The jail is the largest mental-health facility in the county.
That is the mantra of supporters of a $54 million bond package to build new psychiatric facilities at the Kino Hospital campus.
They argue that the two projects — $18 million for a psychiatric urgent-care facility and $36 million for an inpatient psychiatric hospital — will provide a more humane and more cost-effective way to help people with mental illness or substance-abuse problems who currently cycle in and out of jail and clog hospital emergency rooms.
Opponents say the proposed buildings amount to a subsidy for University Physicians Healthcare, the nonprofit corporation that took over the operation of Kino Hospital from the county in 2004. Opening an inpatient facility for psychiatric patients would allow UPH to open more medical-surgical beds at Kino, improving the hospital's bottom line.
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The projects are questions three and four on the May 16 ballot. If voters approve both projects, the owner of a $200,000 home would pay an extra $12 a year on average.
Though both facilities would help people with mental-health problems and they would be located next to each other on the Kino campus, the projects are not related. Voters could vote no on one without affecting the other.
Neal Cash, executive director of the Community Partnership of Southern Arizona, said his organization has seen a 35 percent increase in people seeking mental-health services in the last three years, while the population has increased 7 percent.
Better access to care is driving some of that increase, but so is the meth epidemic, Cash said.
Police bring 10 to 15 psychiatric patients to Kino every day, and they spend 10 to 12 hours in the emergency room, waiting for treatment or placement. When they leave, there is little follow-up.
Roughly 200 inmates at the Pima County Jail on any given day are people with mental illness or substance-abuse problems who committed minor crimes, said Martha Cramer, corrections chief. They contribute to jail crowding and are more likely to act out, increasing the number of assaults on guards and fights between inmates, she said.
County Administrator Chuck Huckelberry estimates the county could save more than $6 million a year from the $80 million jail budget by diverting those inmates.
Judge John Leonardo, presiding judge of the Pima County Superior Court, said diverting mentally ill inmates could free up space for people charged with serious crimes who need treatment to become competent to stand trial. The county spent more than $2 million last year to have people treated for competency in Maricopa County at a cost of $457 per inmate per day.
Cash's organization serves as the regional behavioral-health authority, using state funds to contract out various mental health services. If voters approve the urgent-care facility, the Community Partnership would run it.
Cash said the 60,000-square-foot building would house multiple agencies so people could get the care they need, whether that means medication, substance-abuse counseling or transfer to an inpatient bed, as well as support after discharge.
The $18 million bond issue covers just the cost of building the facility. Cash said the community partnership would cover the operating expenses.
"We hope it's approved," Cash said. "If it's not, we'll just limp on. We'll continue to do the best we can."
Next door to the urgent-care facility would be a $48 million 100-bed inpatient psychiatric hospital run by University Physicians, with the extra $12 million coming from a 2004 bond issue for the expansion of mental-health services at Kino.
The idea for the facility came from a 2005 master plan drawn up by UPH and the county.
There are roughly 65 psychiatric patients in the existing hospital, but many are in standard hospital rooms. The rooms aren't safe; it's hard for the staff to supervise patients; and too often patients share rooms, which increases behavioral problems.
"We're OK with what we got, but we need to do better," University Physicians CEO Norm Botsford said.
In addition to the patients, lawyers, counselors and even a courtroom for involuntary committal are taking up space that could be rooms for 120 medical-surgical patients.
Botsford said a new facility would create 40 additional psychiatric beds, allow for better treatment of psychiatric patients and allow University Physicians to increase the number of medical-surgical patients.
"The reality in health care is, we can get psych to cover its direct costs, but it doesn't build the bottom line," Botsford said. "Our goal is to break even as soon as possible.
"Part of that is expanding the medical-surgical beds. The other part is building our residency programs and training more doctors, which requires a diverse group of patients."
Dr. Alan Gelenberg, head of the psychiatry department at the University of Arizona and a member of the UPH board, said the alternative was clear.
"If the taxpayers don't support this, there won't be a viable hospital at Kino," he said.
It's this aspect of project that bothers some voters.
Bob Shelland, a retired bank employee, said there may be a need for more psychiatric facilities, but he questions why taxpayers should give a private corporation a building.
"They turned it over to University Physicians, and right after they decide they need this," he said. "They should have more facilities, but it's still a business."
Botsford said UPH is investing its own resources in improving the campus, including $25 million in an 80,000 square-foot clinic. But as a tenant, UPH can't show the assets to get financing for larger projects.
"Does it help UPH? A little bit," said Supervisor Ramón Valadez, whose district includes Kino Hospital. "Pima County and the community went into a partnership with University Physicians, and our goal is to have one of the premier medical facilities in town. I think that's a partnership that's served the community."
On StarNet Find more coverage of the upcoming bond election at azstarnet.com/politics
