Representatives of the pop star told Los Angeles Police Department officials they believed Spears needed a psychiatric evaluation because of continuing erratic behavior. After extensive discussions about alternatives, the LAPD mapped a strategy for getting her to UCLA Medical Center amid an anticipated swarm of paparazzi.
Authorities, who had responded to more than 20 calls in the last month involving Spears or the paparazzi trailing her, came up with an elaborate plan. It included many contingencies for such possibilities as paparazzi rushing into her gated home off Coldwater Canyon or mobbing her ambulance and forcing it to stop so they could shoot photos.
Early Thursday morning, the plan was executed with about two dozen police officers, a helicopter and a special team that took Spears out through a gate in an ambulance with covered windows to prevent photographers from looking inside. Police blocked roads so she couldn't be followed.
The effort, which the LAPD estimates cost $25,000, was carried out with the help of the department's Crisis Response Support Section, a unit that deals specifically with the mentally ill. The LAPD responds to about 100 calls a day to deal with mental health incidents, said Lt. Rick Wall, who heads the unit. Of those, about 20 to 25 a day lead to involuntary commitments, Wall said.
"Most go exactly as the one last night, without the 200 paparazzi," he said. "We get calls from family members daily who are worried about their loved ones being a danger to themselves or others."
Police officials defended the cost of the operation, saying that aggressive paparazzi required numerous police officers to avoid a traffic accident that could have caused harm to the public or Spears.
LAPD Deputy Chief Michel Moore said it was "a shame" that scarce police resources had to be diverted from "public safety needs such as violent crime, drunken driving or responding to the ongoing stream of 911 calls." But he said the department "had no choice but to ensure that we appropriately dealt with this incident."
Spears' hospitalization came under Section 5150 of California's Welfare and Institutions Code, which greatly restricts the ability of government officials to hospitalize people against their wills, but allows a person to be held for 72 hours. If Spears won't consent to additional treatment, authorities can petition to have her held an additional 14 days.
Among advocates for the mentally ill, some expressed hope that Spears' hospitalization could help remove the stigma from involuntary hospitalization for mental illness -- easing what is often a wrenching decision for families.
Despite Spears' celebrity, the decision to have her committed involved elements that are typical for many mental health cases in California, said Randall Hagar, head of governmental affairs for the California Psychiatric Assn.
Cases typically involve a family desperate for treatment for a loved one, a patient who appears functional one moment and severely ill the next, and an imperfect legal system struggling to mediate it all, he said.
"Every family will tell you how much they fail before they can finally get a hospitalization," Hagar said.
State Sen. Darrell Steinberg (D-Sacramento), a leading authority on mental health law, said he hoped the attention generated by Spears' case could help increase public understanding of the issues involved in commitments.
"With all that goes on in pop culture, in an ironic way this could be a teaching moment," said Steinberg, an author of a 2004 ballot initiative that sought to reform California's troubled mental healthcare system.
"I sure hope the conversation shifts from the paparazzi and all of that to how many people in this state and this country need mental health services and don't receive them," he said.
Advocates who are otherwise in agreement about many aspects of the mental healthcare system are deeply and often bitterly divided over the issue of involuntary commitments.
Experts on mental illness estimate that as many as half of people who are mentally ill deny that they are sick.
Some believe that virtually any attempt to commit someone involuntarily is a step backward, a reminder of dark days of asylums, forced lobotomies and, more recently, the use of forced restraints and long periods of seclusion.
Others call that wrongheaded and say that with enough protections in place, some people who suffer from mental illness but do not agree that they are sick can be helped by compelled treatment. Failing to compel treatment is akin to denying chemotherapy to a cancer patient, people on that side of the debate say.
In Spears' case, tabloids had been reporting for months about her erratic behavior -- including speaking in a British accent and shaving her head. But it wasn't until a month ago that authorities got involved. Police were called to her house after she refused to turn over her youngest child to bodyguards for her former husband, Kevin Federline, and locked herself in a bathroom. At that time, Spears was taken by ambulance to Cedars-Sinai Medical Center on the same type of involuntary hold. She was released a day later.
Over the last few weeks, her strange behavior continued, authorities said. She drove past the Los Angeles County courthouse several times while custody hearings were underway regarding her children, but didn't go inside.
By this week, the situation appeared to reach a breaking point.
According to LAPD officials who spoke on condition that they not be named, Spears' psychiatrist and family members gathered at her hilltop home Wednesday evening to execute plans to take her in for an evaluation. The news media found out about the effort, and by 11 p.m. her neighborhood was swarming with photographers and TV news cameras. TV choppers hovered overhead.
The police waited until the crowd had shrunk before taking Spears to the hospital about 1 a.m., the officials said.
Times staff writer Lee Romney contributed to this report.