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America’s ‘Only Bipartisan Issue’: Mental Health Is One Of Healthcare CRE’s Greatest Opportunities

The need for — and societal acceptance of — mental health treatment has risen sharply in the last few years, and commercial real estate has a part to play.

A combination of the pandemic, high-profile mass shootings and the opioid crisis has kept behavioral health in the headlines over the past few years, building national consensus that something must be done.

“Covid has really brought mental health to the forefront,” The Menninger Clinic President and CEO Armando Colombo said at Bisnow’s Healthcare South event, held Sept. 8 at the Houston Marriott Medical Center. “The challenge is providing access to care, the right level of care.”

That is where CRE comes in.

Panelists at the event said the significant “underbedding” of behavioral health services and an increased focus on spanning a broader continuum of care present opportunities for new healthcare real estate.

McCord’s Shawn Cloonan, Menninger’s Armando Colombo, Page’s Joan Albert, Houston Methodist’s Michael Garcia, UT Health’s Stephen Glazier and Texas Children’s Jill Pearsall at Bisnow's Houston Healthcare South event Sept. 8, 2022.

Global prevalence of anxiety and depression increased 25% in the first year of the coronavirus pandemic, according to the World Health Organization, which said a shortage in mental health services was preventing people from accessing needed treatment.

”While the pandemic has generated interest in and concern for mental health, it has also revealed historical underinvestment in mental health services,” WHO Director of the Department of Mental Health and Substance Use Dévora Kestel said in a March statement.

As an example, the Houston area has added five psychiatric hospitals in recent decades, but almost all of them are full, according to UTHealth Harris County Psychiatric Center Chief Operating Officer Stephen Glazier, who spoke at the event.

UTHealth opened a 264-bed Houston psychiatric hospital in February, the first new public psych hospital built in Texas in about 30 years. Every morning starts with about 100 people knocking on the doors to be added to a waitlist, he said. 

“We’re still pretty significantly underbedded,” he said. 

The spike in mental health issues nationally spans age groups and severity.

Mental health–related emergency room visits rose 24% for children between ages 5 and 11 and 31% for those aged 12 to 17 during the pandemic, according to the American Psychological Association.

Meanwhile, the number of adults receiving mental health treatment of any kind has risen sharply: In 2019, 19.2% of adults surveyed said they had received either medication or counseling for behavioral health issues in the prior 12 months, the National Center for Health Statistics reports. As of early May, 26.8% of Americans reported receiving mental health treatment of any kind just in the previous four weeks, per the latest available NCHS data. 

Tragedies like mass shootings in Uvalde, Texas, and the Fourth of July parade in Chicago suburb Highland Park have also shone a light on the nation's mental health deficiencies. Incidents like those have been linked by politicians, in particular, to a breakdown in mental health treatment. While that linkage might be unfair, it has spurred cries across the political spectrum to improve funding for behavioral health.

“It’s the only bipartisan issue that I have found dealing with the legislature right now,” Glazier said. 

Glazier said he has been in the healthcare industry for 45 years, yet it is only in the last few he seen real progress in reducing the stigma around mental health treatment.

That has corresponded to new federal support. In every one of the last five legislative sessions, Congress added between $300M and $900M in new mental health funding, some of it directed to infrastructure and renovating old facilities. In March, President Joe Biden funded the Substance Abuse and Mental Health Services Administration to the tune of $6.5B, a $530M increase over fiscal year 2021.

Congress is also debating the Restoring Hope for Mental Health and Well-Being Act of 2022, which could funnel major money into mental health research and treatment nationally. Glazier said the new bills being considered could have an impact on mental health similar to what Texas has seen from the Cancer Prevention and Research Institute of Texas. CPRIT has funneled $3B in grants to cancer research over the last 11 years and has another $3B in funding still to award.

Glazier said that investment spurred research and clinical breakthroughs for cancer treatment that helped drop the stigma surrounding the disease. The same could happen to mental health, he said: As science understands it better and finds ways to treat patients more effectively, society’s view of mental health and mental health treatments will shift. 

One of the focuses of new investment will be on closing gaps in care, Glazier said, and that is driving demand for new space. The largest need is for beds that can serve people needing 60-day to 90-day stays — therapeutic safe places where people can be discharged after completing a short-term acute stay in the hospital.

“If you don’t have a safe, supportive place to live, you’re not going to do well with your mental health problem, and that’s starting to be funded,” Glazier said. “This is really exciting.”

HDR's Fernando Rodrigues, Walter P Moore's Karim Zulfiqar and Page's Joan Albert

The Menninger Clinic on Thursday cut the ribbon on a new 33K SF outpatient building in Houston that will help transition people from inpatient to outpatient services and bridge the continuum of care.

But going forward, Colombo said, the clinic is looking outside its campus for services like sober living homes and substance use rehabilitation. The most important factor in making this kind of expansion successful is partnering with other organizations that can help extend the continuum of care, he said. Those facilities can be located in small assets, like houses in communities, or in office space retrofitted for partial hospitalization or intensive outpatient procedures. 

When the University of Texas was planning for the new UTHealth psych hospital, it looked at putting supportive housing within the hospital, according to Glazier. 

“It took about 10 minutes and we came to our senses and asked ourselves, ‘Why would we put housing, which is really inexpensive to build, in the most expensive kind of building we can build? That makes no sense at all,’” Glazier said.

Instead, UTHealth is working with a partner to expand post-crisis care “in appropriate housing buildings” so the hospital can focus on inpatient care.

A new focus on mental health also extends into the design of facilities, including lighting. Glazier said a member of the architecture team for UTHealth’s new hospital is also a neuroscientist specializing in the effect of light on the brain, and that person dug deep into specific glazing on windows to allow a specific amount of light into the building.

The biggest design focus, however, is on giving people inside these buildings a feeling of control. 

“Many of our patients are there involuntarily, they can’t leave until they’re no longer a danger to themselves or others. They’re locked in there,” Glazier said. “But if you can design a building so they feel they have more control over their environment, they tend to relax, they do better, they get better more quickly.”

Most of this is subtle. UTHealth has built cubicles in its inpatient units where patients can lean back behind a partition and feel like they have some privacy, but open enough that nurses can monitor them and other patients can come say hello or help gradually draw them out.

Control is important for staff, too, Page Director of Healthcare Joan Albert said. The mental health of doctors, nurses and technicians has also come under the spotlight, and new facilities are including respite spaces for staff to have casual conversations and step away from the stress of the job.