrist, who can advise on the best way to talk to a patient and also provide some support to the family.
"But there are people who for various reasons don't understand their problems in the same way their family members might and may resist entering into care," said Shern. "And then that's where it starts to get tough."