The Architect

Our 22-year-old got her first job out of college this month at, of all places, an architecture firm and her first assignment involves the design of an urgent care psychiatric facility in New England. There are now more than 4,000 such same-day mental health emergency centers in the US by our count though just a fraction are dedicated solely as a triage system for mental health emergencies. They were configured initially to give police an alternative place to take people other than hospital ERs. “It was really first a lot about helping in domestic violence situations and has now emerged to become quite critical for families who are in the midst of a potential suicide situation,” says Allie King, a communications director for a Missouri county police force. The urgent care centers sometimes open up to help the uninsured as The Collaborative did in Nashville in 2018 but “we ended up having waiting lines” due to the influx of people with employer insurance, Adam Graham, the program’s emergency director told us at the time. It’s interesting how so much of the public is on board – in Florida, The West Central Mental Wellness Coalition was formed in 2019 with support from the Rays baseball foundation, Florida Blue, and many hospital systems, including leader Baycare. Now called “Tampa Bay Thrives,” funding for these centers is not just from patients and insurance but also grant-funded as a community service. The question for healthcare investors is just how many of these centers are truly needed, how to staff them, and perhaps underappreciated how to quickly connect patients to the next level of care. Amy Flutes said the 10-12 cases she sees a day at her center in Missouri are “high crisis” and “we stabilize” but “sometimes struggle with finding a suitable facility or available psychiatrist for their situation.” Roughly half of psychiatrists in the US are only taking cash pay and many more have full panels. Flutes said they often have to look out of state or “have to settle” for helping the family get their loved one to a center that “isn’t perfect.” For investors, can you design a system that limits wait time, is efficient in a suicide process and importantly can help find that next level of care? Said our daughter, “I didn’t realize all of this Dad….we just need to figure out how to design the space and the waiting area to be suited to people in a mental health crisis.” I know kiddo. And it’s great you're doing this important job. “You know that being an architect is George Costanza’s dream job,” I told her. “Dad! Seriously, why does everything have to be a Seinfeld reference?”