San Mateo County Cordilleras Mental Health Center

A New Vision for Mental Health Treatment

For the past 62 years, the county-owned Cordilleras Mental Health Center has supported essential services for residents of San Mateo with serious mental illness. Significant advances in treatment and system design that have occurred over the past 20 years were not supported by this existing facility—now at the end of its useful life. HGA was retained to help the County create a master plan that would transform Cordilleras into a center for wellness, rehabilitation, and recovery, using the built and natural environment, best practices for treatment, and the expertise of providers, family members, consumers, and the community.

The center houses two separate treatment programs, operated by Telecare Corporation, for adults with chronic mental illness: a licensed, locked 68-bed Mental Health Rehabilitation Center (MHRC) and a licensed 49-bed Adult Residential Facility (ARF). Most patients are admitted to the Cordilleras locked MHRC beds from San Mateo Medical Center’s psychiatric inpatient unit or another locked facility outside San Mateo County. The unlocked ARF is permanent housing in which patients may stay for many years, although most do not. The majority of ARF residents have stepped down from more intensive levels of care including the MHRC and other facilities outside of the County. The average length of stay for those discharged is five months.

The two programs are currently housed in a building originally constructed in 1952 that is deteriorating, maintained at a considerable annual expense, and has deferred maintenance and upgrade needs. The large institutional building no longer supports current treatment practices and support services that promote recovery. The prevailing best practice for treating persons whose serious mental illness/co-occurring disorder requires a secure locked level of care is in smaller homelike settings.

HGA’s study evaluated the existing facility and identified $55 million in infrastructure repairs and renovation required for continued long-term use. Additionally, none of their treatment services are currently federally reimbursable because of federal laws that exclude psychiatric facilities over 16 beds from Medicaid reimbursement. Treatment facilities that are smaller, housing 16 or fewer individuals, and meet various other requirements, are eligible for federal reimbursement of 50% of treatment costs under existing laws and regulations.

The outcome of visioning sessions including stakeholders, staff, physicians, community, patients and families, concluded that in order to remain operationally viable and able to provide better patient outcomes, Cordilleras should be replaced with new facilities. HGA master planned and programmed six new facilities, including five, 16-bed MHRCs, each 10,500 SF in size, and one 37-bed ARF/Campus Center at 35,100 SF, bringing the total number of beds to 135. This would provide greater capacity for MHRC patients to step down to independent living and increase their opportunities for success.