Building a new substance use disorder (SUD) treatment facility can be a transformative step for any community, providing critical services to individuals struggling with addiction. For many, these facilities offer a vital lifeline, improving access to behavioral health care for those who need it most. However, despite the clear benefits, the path to opening a new facility is often fraught with challenges, including overcoming stigma in behavioral health facilities, addressing local resistance, combating community misconceptions, and navigating complex legal and zoning processes.
For providers looking to establish a new SUD treatment center, neighborhood pushback can lead to lengthy, expensive legal and regulatory processes that delay or even prevent the opening of a facility. In addition to this, restrictive zoning policies and a lack of local support can derail efforts before they even begin. Despite these obstacles, there are strategies that can help providers overcome resistance and successfully open a much-needed facility.
The Stigma of Behavioral Health Treatment and Its Impact on Community Perception
The most significant barrier to establishing a new behavioral health facility is often rooted in stigma. While the conversation around mental health and addiction has come a long way in recent years, many communities still harbor negative attitudes toward these issues. Overcoming stigma in behavioral health facilities is crucial for the success of these projects. Andrew Sfreddo, head of behavioral healthcare at Blueprint, a health care real estate advisory firm, noted that while behavioral health care has gained more acceptance, there remains a prevailing sentiment in many communities that these services are acceptable, just not in their backyard.
Even though much progress has been made in reducing stigma, communities often express reluctance when it comes to establishing treatment facilities for substance use disorders or mental health conditions. Sfreddo elaborated that despite the positive strides made, many communities prefer that behavioral health services are located “on the other side of town,” rather than in their own neighborhoods.
This reluctance stems from a combination of outdated views on addiction and mental health, compounded by fear and misunderstanding of what these services entail. Overcoming stigma in behavioral health facilities involves educating the community about the benefits of these centers and the positive impact they have on public health. In some instances, the idea of a behavioral health facility conjures images of unsafe environments or a lack of control over who accesses the facility. These fears are often based on misconceptions and do not reflect the reality of well-managed, professionally run treatment centers.
The Challenge of NIMBYism and Facility Location
One of the most common responses from communities facing the prospect of a new behavioral health facility is what is often referred to as NIMBYism – “Not In My Backyard.” The core of this resistance is the perception that while such services may be necessary, they should be located far away from residential areas.
Nathaniel ‘Tani’ Weiner, a health care M&A lawyer and co-chair of Polsinelli Law Firm’s behavioral health group, explained that facilities in residential neighborhoods often draw concerns ranging from fears of increased traffic and parking issues to worries that the facility may lower property values or contribute to health and safety risks. Even in commercial areas, similar concerns can arise, and outdated views about behavioral health treatment continue to influence local attitudes.
The size and nature of the facility also play a significant role in how the community perceives it. Large facilities or those that treat individuals with more severe forms of substance use disorders or serious mental illnesses (SMIs) are particularly likely to face backlash. These facilities are often seen as more intrusive, and community members may fear that they will have a negative impact on their neighborhood’s social fabric. Overcoming stigma in behavioral health facilities often means working to change the narrative, showing that these facilities are part of the solution, not part of the problem.
Zoning Challenges: The Legal Battle to Open a Facility
Zoning laws and regulations present another major hurdle for providers hoping to open a new SUD treatment facility. According to Weiner, community backlash usually arises once the development becomes public knowledge, often triggered by the need for a zoning variance or special permit. In most cases, a facility will require public approval, and this process is frequently contentious, involving public hearings and comment periods that can drag on for months or even years.
A Blueprint analysis of 50 behavioral health care facilities found that around 19% to 20% of these facilities are located in areas with “by-right” zoning, meaning they do not require discretionary approval to be built. These locations allow for a much smoother and faster development process. However, the remaining 80% of facilities need various types of approvals before they can begin construction or open their doors.
The challenge for providers is that, in most cases, the process of obtaining zoning variances and other permits is complex and can trigger significant community opposition. Even after these approvals are granted, concerns about the facility can persist, especially when the facility is preparing to open its doors. As such, legal challenges and lengthy delays are common in the process of establishing a new SUD treatment facility. Overcoming stigma in behavioral health facilities means working with the community to address these concerns and creating a space that people feel comfortable with, not fearful of.
