Low-profile psychiatric hospitals in high-profile neighborhoods: bridges to recovery opens Bel Air home, expands residential psychiatric treatment options in LA area.
Subject: Mental illness (Care and treatment)
Hospitals (California)
Psychiatric Care
Psychiatric services
Psychiatric hospital care
Psychiatric hospitals
Author: Grantham, Dennis
Pub Date: 01/01/2012
Publication: Name: Behavioral Healthcare Publisher: Vendome Group LLC Audience: Academic; Trade Format: Magazine/Journal Subject: Health; Health care industry; Psychology and mental health Copyright: COPYRIGHT 2012 Vendome Group LLC ISSN: 1931-7093
Issue: Date: Jan-Feb, 2012 Source Volume: 32 Source Issue: 1
Product: Product Code: 8060000 Hospitals; 8000186 Mental Health Care; 9105250 Mental Health Programs; 8063000 Psychiatric Hospitals NAICS Code: 622 Hospitals; 62142 Outpatient Mental Health and Substance Abuse Centers; 92312 Administration of Public Health Programs; 62221 Psychiatric and Substance Abuse Hospitals SIC Code: 8062 General medical & surgical hospitals; 8063 Psychiatric hospitals; 8069 Specialty hospitals exc. psychiatric
Geographic: Geographic Scope: California Geographic Code: 1U9CA California
Accession Number: 282841919
Full Text: In the summer of 2011, Bridges to Recovery, which already operates mental health treatment residences in Pacific Palisades and Santa Monica, Calif, opened a new facility in nearby Bel Air. Though indistinguishable from neighboring residences, this spacious, gated, hilltop site (Figure 1) is licensed to offer acute crisis mental health treatment for individuals facing complex psychiatric disorders.

Here, and at the other two Bridges to Recovery sites, one thing is clear: Bridges appeals to those who want a top-notch alternative to long-term treatment in a traditional psychiatric hospital, an alternative that feels more personal, more like home.

"This type of arrangement--where Bridges locates a system of treatment within a converted home in a residential area--is really unique," explains Katie Gregory, executive director, Bridges to Recovery. In fact, the location of each Bridges facility--or "community," to use her terminology--reflects the demographics of likely clients.

Environment: "structured ... but in a way you don't really feel it"

Those who select care at Bridges to Recovery do so because its three locations offer a highly structured system of treatment in an environment that allows for an unusual degreeofindividuality, privacy, and comfort. "Many of the people that come here would not do so voluntarily unless we provided the kind of environment that they are used to," says Gregory.

The Bel Air house was selected and furnished to appeal to the needs of an "executive-level" demographic. Here, those seeking treatment come from as far away as Europe or Hong Kong, or from as close as the surrounding neighborhood. And, although Bridges doesn't necessarily attract (or seek) movie-star types from nearby Hollywood, Gregory says that it has attracted high-profile professionals--or their family members--who seek intensive treatment in a uniquely comfortable and private environment.

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During treatment, which may last between one and six months, individuals at the Bel Air house may reside in one of six private suites, which range in size from a multi-room residential suite of approximately 800 square feet to a smaller, hotel-like space. All are equipped with desks, telecommunications, and private baths. And, like all of the Bridges facilities, Gregory notes that the Bel Air site reflects a balance: "Everything is carefully structured, but in a way that you don't really feel it."

Common areas include a large, vaulted living room (Figure 2) that offers an expansive view of the Los Angeles; a well-equipped kitchen where meals and snacks are prepared to the specifications of Bridges' staff nutritionist; individual and group therapy rooms; and a variety of indoor and outdoor spaces for art, meditation, fitness, yoga, massage, or relaxation.

"In Bel Air, the feel is expansive and open," says Gregory, noting that other Bridges locations offer a different feel and reflect different target demographics. The nearby Pacific Palisades facility consists of two homes (a residential building and a therapeutic/operations building) on a more compact, wooded property.

The feel of the Pacific Palisades site is smaller, more intimate and more traditional in design and furnishing, yet it too offers a range of quiet, comfortable spaces for rest, common activities, and individual or group treatment. Often, says Gregory, the Pacific Palisades site offers the best fit for individuals with higher-acuity issues. And, in keeping with the Bridges approach, Gregory says that although the location has provided treatment since 2002, "no one even knows we're there."

