Caring for People with Bipolar Disorder
Major Mental Illness Bipolar disorder is a major mental illness, which occurs in around one percent of the population. It is a recurring disorder, which affects a person's mood in a number of ways. There are generally changes in an individual's level of energy (lots of energy through to little or no energy) as well as the type and quality of feelings that they may have (their emotional state). These changes may be quite sustained over a period of time. Although we all have fluctuations in our mood state, in people with this disorder the changes are often more pronounced and sometimes unpredictable. There may be alternating periods (or episodes) of "high" (mania) and "low" (depressed) mood, with periods of normal mood in between. Some individuals experience only the "highs", alternating with normal mood. Others may experience "mixed states" where symptoms of both mania and depression are present in the same period of time. There are many variations in the frequency, duration and severity of episodes of mania and depression. The illness can have long periods of remission (sometimes years) for most people, but a small proportion suffers frequent episodes that are resistant to modern treatment. This disorder usually occurs before a person reaches 30 years of age but can occur at any time of life. Diagnosis & Treatment Although the person that you care about may never have received a formal diagnosis of bipolar disorder, you may suspect from what they are saying and how they are acting that they may be mentally unwell. The person will initially need to be assessed to try and confirm what the problem is. Your GP may carry out this assessment. Alternatively you may try your local public mental health services, a private psychiatrist, or, if the person is very unwell to the extent that they are a danger to themselves of others, (see under Mental Health Act below) they may be seen by the local psychiatric emergency service. Unfortunately if the person is unwilling to seek help there may be little that you can do (unless they are seriously unwell in which case they may be compulsorily treated under the Mental Health Act). If a person will not seek help you need to do things to help and protect yourself. Once a person has been diagnosed, often they need treatment in the form of medication. Again this can be, and often is, handled by your GP, or it may be handled by a psychiatrist in the public system, or a private psychiatrist. It is very useful for a partner, relative or perhaps a friend to be a part of the assessment and treatment process. You will be able to give the health care provider information that the person themselves is unable or unwilling to provide. Another useful thing that you can do is to monitor the person's mood from day-to-day. Changes in the person's mood may mean that they are becoming unwell. There may also be other warning signs that a person is becoming unwell. Knowing these signs, e.g. a change in the persons' sleep patterns, will help you to detect and prevent future episodes. It may be helpful to write an action plan in advance so that you know what to do in cases of emergency and to make sure that all the health care providers know how to contact you if necessary. If it is your son or daughter It's not easy for anyone to accept that she or he has a mental illness, and young people particularly may be reluctant or even hostile. Some people take years to come to terms with having the disorder and to try to take responsibility for themselves. You will want to protect your child from damaging consequences but this may not be possible. If your daughter or son lives with you, ask yourself how much you are prepared to put up with in the way of difficult behaviour, or should she/he live elsewhere. Should your son or daughter be hospitalised, you may find that doctors/hospital staff are not prepared to discuss their condition with you (confidentiality). You may have to respect your son's or daughter's wish for independence. However, if the person normally lives with you, or you are likely to be the main support for him/her until a stable mood is reached, you need to know about medication and how to get help in the future. You may need to be assertive to convince health professionals of your need for help and information. Treatment in hospital If the person has been admitted (voluntarily or compulsorily) to hospital for mania, they may be given medication to slow them down. Seeing someone you care about in this "drugged" state may be disturbing, but the medication will be reduced as soon as possible. Antidepressant medication takes longer to work and it may be several weeks before you notice that the person's mood has lifted. When patients are admitted to a psychiatric unit they are given a physical examination. However, just to make sure, if you know of any other medical condition or medication the person has, mention these to the doctor, in case the patient has not done so. You can ease the patient's admission to hospital by making sure that he/she takes their own clothes, toilet gear, comforts etc. If the patient is to be discharged to your home, make sure you know in advance when this is to happen. Usually the person's discharge from hospital will begin with a series of trial leaves to home. If you feel that you cannot cope with the person back at home, say so to the hospital staff. If it is not possible to keep the person in hospital longer, arrange for some back-up help such as a visiting nurse or a mental health facility in the community. Make sure that the patient knows what medication is prescribed and what the next point of contact is. If you are dissatisfied with the service, discuss it with senior staff at the time. They will probably want to know about any shortcomings and put them right. Sometimes a patient may feel unable to make clear to staff about discomfort with the effects of medication or about side effects. You may be able to approach staff on her or his behalf. Any concerns that you have should be expressed to the nurses, doctors, or unit manager. Most people are either treated solely by a GP, or are returned to the care of a GP after psychiatric care. If there is a lack of confidence in the GP, suggest trying another doctor. You can ask at a medical centre if a doctor there is interested in the treatment of this disorder. It might be easier for you to do this on behalf of your relative. Discuss it