An AIASF Health + Science Committee program; registration for this presentation is open at the bottom of this page. This program is accredited by AIASF to provide 1 HSW learning unit to AIA member attendees

Lack of appropriate behavioral health (BH) services is straining our nation’s health system, in particular our already stretched thin emergency departments (EDs). Mental illness is a risk factor for homelessness with 45% of the homeless population having a psychiatric diagnosis and 25% having severe mental illness.

What can be done?
Project California Dreaming envisions a future in Los Angeles, with one of the largest homeless populations in the US, where existing infrastructure is repurposed to address the community’s behavioral health and housing needs and sustainably invest in community development.

How would it work?
There is an opportunity to utilize existing California hospitals set to close by 2030 for seismic conditions. NBBJ proposes using hospitals with a structural performance category (SPC) rating 1 and 2 scheduled for closure/decanting of general acute care (GAC) services as whole health environments for behavioral health (BH) and homeless populations.

Where would the whole health environments be located?
Currently, emergency departments (ED) with high BH and homeless populations are experiencing increasing numbers of patients who leave without being seen (LWBS) and frequent ambulance diversion, costing millions of dollars to the health system and an inability to provide medical care to those in need. We propose identifying locations for the proposed whole health environments near these challenged hospitals to provide an alternative to the ED and reduce recidivism.

Are there proven models to emulate?
Both the John George model (Alameda County, CA), and the Unity model (Portland, OR) which brings together multiple health systems and creates one centralized location for BH and homeless populations in need of care, provide the right services in the right location for emergency events, minimizing overcrowding in EDs and jails.

Learning Objectives

1. Maximize building infrastructure and re-use of SPC 1&2 GAC hospitals
2. Understand health system challenges to serve populations in an environment designed for a different kind of care
3. Understand the behavioral health and homeless growth impact to communities through data
4. Potential program and space use for care driven by whole health

About the Presenter

Andrea Rufe
Principal I Healthcare, NBBJ

Andrea Rufe is a Principal with NBBJ and has been with the Firm since 2013. Her passion for the patient care environment has become her career: analyzing the past, present and future to help health systems define the right-services in the right location and making sure they are right-sized. Having worked all over the United States and Internationally, Andrea helps define the future of care with her deep understanding and knowledge of patient needs and health-system strategies for the built environment.