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Judge turns passport fees into mental health care

By MARY SELL, Alabama Daily News

In his first term as Madison County Probate Judge and in his years of work for his predecessor, Frank Barger has witnessed thousands of involuntary commitment hearings for people with mental illness and in crisis.

“We were seeing many of the same people over and over and over again,” Barger told Alabama Daily News. They’d get court-ordered inpatient care, get better and be released. But whether because they stopped taking their medications or didn’t have a support system to help them in their continued care, “in a few weeks, they’d be back to square one,” Barger said.

In late 2019, Barger created, in partnership with Wellstone Behavioral Health and with approval from county officials, an assisted outpatient treatment program within the Madison County Probate Court as an alternative to inpatient commitments.

State law lets probate judges use however they see fit the $35 application fees for the U.S. Passport applications their offices process. So Barger used the money to hire a mental health case worker to ensure patients go to their doctor and therapy appointments and are compliant on their medications. He recently hired a second case manager. 

State law also allows Barger to require patients to report to his office for up to five months.

“If (the patient) has an employment or a basic needs issue, (the case workers) plugs them into community resources to help them,” Barger said. “You would be amazed at, when educating an individual, what 150 days can do.”

Since late 2019, about 63 individuals have gone through the program. He said he knows that’s not a huge number considering Madison County had nearly 400 involuntary commitment hearings last year. While outpatient treatment isn’t right for those experiencing severe mental illnesses, the recidivism rate so far for people who have gone through the assisted outpatient treatment is low. Only about 10% have shown up again in his courtroom because of another mental illness issue, Barger said. That compares to nearly 50% of traditional commitment patients.

Barger said too many times, people are released from involuntary commitments with a plan for continued treatment, but there’s little follow-up.

“We need to have a continuum of care and that’s what we’re trying to create,” Barger said.

State Rep. Rex Reynolds, R-Huntsville, praised Barger’s efforts.

“Anytime a local probate judge can think out of the box and deliver care to those in need, it’s a positive,” he said.

Barger this year helped draft House Bill 70, sponsored by Reynolds, to modify the civil commitment process. The new law will allow probate judges to, in some cases, change an individual’s treatment plan from inpatient to outpatient without having to attend another commitment hearing.

Barger said outpatient care saves thousands of dollars per individual. He and other probate judges have said finding space for involuntary commitments has been a challenge following major state funding cuts in 2010 and the 2012 and 2015 closure of three state mental health hospitals.

“More bed space is critical,” Barger said about state funding needs he sees.

Alabama Department of Mental Health Commissioner Kim Boswell said the ongoing creation of six mental health crisis centers around the state, where people can be stabilized and possibly referred for outpatient treatment, may reduce the need for civil commitments and the need for inpatient care.

Boswell also said more of the 268 beds at Bryce Hospital in Tuscaloosa will be available for court-committed individuals when a $60 million, 96-bed expansion at Taylor Hardin Secure Medical Facility is complete, likely in late 2024.

The addition at that Tuscaloosa facility for the criminally committed is the result of a federal court settlement following a 2016 lawsuit from the ACLU. The organization argued that lack of space at Taylor Hardin meant people with mental illnesses were being held for months in county jails that weren’t equipped to treat them.

Barger said there will always be a need for space to house individuals during what can be months-long commitments.

“We still have a tremendous need for increased beds,” he said.

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