Legal Protections and the Role of the Fair Housing Act
While the legal barriers can be daunting, there are protections in place to ensure that individuals with substance use disorders and mental health conditions have equal access to housing and care. The Fair Housing Act, enacted in 1968, provides legal protection for behavioral health residential facilities, ensuring that communities cannot discriminate against them based on the nature of the services they provide.
Matt Pettinelli, founder and CEO of CapGrow Partners, explained that the Fair Housing Act acts as a “protective shield” for behavioral health facilities, making it illegal for local governments or communities to block these services based on discriminatory beliefs. However, Pettinelli also acknowledged that some communities still attempt to ignore the law or argue that it does not apply to their specific situation. While they often lose in court, the legal battle can be costly, time-consuming, and emotionally draining.
In some cases, providers may choose to relocate their facility to a more welcoming neighborhood rather than engage in a lengthy legal battle. While this can be a practical solution, it can also delay access to care for individuals who need treatment in underserved areas. As Pettinelli noted, shifting a facility’s location can prevent certain communities from benefiting from much-needed services, leaving them without the necessary resources to address the substance use disorder crisis in their area. Overcoming stigma in behavioral health facilities requires perseverance and a willingness to confront these challenges head-on, regardless of legal battles or public perception.
Strategies for Overcoming Community Backlash and Zoning Challenges
Despite the many obstacles that come with opening a new behavioral health facility, there are several strategies providers can use to mitigate resistance and increase the likelihood of success.
1. Building Community Support Through Education:
One of the most effective ways to counteract community resistance is through education. Sfreddo stressed the importance of engaging with local stakeholders early in the process, including the township, local mayor, police and fire departments, and community members. By sitting down with these groups and explaining the mission of the facility, the types of patients it serves, and the ways it will be governed, providers can help alleviate concerns and build trust with the community.
“Let’s sit down, break bread, and have a meeting,” Sfreddo advised. “It’s critical to get community support on your side. It’s tough to win without that.” Overcoming stigma in behavioral health facilities is a critical part of these conversations, as education helps dispel myths and address concerns before they become larger obstacles.
2. Seeking Legal Guidance:
Navigating the intricacies of zoning laws and understanding the legal landscape is essential for any provider looking to open a new facility. Legal counsel with expertise in land use, zoning regulations, and disability protection laws can help providers understand what’s required to open a facility and how to navigate local opposition. Weiner recommended that providers seek legal advice early in the process to ensure they are prepared for any challenges that may arise.
3. Collaboration and Information Sharing:
Collaboration among providers can also help expand access to behavioral health care. Although it can be risky to share information with competitors, Pettinelli emphasized the value of learning from others’ experiences. Working together to share knowledge and strategies can increase the chances of success when establishing a new facility.
4. Flexibility and Persistence:
Ultimately, flexibility and persistence are key to overcoming community resistance. While some communities may be adamantly opposed to a new behavioral health facility, others may be more open to the idea once they are fully informed about the benefits these services provide. If one location or approach does not work, providers must be willing to try different strategies and locations until they find a more welcoming community.
The Path Forward: Making Behavioral Health Care Accessible to All
Opening a new SUD treatment facility is not an easy task. It requires navigating complex zoning laws, overcoming stigma, and addressing community concerns. However, with the right strategies in place—education, legal guidance, collaboration, and flexibility—providers can break down barriers and bring essential services to communities in need.
Despite the challenges, the ultimate goal is to improve access to behavioral health care for individuals struggling with substance use disorders. Through persistence and dedication, behavioral health providers can help shift public perceptions, expand treatment access, and make a lasting difference in the lives of those affected by addiction. The journey may be long and difficult, but the rewards of building a successful facility are well worth the effort. Overcoming stigma in behavioral health facilities is an ongoing challenge, but it is one that can be conquered with the right approach and commitment to community education and engagement.