together first. Some bipolar disorder groups may have a list of GP's that their members have found helpful. The Mental Health Act 1992 If a person is believed to be in an abnormal state of mind which either poses a serious danger to the health or safety of the person or others, or seriously reduces the ability of the person to take care of him or herself, an application may be made (by anyone over 18 who has seen the person within the last three days), for an assessment of that person. Contact your Mental Health Service and ask for the Duly Authorised Officer, who will advise and assist you in the procedure. If a doctor has seen the person within the last three days, she or he should be approached for a medical certificate to accompany the application. This may result in the person being admitted to hospital, for assessment and treatment, possibly against their will. You may be reluctant to take this step, but the consequences of untreated severe mania or depression may be worse than a stay in hospital or any subsequent ill feeling which arises from the compulsory admission. You can only do what you think is best. The compulsory admission is frequently reviewed and the person has a right to appeal with legal advice if they continue to oppose it. The Threat of Suicide Sadly, suicide is much more common in people who have bipolar disorder. Treat any threat of suicide seriously. Get professional help - from GP or emergency services. Telephone the emergency service and tell them as much as you can about what the person has been saying, how they have been acting and anything else that may be relevant to the situation. There may be warning signs. A person may take steps to "wind up her or his affairs", make preparations for the welfare of the family, rehearse suicide or seriously discuss specific methods. You may feel the sufferer is manipulating you by threatening suicide to get her/his own way. It may be helpful to talk with a counsellor who knows the sufferer, or you may advise the person expressing the suicidal thoughts that you are phoning an emergency service for help. This may make the real intention clear. However, many suicides, even with hindsight, are completely unpredictable and, if a suicide attempt is made, you are not to blame. If suicide happens you may wish to contact a Bereaved by Suicide support group to help you get through this difficult time (Enquire at Citizens Advice Bureau). | There are many variations in the frequency, duration and severity of episodes of mania and depression. Support Groups Encourage the person to try a support group, if there is one in your area. Enquire at your local Citizens Advice Bureau. Some Mental Health Services have support groups, perhaps in connection with an education course. For yourself, there may be a group or network of relatives attached to a bipolar disorder group (or a Schizophrenia Fellowship) who can support each other. It may be helpful to talk to others about what is happening. How to Cope - Ideas for Carers - First and foremost, take care of yourself. Develop your own interests. Maintain good social support for yourself; it help to have people that you can confide it. It also helps to look after yourself physically; exercise regularly, have a good diet and do what you can to ensure that you get good sleep. Sometimes stress can lead to anxiety and depression. If you feel this way, see your GP and look at the option of counselling for yourself.
- Learn about the illness; it can help to understand why the person is acting the way they are and to know what to expect. Pamphlets are available from the Bipolar/Manic Depression Society and there may be book on bipolar disorder in your local library (there are some suggestions at the end of this page).
- Know your limits. Sometimes people with bipolar disorder can be verbally and/or physically abusive. Sometimes they choose not to, or cannot, take responsibility for their illness. They may not be taking their medication and doing all they can to self-manage the illness. They may even deny that they have an illness. If this is the case you may want to think about the various options available to you, perhaps discussing these with a counsellor and/or a lawyer.
You are entitled to keep yourself safe Some people have experienced abuse or violence from the person who is unwell. The person may also be destructive of your property. Under these circumstances you should think about using the Mental Health Act. When people are in a manic state they sometimes recklessly spend large amounts of money, so:
Avoid joint accounts when only one signature is required for withdrawal of funds
Make sure you have money in your own control.
Before you lend the money, or pay debts a person may have incurred, seek legal advice.
Have your property in joint names (house and care). Some people drive dangerously when manic. If you believe that this may happen you may be able to immobilise the vehicle or remove the keys, or you could warn the police to look out for her/him. You can take action to prevent a person from entering your property without your permission. Contact the Family Court or a lawyer about what you can do. Telling the person of your plans may make clearer the effect her/his behaviour is having. Where to go for help: Community Law Centre for legal advice
General Practitioner
Psychiatric unit or health professional previously used
Psychiatric emergency or general hospital emergency service
The Duly Authorised Officer (see Mental Health services) for advice about the Mental Health Act
The Police if the person is violent or seriously unwell and unwilling to get treatment. Suggested Reading ARTICLES: " Bipolar Disorder/Manic Depression - A Guide " - a comprehensive booklet available from the Bipolar/Manic Depression Society (send a stamped addressed pamphlet sized envelope please). BOOKS:
"Bipolar Disorder - A guide for patients and families", Francis Mondimore "When Someone You Love Has a Mental Illness - A handbook for family, friends and caregivers", Rebecca Wollis "Living with Mental Illness", Liz Kuiper and Paul Bebbington "We Heard The Angels of Madness - a family guide to coping with manic depression", Diane and Lisa Borger (This book was written by the family of someone with bipolar disorder). Your library may have other books. Compiled by Craig Thompson and members of the Bipolar/Manic Depression Society Inc.
P O Box 25-068
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