The Bridges to Recovery Outcomes Studies: An Interview With Dr. Judy Ho

Earlier this year, we released our first outcome study. The study was led by Dr. Timothy Fong, associate clinical professor of psychiatry at UCLA, with Dr. Ho providing secondary analysis. It examined the experiences of 22 patients who received treatment from 2015 to 2016, focusing on perception of care, negative and positive aspects of care, lessons learned while in care, and depressive symptoms. The study was conducted via a self-administered questionnaire two weeks after initial admission as well as phone interviews 30-240 days after discharge.

The findings reveal:

• The majority of clients were highly satisfied with the physical facility.
• Most clients had a high rate of satisfaction with the treatment received, particularly the development of specific therapeutic techniques designed to alleviate symptoms and enhance function.
• Mindfulness, sleep hygiene, relaxation strategies, somatic therapy, acceptance of the clinical condition, and self-compassion were perceived as particularly important lessons by respondents.
• The majority of patients (67%) reported minimal levels of depression at follow-up interviews, while 10% reported mild symptoms, 4% reported moderate symptoms, and 19% reported severe symptoms.

“Some of the general trends are that clients felt very comfortable being at Bridges and were very happy overall with the quality of services provided to them,” says Dr. Ho. “The biggest take-home message from that first study was that clients really perceive that they had high quality of care. They perceived that they were treated with respect and enjoyed being at Bridges.”

Perhaps one of the most interesting and valuable findings was that clients report perceiving themselves as having the ability to take an active role in the treatment process, which research suggests is instrumental in improving treatment outcomes and promoting mental health care behaviors in patients. As Dr. Ho explains:

When people have higher or more urgent mental health needs that necessitate treatment at a residential treatment center, they really lose a lot of self-efficacy and have all kinds of negative self-perceptions and, often, low self-esteem. I think it’s really crucial that individuals feel they have agency and that they have an active role in treatment because it’s almost like practicing that efficacy in a safe environment. I have heard clients say that they feel in control now and even if they get depressed again they know what to do. One of the best compliments I can hear from a client who has received treatment is that they feel like they have the ability to improve their own outcomes.

Indeed, the fostering of agency and inclusion in the treatment process may help explain the high rate of patient satisfaction and symptom remission.

While the first outcomes study provided an invaluable starting point for understanding client experiences, the study was small and primarily qualitative. Now, Dr. Ho is embarking on a second phase of research via a longitudinal study focused on the quantitative evaluation of outcomes. “In this second phase of the study what we’re hoping to do is really collect a multidimensional picture of how this client is functioning after treatment at Bridges,” she says. “We’re hoping to get a full picture of whether or not people have improved and whether they can sustain that improvement over time.”

While the study will focus partially on the kind and extent of symptoms experienced before and after their treatment at Bridges, it also seeks to take a more holistic view of overall clinical functioning.

We will also be looking at things like how they report meaningfulness and quality of life at admission and after treatment is complete. And we’ll also be looking at things like whether they are fully engaging in all the various domains in their lives before and after treatment. So for example, do they want to be employed and if so, do they have a job? Do they feel they have necessary social support? Are they engaged in meaningful family relationships or friendships? Are they engaging in hobbies? So we’ll know exactly how they’re doing in all aspects of their lives because those are ways to assess their overall mental health and physical health.

The study will also continue to investigate perceptions of treatment at Bridges to provide insight into strengths and weaknesses of the program.

In order to capture this information, clients will complete questionnaires upon admission and then participate in telephone or online questionnaires at one, three, and six months to track ongoing outcomes. By creating precisely targeted surveys and allowing clients to choose the format in which they will participate, Dr. Ho hopes to encourage participation and expand the sample size to create a more meaningful dataset and gain deeper insight into client experiences.

Understanding the lives of people with mental illness and the impact of treatment is invaluable to creating better resources to alleviate distress and break through the negative stigmas that keep so many people from seeking the care they need. The outcomes studies are designed to guide our team at Bridges to Recovery to continually improve quality of care in order to create the best possible treatment experiences for clients.

But the studies go beyond guiding treatment; while our clinicians understand patient outcomes in an observational way, quantifying those outcomes provides a way of communicating those outcomes to others who are not central to the Bridges community and offers a glimpse of how treatment is truly working and impacting the lives of patients in meaningful ways after their discharge. In addition, the study results can help to share expectations and perceptions of the possibilities of mental health care in the broader community.

As Dr. Ho says:

We want the Bridges to Recovery clients to be informed about their own conditions and to really understand how they will benefit from getting treatment at Bridges. I believe it will help encourage potential clients and give them hope if they can see what is known about people who have gone through this program. It is also important to educate the public, whether it’s referents or patient families, that the benefits of treatment can be documented very specifically and meaningfully via research.

Indeed, the lack of true quantitative analyses of mental health treatment outcomes leaves a kind of silence in which doubts and negative stigmas flourish. While quantitative research on the outcomes of substance abuse treatment programs has helped to destigmatize and inform the public about the possibilities of treatment, the mental health community lags behind. By supporting outcomes-oriented quantitative research and contributing to public knowledge about the efficacy of mental health treatment, at Bridges to Recovery the clinical team hopes to break through misinformation that prevents people from getting help. At the same time, the studies may be used as models for other treatment programs who want to investigate their own services.