Will I lose control of my facility?

No. You sign a long-term lease at closing. You stay in your building. You run your program. The investor owns the real estate; you own the operations and the clinical program. This is the standard structure used by national behavioral health platforms, regional hospital systems, and virtually every major commercial operator in healthcare. It is not a concession , it is how sophisticated operators manage their real estate.

My license is tied to this property. What happens to it?

This is the most important question, and it is exactly the right one to ask. BHP structures every transaction to protect licensing continuity. We have navigated licensing real property dependencies in multiple states across detox, residential SUD, and mental health residential programs. The transaction is structured and timed to ensure no gap in licensure. If your state's licensing framework creates complications, we identify them before you sign anything.

Won't the tax hit wipe out the benefit?

Sale-leaseback proceeds are treated as a property sale and subject to capital gains on appreciation , not ordinary income. For operators who have held the property for years, the gain is often modest relative to total proceeds. The right CPA should model this for your specific situation. BHP can facilitate that conversation and has worked with advisors who specialize in behavioral health operator tax planning.

What if I want to sell my program later?

A well-structured long-term NNN lease is a PE buyer's preferred real estate structure. It removes the real estate from the operating company balance sheet, makes the business easier to value, and eliminates real estate risk from the buyer's diligence scope. Operators who execute a sale-leaseback prior to a PE process often achieve better EBITDA multiples , not worse , because the business being sold is cleaner and more comparable to other platform investments the buyer has underwritten.

I've had brokers approach me about this before and it went nowhere. Why is BHP different?

Most sale-leaseback approaches to behavioral health operators come from generalist commercial real estate brokers who lack behavioral health-specific investor relationships. They put your facility in front of buyers who have never underwritten a detox census, don't understand co-occurring disorder program licensing, and require a lengthy education process before they can make an offer. BHP works exclusively in behavioral health. We approach buyers who already understand the tenant and the asset class.

Modern behavioral health treatment facility exterior at golden hour

Sale-Leaseback

Sale-Leaseback Advisory

You built the program. You own the building. That building is growth capital you haven't accessed yet.

Schedule a No-Obligation Valuation Call How It Works

The Short Version

What Is a Behavioral Health Sale-Leaseback?

A behavioral health sale-leaseback lets a treatment facility operator sell its real estate to an investor and simultaneously lease it back on a long-term basis, converting owned real estate equity into capital while continuing to operate. Behavioral Health Properties structures these transactions for detox, residential SUD, PHP/IOP, and mental health operators , typically under long-term absolute NNN leases with market-standard escalations.

What Changes

The property converts to capital. The program keeps operating.

A properly structured sale-leaseback separates the real estate from the operating company without disrupting care. BHP manages the valuation, investor process, lease structure, and property diligence as one coordinated transaction.

Market-informed valuation
Understand the property value and likely lease economics before entering the market.
Use and zoning protected
Confirm that the property and transaction structure support continued behavioral health operations.
One controlled process
Coordinate investor outreach, diligence, documentation, and closing without distracting the operating team.

What a Sale-Leaseback Actually Means for Your Program

A sale-leaseback is not a distress transaction. It is not a sign that your program is struggling. It is a capital strategy used by sophisticated operators , and increasingly required by PE-backed platforms , to keep real estate equity working rather than sitting on a balance sheet.

You sell your facility to an institutional investor at fair market value.
At closing, you simultaneously sign a long-term NNN lease , commonly structured with renewal options.
You continue operating your program exactly as you do today. Nothing about your clinical operations, staffing, or patient relationships changes.
The only thing that changes is your balance sheet: illiquid real estate equity becomes liquid capital.

What Operators Do With That Capital

Open a second location without taking on additional debt
Fund a de novo build-out or facility expansion
Retire acquisition debt secured against the property
Hire clinical leadership or invest in program infrastructure
Strengthen the balance sheet ahead of a PE process or recapitalization

The Economics, Plainly Stated

Current market context for behavioral health NNN sale-leasebacks. Every program is different; BHP will provide a preliminary estimate tailored to your specific facility before you commit to anything.

