A Randomized Controlled Trial of Mental Health Peer-Led Education (BRIDGES)

• Recovery from mental illness [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  Recovery is a psychosocial outcome assessed via patient self-ratings on a 41-item scale using a 5-point Likert-response format ranging from "strongly agree" to "strongly disagree." Dimensions of recovery include personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, and no being dominated by one's residual psychiatric symptoms.
• Personal empowerment [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  Personal psychological empowerment is measured via patient self-report using a 28-item instrument designed to measure subjective feelings of empowerment in which respondents answer questions on a four-point scale ranging from Strongly Agree to Strongly Disagree.

• Hopefulness [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  Hopefulness as a cross-situational long-term trait is assessed via patient self-report using a 12-item scale assessed on a 4-point Likert response scale with options ranging from "definitely false" to "definitely true" and summed to produce a total score and sub-scale scores.
• Patient self-advocacy [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  The ability to advocate for oneself with medical care providers is assessed via self-report using a 12-item scale with a 5-point Likert response set ranging from "strongly agree" to "strongly disagree." Dimensions include in patient knowledge, assertiveness, and potential for mindful non-adherence to treatment.
• Coping style [ Time Frame: 9 months ] [ Designated as safety issue: No ]
  Coping is measured via patient self-report using a 28-item scale with 4-point Likert responses ranging from "a lot" to "not at all." Both positive and negative coping styles are assessed along with emotion-focused and problem-focused styles of coping.

This randomized controlled trial tests the efficacy of a mental health peer-led educational intervention called BRIDGES (Building Recovery of Individual Dreams and Goals through Education and Support). The BRIDGES program is a 10-week, manualized education course designed to provide basic information about the etiology and treatment of mental illness, self-help skills, and recovery principles in order to empower participants to return to valued social roles within their communities. BRIDGES is a peer-led program and all instructors are adults with mental illnesses.

Hypothesis #1: Compared to wait-list controls, intervention participants will report increased feelings of psychological empowerment.

Hypothesis #2: Compared to wait-list controls, intervention participants will report increased feelings of hopefulness.

Hypothesis #3: Compared to wait-list controls, intervention participants will report enhanced coping ability.

Hypothesis #4: Compared to wait-list controls, intervention participants will report enhanced recovery.

Hypothesis #5: Compared to wait-list controls, intervention participants will report greater ability to advocate for themselves with health care providers.

Hypothesis #6: Compared to wait-list controls, those in the BRIDGES education course will report increased knowledge of the causes and treatment of mental illness and recovery principles.

Eligibility criteria included having a diagnosis of serious mental illness and experiencing severe functional impairment in one or more life roles. All study participants completed telephone interviews at three points in time: study entry (pre-intervention); 8-weeks later (immediate post-intervention); and 6-months after intervention (approximately 8 months after study entry). Blinded interviewers administered valid and reliable outcome assessments that measured changes in subjects' knowledge about mental illness; emotional well-being; empowerment; hopefulness; self-advocacy; and recovery. All study participants were compensated for their time at each interview. All BRIDGES instructors were people in recovery from serious mental illnesses who were certified and experienced BRIDGES teachers. Fidelity to the BRIDGES curriculum was assessed on an ongoing basis throughout the study.

Inclusion Criteria:

• Clinical diagnosis of mental illness
• Disability due to mental illness
• Age 18 years or older
• Willingness to receive the intervention

Exclusion Criteria:

• Inability to understand spoken English