McAlister Institute has spent the last three years searching for a suitable site to put substance use treatment beds. In the process, they have decided against 44 different properties.
The region’s largest substance use treatment provider recently set its sights on a Bankers Hill property. With $12 million in pledged local government support, McAlister thought it might be the place where it could finally open more beds for people desperate for help. Then, the nonprofit decided it wouldn’t work.
Among the snags that emerged: McAlister would need to use another business’ space as its only entrance for people with disabilities and McAlister clients taking breaks outside would encounter other visitors in the site’s only outdoor area. That would compromise patients’ privacy.
“Just because it’s a good real estate deal doesn’t mean that it’s appropriate for our use,” Marisa Varond, executive director at the McAlister Institute, said.
So McAlister moved onto property No. 45 in East Village.
The nonprofit’s search has coincided with a crush of demand. Varond said that during a recent five-day period alone, McAlister received 172 calls from people seeking a bed in its 24-bed adult detox program.
McAlister isn’t alone. Two other treatment and detox providers desperate to expand at a time when overdose deaths are spiking also keep running up against all sorts of barriers: property restrictions, bureaucratic red tape and a competitive real estate market. All three providers say they remain committed despite the roadblocks.
The logistical barriers have meant people desperate for care often can’t quickly access services, a reality that can have life or death implications.
“People are dying on the streets while we are doing everything we can, and it still doesn’t feel like enough,” Varond said.
The providers say they have grappled with challenge after challenge as they try to find sites to quickly open more residential treatment beds for low-income and homeless patients with Medi-Cal insurance.
The race has been on to add more beds since the abrupt 2020 closure of a National City facility that had supplied dozens of treatment beds for Medi-Cal patients. The loss of those beds put more pressure on a substance use treatment system unable to keep up with demand for residential care.
The three providers say they have struggled to secure workable properties before other buyers poach them and faced numerous other site-related hurdles – from zoning to the need to secure local government support and permits.
McAlister has been working with a team of developers, land use attorneys, consultants, architects and contractors – most of whom are volunteering their time. Varond said the city of San Diego and county have been supportive, too. That hasn’t stopped the real estate market and various issues from stymieing progress.
Meanwhile, Mayor Todd Gloria’s office says the city is considering land use code updates to speed up the process for McAlister and other behavioral health providers. A City Council committee also recently directed work on a crisis declaration that could pave the way for more zoning changes and calls for state and federal support.
“We won’t stop until we figure this out,” Varond said.
The two other providers pushing projects elsewhere in the county are praying they’ll get support from local governments too.
Interfaith Community Services CEO Greg Anglea said finding suitable locations for people to overcome addiction is one of the biggest roadblocks to supplying more care.
The nonprofit is on the hunt for a new, larger location for its current 49-bed Escondido program with 11 detox beds. Interfaith told the city about a property it identified this summer since it will likely require support from the city’s Planning Commission and City Council for a permit to operate there.
Anglea’s not counting on their support.
An Escondido spokesman declined to comment on Interfaith’s proposal.
San Diego Freedom Ranch, which has a 54-bed facility in Campo, has assessed 40 to 45 properties in recent years, Executive Director Jerry Shirey said.
Freedom Ranch is now working on a state grant-funded expansion at its Campo headquarters that’s expected to supply new residential treatment and detox beds plus new outpatient and narcotic treatment programs – in 2027.
Freedom Ranch also has its eye on a long-vacant treatment center for teens in unincorporated El Cajon they could quickly turn into a 90-bed substance use residential treatment campus. Shirey estimates that could be ready within about a year if the county helps fund it. Shirey believes the campus could swiftly supply dozens of new detox beds and later include a chemical dependency recovery hospital, outpatient services and more.
Shirey said he had an initial meeting with county officials about his proposed El Cajon project in August. His nonprofit wants the county to initially chip in about $15 million to help kickstart the project and to commit millions of dollars in annual county contracts once the facility opens. He is convinced the additional capacity could end wait lists for local residential programs and detox – and the tragedies that come with them.
When Shirey met with the county in August, officials requested that he run some additional numbers. He shared those with the county on Thursday.
Shirey also recently reached a non-exclusive deal with the landowner for a potential 10-year lease if things come together. He ordered renderings and is working on other pieces without certainty he’ll be able to pursue the project. After all, a competitor could swoop in and take the property since it’s still technically on the market while Freedom Ranch figures out whether the project will come together.
Once the county sees Shirey’s updated proposal, he wants staff to quickly sign off on tweaks to current major and special use permits to allow the facility to treat adults rather than teens and ideally, to increase the number of allowable beds for future expansions. He believes the process could be fast-tracked with a Board of Supervisors vote to allocate funding and approve the changes.
For nonprofit leaders like Shirey and Varond and their teams, the years-long quest for treatment beds has been excruciating. They are haunted by their inability to quickly deliver new options for people crying out for help.
“We’re losing people,” Shirey said. “People aren’t getting beds.”
A county spokesman recently declined to comment on Shirey’s proposal.