The same cannot be said for Bridges' third location in Santa Monica, since its role as a mental health treatment facility became known to the community shortly after it was proposed. Rather than trying to quiet neighbors who raised concerns about safety and property values, Bridges sought to "bring awareness of the need for mental health treatment into the community," says Gregory. "That meant being available and open to the community. We had a big open house and invited people--adults and children alike--to tour the facility and learn about our mission."

The most compact of the three residences, the modern, ranch-style design of the Santa Monica home generally appeals to what she terms a "younger, hipper" demographic. Here, the sleeping areas are somewhat smaller and most individuals share accommodations with a roommate. However, the common areas are larger by comparison, reflecting the more communal nature of many young adults.

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Therapeutic approaches matched to individual needs

Bridges admits individuals for treatment of a range of primary psychiatric, mood, and personality disorders as well as co-occurring addictions.

"We see a lot of individuals with complex psychiatric issues including bipolar disorder, delusions, severe depression, or severe OCD," says Trevor Small, PsyD, Bridges' clinical director. "These are people that just can't function effectively in their own worlds."

Often, he says that individuals' dysfunctional behaviors are induced or exacerbated by trauma and that they affect relationships, career, or aspirations. According to Gregory, many individuals seek treatment at Bridges after an unsuccessful treatment episode somewhere else.

While Bridges to Recovery operates three locations, all deliver the same system of treatment, explains Small. "We offer a three-fold program of individual therapy, group therapy, and adjunctive therapies. We blend a very individualized approach with a small-group dynamic. Groups deal with both didactic, or skills-oriented work, i.e., DBT, anger management, conflict resolution, relationship dynamics) as well as more open-ended, process-oriented work. Individual and group therapies are also complemented by a range of adjunctive therapies that include art, pottery, massage, exercise, nutrition, mediation, and more." Many of these services are offered by a local professionals under contract.

While individual and group therapies help to identify and address psychiatric and life-skills issues, Small emphasizes that adjunctive therapies play a vital, holistic role. "Let's say you're throwing a piece of pottery. Within that, you may learn about how to be more creative, how to experience the feel of working with your hands, or how to deal with disappointment. Maybe you learn things that exercise other skills or that you can apply to other forms of personal growth." One way or another, he states, "anything we do at Bridges to Recovery is about helping a person grow."

Small says that despite its low number of treatment beds--just 18 overall or six per facility--Bridges to Recovery assures the delivery of high-quality clinical care through a mix of contract and full-time staff. Bridges engages long-tenured psychiatrists, clinical psychologists, and psychoanalysts from the region's numerous psychotherapy institutes, as well as institutions like the nearby UCLA Medical Center. "Some are more relational, others inter-subjective or multi-systemic, yet all are well-rounded and well-versed enough with individual needs to meet each individual where he or she is and do what is needed in both skills and process work."

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While Bridges to Recovery has always featured a special expertise in psychotherapy, Small explains that daily therapy sessions also provide cognitive-behavioral elements, including weekly somatic experiencing or EMDR (Eye Movement Sensitization and Reprocessing) therapy, based on individual need. The cognitive elements offer individuals dealing with difficult issues a means of coping and feeling better daily through the sometimes long course of complete psychotherapeutic treatment.

Upon admission, each individual is thoroughly assessed by a psychiatrist and assigned, based on that assessment and history, to a primary therapist, who meets with the individual a minimum of four times weekly (the fifth meeting is reserved for somatic therapy). This therapist also acts as the individual's case manager, handling all treatment, family, and milieu concerns.

A unique twist at Bridges to Recovery is that therapists and staff are available 24/7, not just for medical or emergency concerns, but for the full range of therapy and services. This service approach offers individuals a measure of responsiveness and control over the course of treatment that is uncharacteristic of larger or lower-priced institutional environments, yet commensurate with an environment of care that costs, on average, about $45,000 per month. According to Gregory, this price point puts Bridges to Recovery on par with many top-end psychiatric hospitals.

Katie Gregory, executive director, Bridges to Recovery

Trevor Small, PsyD, clinical director, Bridges to Recovery
Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.