Healing Villages

Healing Villages – Behavioral Health Campus Network (BHCN)

1) The New Continuum (least-restrictive → most-protective)

Crisis & Stabilization (hours–days)
23-hour crisis centers and 3–7-day Acute Stabilization Hubs (ASH) that replace ER boarding. No bars, no shackles; quiet rooms, sensory regulation, med initiation, safety plans.
Respite Houses (days–weeks)
Small (6–12 beds) neighborhood homes staffed by clinicians + peers. Voluntary stays to avert hospitalization.
Open Residential Villages (weeks–months)
Community Recovery Villages (CRV): cottage clusters around a commons; therapy, sleep clinics, nutrition, addiction treatment, work/learn programs. Residents move freely on campus; community day-passes when clinically appropriate.
Secure Therapeutic Units (as needed for danger risk)
Secure Therapeutic Care Units (STCU): hospital-grade safety without prison aesthetics. Clear admission thresholds, frequent judicial/clinical review, step-down targets from day one.

2) Design Principles (fix what deinstitutionalization got wrong)

Dignity + Safety together: trauma-informed architecture, natural light, outdoor access, normalized clothing & meals, de-escalation-first staffing.
Measurement-based care: standardized tools (PHQ-9, GAD-7, C-SSRS, etc.), published outcomes, and “step-up/step-down” rules based on data.
Integrated SUD care: co-located medication-assisted treatment, detox beds, and relapse-prevention groups. No more bouncing between systems.
Housing pipeline: guaranteed exit pathways—supportive apartments or micro-village units so discharges don’t mean the street.
Work, purpose, belonging: maker spaces, gardens, kitchens, music rooms; stipended roles on campus (kitchens, grounds, peer mentoring).

3) Legal & Rights Framework (never repeat the abuses of old asylums)

Least-restrictive mandate: must document why each level is necessary; automatically re-evaluate every 72 hours (crisis) / 14 days (residential).
Due process & advocacy: independent Ombuds Office on every campus; on-site legal aid; appeal rights; family/ally inclusion by consent.
Clear commitment standards: imminent risk, grave disability, or repeated failure of outpatient care with documented harm. Sunset dates; periodic judicial review (“Care Court” with defense + peer rep).
Assisted Outpatient Care (AOC) with safeguards: time-limited orders, housing/transport guaranteed, meds never a condition without offered alternatives; rapid path back to respite/residential if deterioration resumes.

4) Staffing & Culture

Team mix: psychiatrists/NPs, psychologists, LCSWs, addiction specialists, occupational therapists, peer support (≥20% of staff), somatic & sleep specialists.
Ratios & coverage: 24/7 clinician presence; safety techs trained in de-escalation; mobile teams for community follow-up.
Training: trauma-informed, harm-reduction, cultural humility, neurodiversity competence; annual simulations for crisis scenarios.

5) Technology (servant, not master)

AI triage + care navigation: routes people to the right level within minutes; flags relapse signals (missed refills, ER visits).
Measurement dashboards: resident & clinician see progress; aggregate metrics go public (with privacy).
Passive safety: non-invasive fall/self-harm detection in rooms; audit-logged access; ZERO facial recognition for policing.

6) Ties to Society 2.0 stack

UMHAP on-site: daily groups, 1:1 sessions, and post-discharge continuity via pharmacies/libraries/cafés.
URMAP kitchens: “Food as Medicine” menus; cooking classes as therapy + skill.
Community colleges: on-campus practicums for counseling/social-work students, creating a sustainable talent pipeline.
Elder micro-villages: intergenerational programs—story circles, tutoring, music nights.

7) What replaces today’s jail/ER default?

Behavioral Health 988 + Mobile Crisis teams authorized to bring people directly to ASH/respite instead of ER or jail.
Co-response with police only when necessary, with mandatory transfer to clinical lead within 15 minutes on scene or upon arrival.

8) Funding & “Why This Pays For Itself”

Reallocate spend from ER boarding, jail days, encampment abatement, and avoidable medical admissions into the new tiers.
Global budgets for campuses (predictable revenue) with bonuses for: fewer re-admissions, faster access, higher resident-reported wellbeing.
Capital from state bonds + philanthropy + social impact funds; operations from redirected S1 waste (already in your S2 health pays-for).

9) Metrics that matter

10) Implementation Sequence (18–36 months)

Month 0–3: pick 3–5 pilot regions; stand up 23-hour centers; contract for respite beds; hire mobile crisis teams.
Month 4–12: open first CRV (open residential) and a small STCU wing; launch “Care Court”; publish first public dashboard.
Month 13–24: add housing exits; embed UMHAP/URMAP; integrate community-college practicums; expand to second region.
Month 25–36: prove jail/ER diversion and housing stability → scale via auto-expansion triggers in statute.