The United States face a behavioral health crisis: Existing healthcare facilities are struggling to accommodate people with serious mental illness. A lack of integrated care — where clinical behavioral healthcare services pair with programs that foster self-efficacy and independent living skills — has led to high recidivism rates. That scenario, coupled with the persistent social stigma surrounding serious mental illness, has created a direct link between serious mental illness and homelessness.

To break this vicious cycle, healthcare industry leaders must reimagine how treatments are delivered in behavioral healthcare facilities and find cost-effective solutions, and behavioral health clinicians must extend their services beyond medication management and therapy.

Across chronic medical conditions, it is increasingly recognized that clinical services alone are not enough to achieve lasting health and well-being. As a result, diabetologists prescribe healthy foods and exercise in addition to medications, and more healthcare systems are introducing food pharmacies and therapy gyms that double as fitness facilities to support these non-medication prescriptions.

Behavioral healthcare facilities that adopt similar treatment paradigms will be more effective in achieving lasting symptom control for serious mental illness. Besides medications and talk therapy, treatment must focus on developing life skills and marketable skills — critical areas often lacking in those with poorly controlled serious mental illness.

Rethinking traditional facilities

A comprehensive behavioral health facility (CBHF) that integrates medical treatment, talk therapy, life skills coaching and job training can empower seriously mentally ill patients to manage their symptoms, secure stable employment and live independently in safe housing. Unfortunately, more than one-half of homeless Americans with serious mental illness live in dense urban areas where high land and labor costs make building new behavioral health facilities prohibitively expensive.

One solution is to implement the adaptive reuse of shipping containers. This approach offers a cost-effective, scalable solution for developing CBHFs, providing accessible care without the expenses of traditional construction.

Adapting used shipping containers to create several different components of a CBHF offers a low-cost, environmentally friendly solution. These containers are also generally climate-resilient, making them viable in regions with extreme weather.

While each container would be customized for a specific service, all containers would share a standardized, solar-powered mechanical, electrical and plumbing system. As patient needs or healthcare paradigms change, the containers can be reconfigured or relocated within the system to adapt to changing capacity demands and service needs.

Container-based CBHFs can feature clinical facilities alongside other critical components, either fully owned by the health system or developed as a joint venture, to provide additional therapies through education and independent living training. A container can be customized and stand alone or be stacked blocks to serve several functions:

Behavioral healthcare. Containers can be designed to accommodate various levels of psychiatric care, including one-on-one counseling, group therapy, partial hospitalization programs, witnessed medication administration and drug testing. As the core service of the integrated supportive housing facility, these spaces can be operated by the healthcare system or public health department.

Staffed by psychiatrists, psychologists, nurses, social workers and support staff, this block also can include designated workspaces for administrative tasks and respite areas for staff.

Ambulatory medical care. Poorly controlled mental illness and homelessness often coincide with poorly controlled chronic diseases, limited access to preventive care and overuse of emergency departments.

To address these needs, a dedicated block of containers can be adapted for outpatient medical services, including primary care, urgent care and chronic disease management. Containers can house exam rooms, vital sign and weigh-in areas, phlebotomy areas, radiographic imaging and ultrasound rooms, and a pharmacy.

This block can be staffed by physicians, physician extenders, nurses, phlebotomists, radiology technicians and pharmacists, and imaging studies can be transmitted electronically for interpretation, eliminating the need for on-site reading rooms. This block also can feature containers designed as a combined fitness center and outpatient physical therapy treatment area, providing residents with general gym access while offering supervised physical and occupational therapy as needed.

Patient housing. Containers also can serve as housing for patients, designed as individual studio-style units arranged around common areas. These spaces can accommodate recreation, group therapy, GED classes and milestone celebrations.

Housing blocks can be structured around stages of recovery, gradually increasing independence. Stage 1 housing, located closest to intensive treatment areas, can provide 24/7 support and supervision from an assigned onsite counselor. Stage 2 housing, set farther from the main behavioral health block, can maintain the same layout but without constant onsite support. Stage 3 housing can be integrated into the broader facility, allowing residents to live more independently while remaining connected to the supportive environment.

Outside of healthcare and housing, residents in these neighborhoods can have access to educational opportunities that eventually can lead to employment. Container towns can collaborate with local community colleges and businesses to integrate with the community, destigmatize mental illness and foster social connections. After progressing through two years of staged housing and increased education and workplace opportunities, patient residents will be prepared to seek employment and secure housing in the broader community.

Adaptive reuse of shipping containers offers a low-cost, sustainable solution for providing integrated behavioral healthcare, medical care, secure housing with decreasing supervision, education and job training, and wage-earning opportunities. It also addresses healthcare capacity challenges for this vulnerable population while creating a clear path to long-term employment and housing stability. This model also highlights the importance of healthcare facilities adopting a low-cost, sustainable approach to effectively address unmet behavioral healthcare needs, providing lasting solutions for individual well-being and the community.

Heena Santry, M.D., MS, FACS, is principal for healthcare at Arcadis.