For many people with bipolar disorder, the inconvenience of needing to take medications, stay in touch with a doctor and therapist, and perhaps experience some side effects from the medications from time to time is by far outweighed by the good that comes from living a fully functional life with bipolar disorder well controlled. Being proactive and responsible about maintaining your participation in treatment can help prevent crises from occurring. But what happens if they do?
First of all, it is important to intervene as early as possible before too much damage has occurred. This may not always be possible, as crises do occur without any warning at times. Sometimes, though, there are warning signals or what doctors call “prodromal signs” that indicate that a crisis is brewing. While these may be different for each person with bipolar disorder, certain potential danger signs to watch for would include a sudden change in sleep, eating habits or appetite, and/or obvious changes in mood (e.g. a sudden increase in irritability).
Things You Can Do to Minimize Stress
When you first discover that your loved one has bipolar disorder, make a crisis file folder or notebook with important names, phone numbers and contact information in it. Pre-crisis, have your loved one or friend sign consent forms so that in the event of a crisis, someone will be able to communicate with that person’s doctor and/or therapist. Sometimes people with bipolar disorder present themselves inaccurately while at the doctor’s, under-reporting their symptoms or, if they become paranoid when in crisis, intentionally hiding symptoms from their caregivers. Having someone who knows what’s happening on a daily basis able to provide unbiased reports to the doctor can be key when a crisis is brewing. Also, while things are calm and your friend is functioning well, research mobile crisis teams in your area, so that you are aware of the available resources should you need them.
Not every county has a mobile mental health crisis team, but where they exist they can be life saving. Also suicide prevention hotlines may be helpful in providing information or helping your loved one access emergency help when they need it. Find out what is available in your locality, and if your friend is open to discussing it, ask them how they’d like you to intervene. They may be most comfortable with using the hospital or using the mobile crisis unit, and they might be negatively triggered by the police. The time to find out is not during the heat of the moment.
What To Do During a Crisis
If you suspect your loved one is currently in crisis, step one is also to ensure safety. If your loved one is talking about self-harm or suicide it is time to involve professionals. You can call 911, or if you feel that you can transport your loved one to a hospital’s emergency room safely (with another adult present to sit with your loved one in the back seat) do so. If you feel that this isn’t safe, do not attempt to move your loved one. Call for professional assistance. Use 911, police or ambulance professionals, as they are trained to manage crises of all kinds. Don’t leave your loved one alone, but don’t “breathe down their neck” either.
If your friend is able and willing to talk with you, stay calm and talk with them about what’s happening. Be supportive, and be positive. Don’t argue with them, even if they are irrational or argumentative. Stay calm, and keep repeating something to yourself that helps you stay focused and anchored in reality, as your loved one might try to convince you that what they are experiencing (be it hallucinations, delusions, or paranoid thinking) is real. Don’t give orders or make accusations (for example, don’t tell them that they are acting crazy, and don’t tell them to “just stop it”), and if you feel that the conversation is making either one of you more stressed and upset, then stop the discussion.
If the crisis has not reached the hospital level of danger, but you feel that things are deteriorating, your loved one might be given an appointment with his or her doctor for sometime in the future. If your loved one needs to wait several days for an appointment, you might be called upon to help them stay safe and pass the time while waiting. Help distract your friend with structured things to do, and give choices or options in clear and simple terms, such as “would you prefer to stay home and watch TV or would you like to go to the movies?” Have things to do in the house kept in reserve for times like these: jigsaw puzzles, Sudoku, books to read, crossword puzzles, knitting or other needlework, etc. Have a stash of activities available so that if your loved one is in a manic phase and sleeping very little, they can do things to pass the time.
Crises are often precipitated by changes in medications or forgetting or refusing to take medications. Help your loved one connect with and confide in a therapist about any desire to stop taking medications. Managing bipolar disorder without the use of medication may be possible, but it will require a real team approach. Letting your loved one know that you are on their team will be a key intervention: before, during, and after a crisis.