Providing a continuum of care, one capable of addressing early symptoms before they spiral into crisis, has long been the rallying cry of mental health care reform. A new grant proposal approved this week by the county board of supervisors hopes to turn that vision into a physical structure capable of serving up to 20,000 people per year.
The county’s behavioral health department intends to ask the state for a $100 million Proposition 1 grant that would build a “behavioral health wellness campus” on land it owns on Rosecrans Street next to the San Diego County Psychiatric Hospital. It would replace the county’s former health services complex, a now-vacant single-story structure that housed a wide range of departments, from epidemiology and immunization services to the region’s public health lab, before those functions moved to the county operations center on Overland Avenue in Kearny Mesa.
San Diego County, like communities across the nation, has struggled to keep up with the increasing demand for mental health care services, with beds in locked, hospital-based units usually full and patients often held in emergency departments for far too long.
Initial investments have focused on helping those immediately in crisis, through opening new stabilization centers and adding specialized response teams. But experts have warned that a more holistic approach is needed over the long term that would allow a steady drip of services rather than responding when symptoms become so severe that law enforcement must get involved.
Initially approved by the county board in August, a more detailed description of the project, complete with a higher price tag, appeared on the supervisors’ consent calendar this week, sailing through without debate.
Fleshed out plans call for the project’s total budget to increase from $150 million to $210 million, a budget that now accounts for the value of the county’s land with an estimated value of $27 million. The county proposes spending the cash to build a multi-use complex with a crisis stabilization unit, a mental health rehabilitation center, a social rehabilitation facility, an adult residential substance use disorder treatment facility and an outpatient community mental health clinic.
If awarded grant funding, it would be the first time that so many different types of mental health care were combined in one location in San Diego County. Karen Larsen, executive director of the Steinberg Institute, a Sacramento-based nonprofit focused on mental health care and substance use reform, said that she is only aware of two similar facilities in California, one in Riverside and another in Orange County.
“It’s very in line with what the state intended with this funding,” Larsen said. “They were very clear that they will be favoring these kinds of campus models where you have sort of a one-stop shop for people with both mental health and substance use disorders.”
The idea, she added, is to offer a combination of programs that can provide both residential and outpatient treatment, allowing clients to more easily move from one program to another as their condition improves or worsens.
“One of the biggest problems for people struggling with mental health and substance abuse issues is those transitions of care, whether they’re stepping down or stepping up, they can fall through the cracks,” Larsen said. “That’s less likely to happen if everything’s on the same campus.”
The types of care proposed for the campus on Rosecrans attempt to ensure that there is a smooth ramp of services capable of intersecting with a wide range of symptom severity, from moderate anxiety to suicidal ideation.
Crisis centers are gradually becoming the first step, with those experiencing symptoms of distress able to sit in comfortable recliners and destress for up to 24 hours while trained clinicians assess whether they need an inpatient stay or can be referred to an outpatient program.
Some may need long-term residential treatment, and that is where the mental health rehabilitation center planned for the campus would be involved, offering rehabilitation services from group and family therapy to medication management and other customized care designed to prevent them from needing a hospital stay.
Others may not be adjudged to need inpatient treatment, but still need significant support along the road to recovery. A social rehabilitation facility would be open 24 hours and staffed with peers who have personally experienced the same challenges. Clinical staff would also be available in this setting, though at a level that is more short-term and voluntary.
The substance use disorder treatment facility on-site would provide medically-monitored intensive inpatient services that follow protocols established by the American Society for Addiction Medicine. Said to offer a level of care not currently available in any other local program, patients would be overseen by doctors and nurses who would oversee withdrawal management and therapy designed to prevent relapses.
An outpatient mental health clinic also on site would offer walk-in and appointment-based care, providing everything from mental health screenings to various types of individual and group therapy and medication and case management.
The campus is designed to follow the county’s previously adopted “optimal care pathways” plan, which favors keeping those with mental health care needs continuously connected to treatment, recognizing that making progress in coping with a psychiatric diagnosis, which often includes “self medicating” with drugs or alcohol, is a long-term process.
Keeping patients engaged in behavioral therapies and taking prescribed medications, research has shown, is far more effective when patients have regular check-ins, and those encounters do not necessarily need to be with licensed medical personnel. Often, meeting with peers and coordinators can complete this beneficial feedback loop.
County supervisor Terra Lawson-Remer has been a vocal proponent of the long-term transition to a more holistic and proactive mental health system.
“The kind of framework where you get substance abuse treatment in one location and mental health treatment somewhere else, we know, makes no sense, because these are so often co-occurring conditions,” Lawson-Remer said. “They kind of reinforce each other clinically, and I believe that this wellness campus will allow us to engage in both.”
“We think this is an incredibly important investment for San Diego, and we think it is a very competitive project, and it’s a very visionary project.”
The county will face fierce competition to win a big award in the second round of Proposition 1 funding, which will allocate more than $800 million for “unmet needs” after the first round of the $4.4 billion statewide behavioral health infrastructure bond that voters passed in March of 2024. A request for $100 million from the bond program would not, in and of itself, be enough to pay for the entire campus. But if the grant request is successful, the county would pull together a finance plan, working with private partners, to identify sources of additional funding.
Would the county still build the campus if it did not win a round-two Proposition 1 grant?
“You know, I would never say that something like this would be at the end of its possibilities because one door closed,” Lawson-Remer said. “But I would say, I could not tell you right now what plan B would be if we don’t get the grant.”
Palomar Health in North County is also seeking round two funding. Its board unanimously voted this week to apply for a $50 million grant that would build a 120-bed behavioral health specialty hospital on the campus of Palomar Medical Center Escondido. The state rescinded a round-one grant in the same amount in September, because Palomar, working through its charitable foundation, was unable to meet a 10% funding match for the award.