Cap rates. BHP typically sees behavioral health NNN sale-leasebacks trade in a range that varies with geography, facility type, operator credit profile, and lease term. Detox and residential SUD facilities with strong census histories and clean licensing generally command more favorable pricing than programs earlier in their operating history. Current market ranges will be shared in your valuation call.
Lease structure. Absolute NNN is standard , you retain responsibility for real estate taxes, insurance, and maintenance, the same as owning. The investor owns the land and building; you own the operations.
Initial lease term. Long-term, commonly with multiple renewal options. Provides the operating certainty your program requires.
Annual escalations. Fixed annual rent increases or CPI-capped structures are standard. The exact number is negotiable and is set at a level a stable census can support.
Proceeds. Based on appraised fair market value, negotiated against the investor's required cap rate. BHP will walk you through the specific math for your facility on the first call.

We publish this framework because specificity builds trust. A conversation that starts with real economics is more useful than one that starts with a brochure.

When a Sale-Leaseback Is Not the Right Move

BHP will tell you directly if a sale-leaseback does not make sense for your program right now. Common situations where timing is wrong or the transaction is not appropriate:

Your program is in its first 12 to 18 months of operations , census stabilization history matters to investors
Your property has unresolved zoning, licensing, or title issues that would complicate a transaction
You are in active financial distress , a sale-leaseback can provide capital, but it is not a workout tool
Your lease-equivalent cost post-transaction would exceed what your census supports at current payer rates

If any of these apply, we will tell you on the first call and point you toward what the right next step actually is.

Who We Work With

BHP advises operators of the following facility types. If you own the real estate your program operates from, we can help you evaluate whether a sale-leaseback makes sense.

Established behavioral health facility with a landscaped entrance

Detoxification facilities , medically managed and social model
Residential SUD treatment programs , 28-day, long-term, and extended care
Full-continuum platforms , detox through PHP, IOP, and outpatient
Residential mental health programs
Dual diagnosis and co-occurring disorder facilities
Acute psychiatric, eating disorder, and TBI programs (select experience)

Frequently Asked Questions

Will I lose control of my facility?
No. You sign a long-term lease at closing. You stay in your building. You run your program. The investor owns the real estate; you own the operations and the clinical program. This is the standard structure used by national behavioral health platforms, regional hospital systems, and virtually every major commercial operator in healthcare. It is not a concession , it is how sophisticated operators manage their real estate.
My license is tied to this property. What happens to it?
This is the most important question, and it is exactly the right one to ask. BHP structures every transaction to protect licensing continuity. We have navigated licensing real property dependencies in multiple states across detox, residential SUD, and mental health residential programs. The transaction is structured and timed to ensure no gap in licensure. If your state's licensing framework creates complications, we identify them before you sign anything.
Won't the tax hit wipe out the benefit?
Sale-leaseback proceeds are treated as a property sale and subject to capital gains on appreciation , not ordinary income. For operators who have held the property for years, the gain is often modest relative to total proceeds. The right CPA should model this for your specific situation. BHP can facilitate that conversation and has worked with advisors who specialize in behavioral health operator tax planning.
What if I want to sell my program later?
A well-structured long-term NNN lease is a PE buyer's preferred real estate structure. It removes the real estate from the operating company balance sheet, makes the business easier to value, and eliminates real estate risk from the buyer's diligence scope. Operators who execute a sale-leaseback prior to a PE process often achieve better EBITDA multiples , not worse , because the business being sold is cleaner and more comparable to other platform investments the buyer has underwritten.
I've had brokers approach me about this before and it went nowhere. Why is BHP different?
Most sale-leaseback approaches to behavioral health operators come from generalist commercial real estate brokers who lack behavioral health-specific investor relationships. They put your facility in front of buyers who have never underwritten a detox census, don't understand co-occurring disorder program licensing, and require a lengthy education process before they can make an offer. BHP works exclusively in behavioral health. We approach buyers who already understand the tenant and the asset class.

Discuss a Property

Start a Confidential Conversation.

Tell us what you are considering. BHP will route the conversation to the right service and give you a direct answer.

Let's Talk

Find Out What Your Facility Real Estate Is Worth in Today’s Market.

The first call is 30 minutes. No obligation. BHP will give you a preliminary cap rate range and an honest assessment of whether a sale-leaseback makes sense for your program right now.

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Last updated: August 2026