My involvement with the annual Behavioral Healthcare Design Showcase—and a trip earlier this year—gave me an opportunity to visit the CPSA/Pima County Crisis Response Center in Tucson, a design that won top honors in the 2011 Design Showcase (May/June 2011 issue). And, while our annual Showcase honors the work of architects and designers in our field, we all know that great design is but one element of a successful treatment facility.
The Crisis Response Center is the product not only of great design and execution, but of one community’s efforts to do the right thing and do it well. Plans for the $18 million CRC and the neighboring $36 million Behavioral Health Pavilion at University Physicians Hospital in southern Tucson were funded through two voter-approved bond issues that joined a local transportation bond issue on the ballot for the county’s special election in May 2006.
2005: Problems in search of a solution
By 2005, years of rapid growth had pushed Tucson toward a significant milestone: a population nearing one million citizens and recognition as a major US city. But with growth came challenges: an overtaxed road and transport network; increasing rates of crime, arrests, and incarcerations; a growing problem with methamphetamine and street drugs; and an overstressed hospital system considering how to keep pace with local growth. One hospital system in particular, University Physicians Hospital (UPH) was considering plans to address a regional shortage of inpatient psychiatric beds.
As CEO of CPSA, the Community Partnership of Southern Arizona—the managed behavioral health organization contracted with the Arizona Department of Health Services to administer behavioral healthcare in the Pima County area—Neal Cash had shared his views on the region’s challenges with local officials for years. But in 2005, he sensed that local officials—county supervisors, the county administrators, the county bond committee —were open to ideas on a new scale: the city was gaining more national attention almost every day.
So, he asked them some big questions: “Are we big enough now to warrant a psychiatric crisis care center?” “Would you be open to CPSA leading an effort to develop concepts for a center?” When they agreed, he then asked if they would consider placing an additional bond issue before voters, on a May 2006 ballot, to fund it.
“Amazingly, they agreed. I got a very positive response. They encouraged me to pursue the concept for a facility,” he recalls. The facility would have to meet a range of needs:
• divert many psychiatric emergency or crisis cases from emergency departments at hospitals
• divert adults from jails and juveniles from the detention system into care
• combine multiple medical disciplines
• engage consumers and families as part of the workforce
• engage people at the point of crisis—people with or without other medical benefits—to get them crisis psychiatric care
• reintroduce them to the community—return them their lives, families, work, and relationships in a more integrated and effective way.
After a proposal was developed, there was a public hearing to consider whether the crisis center concept should be placed on the ballot. The response was overwhelming; over 500 citizens attended that meeting. County supervisors voted the bond-issue measure for construction of the Pima County Crisis Response Center onto the ballot unanimously. At the same time, they approved placing another bond issue measure before voters that would support UPH’s expansion plans. This would support a UPH project that would become known as the Behavioral Health Pavilion.
After both of these bond issues were approved by strong margins in the May 2006 election, Cash and his CPSA team headed into the project’s toughest phase, which was “staying on track with the vision we had for what this facility should look like between the time the bonds passed and the time that we broke ground in September 2010. While we (CPSA) were involved in every phase, there were a lot of other entities involved as well. And, when a project is publicly funded, there is a lot of scrutiny, too.”
Thankfully, project plans and finances were well advanced when the nationwide recession hit in 2008. The recession had two major impacts: On one hand, the recession-driven slowdown in construction led to lower bids and lower-than-anticipated construction costs for the project, which broke ground in September 2010. On the other hand, Cash said that the recession caused “an erosion in funding—particularly for continuous care—along with a greater demand for services in the community.”
Why voters went along
How, one wonders, were local voters convinced to support the center?
Cash explains. “I was speaking throughout the community—at hospitals, Kiwanis clubs, with law enforcement, all sorts of people. Through those conversations, I could see that there were a few things that really appealed to local people.”
1) Mentally ill people shouldn’t be in jail. “People understand that those who are mentally ill don’t belong in jail and that it makes sense to get people care in the right setting. They realized that this would save precious law enforcement resources for where they were really needed.”
2) Those in psychiatric crisis shouldn’t be in hospital ERs, either. “I presented to local hospital officials and suggested that if there were a more appropriate place to provide care for people in psychiatric crisis, their ERs wouldn’t be so crowded with people who shouldn’t really be there,” Cash recalls. He adds that “since a significant number of the mentally ill are also uninsured or homeless, caring for them in a crisis response center could cut hospital expenses for uncompensated care. And, that is a problem in nearly every community.”