Supporting someone with bipolar disorder

What is bipolar disorder?

Bipolar disorder is a mental illness that chronically affects moods. The word bipolar refers to two different and contrasting “poles” of mood. People with bipolar disorder have episodes of where they feel very energetic and even euphoric (mania), and episodes of depression. Sometimes mixed episodes occur, where a person has the moods associated with depression, but the energy associated with mania. These moods can be difficult to regulate without treatment.

Mania is sometimes mistaken for psychosis, because it results in severe disturbances to feelings, thinking and behaviours, and can change the way a person perceives the world around them. In the past, bipolar disorder has been confused for other mental illnesses, such as a form of depression or schizophrenia. While these illnesses can share some traits, they are not the same. However, manic episodes can have features of psychosis, where the person experiences delusions or hallucinations.

People who experience bipolar disorder may have varying degrees and frequency of mood changes. Untreated episodes of depression can last for months or longer, and untreated episodes of mania usually last from days to weeks. For some people (particularly young people) moods may cycle more quickly, from hours to days at a time.

Without treatment and support, bipolar disorder could impact on daily life, such as employment, relationships, social interactions and day-to-day living. Bipolar disorder can pose a threat to long-term wellbeing and there are increased risks of harm and suicide. However, with the appropriate supports and treatments, a person with bipolar disorder can live a full and productive life. Clinical diagnosis and ongoing care are important, as are the support of family and community networks. As a First Aider, you can help play a positive role.

What are some of the signs and symptoms?

A person who is experiencing bipolar disorder may have significant and noticeable changes in mood. You may notice these over either a short or longer time frame. For some people, these mood changes might appear subtle, while for others they might be more obvious.

Signs include:

• Intensity of expressions– expressions verbally and through body language in a way that seems ‘over the top’, at the extreme end of high or low, or outside of normal range.
• Changes in activity, behaviours and interests– significant increases or decreases in normal activities and actions – the person seems to have two modes of operation. A person with bipolar disorder may act very impulsively during episodes of mania, engaging in behaviour they otherwise would not.
• Changes in self-care– extremes in ability to take care of daily physical and living needs, such as eating, sleeping, time management, money management, use of alcohol and other drugs.
• Unusual interests or thoughts – expressions, interests or ideas that seem strange, obsessive or unhealthy, which can include persistent thoughts, paranoid thoughts, focus on symbolism or implied meanings, over-energised plans or motivations, and thoughts of risk taking, self-injury or suicide.

Common symptoms of depression

• Changes in sleep patterns – insomnia or excessive sleeping
• Fatigue and exhaustion
• Sadness, sorrow or feeling particularly down
• Withdrawal, disinterest in life and avoidance of others
• Changes in appetite and eating patterns
• Lack of motivation
• Negative thoughts, worries and anxieties
• Feelings of worthlessness or negative self-talk
• Reduced sex drive
• Loss of interest in leisure activities, hobbies and social interactions
• Crying a lot or suddenly
• Talking about or indulging in sad or morbid ideas and content
• Suicidal thoughts or behaviours

How can I help someone with bipolar disorder?

Many people have heard of bipolar disorder but do not really understand what it is or how it affects people. Despite the efforts to raise awareness and improve the quality of life for people with mental illness, there remains a significant stigma around certain conditions. Bipolar disorder is one of the conditions often misunderstood. This can be very damaging to the people who experience it, and prevent them from getting the support they need, or from reaching their full potential in life.

Some people diagnosed with bipolar disorder will feel that they have to hide their condition from others. Particularly if they feel it will impact things such as job prospects. They may experience concern or shame around the way their moods cause them to think, talk and behave. By being open and empathetic you can demonstrate your support for someone with bipolar disorder. Being inclusive of people with mental illness such as bipolar disorder in the workplace, home or social situations, can help them get on with life as they manage their illness.

Reduce stigma

Talk openly and accurately about mental illness and bipolar disorder. This normalises conversations about mental health and help seeking through positive, encouraging words. Avoid labels or negative words e.g. ‘nuts’, ‘psycho’, ‘crazy’. Remain open to learning about how the person would like you to refer to their mental illness and use the same words they use where appropriate. Politely challenge the negative thinking of others who might speak badly of someone who has bipolar disorder or use incorrect language.

Convey empathy and show support:

Show the person that you are trying to understand their mental illness and that you are an approachable ally.  Use non-judgemental, active listening when the person is talking to you about their problems, or when they are exhibiting symptoms. Simple, supportive comments such as ‘that sounds very difficult’, ‘I hear you’, and ‘it sounds like you are having a hard time,’ can help in challenging situations. Be a calming presence at times when the person seems manic or agitated and a supportive presence when they are down. Let the person know if you are happy to continue to be a contact when they are struggling. 

Respect boundaries:

Understand that a person with mental illness still has a right to autonomy, self-respect and privacy. Avoid prying for information that the person is not comfortable sharing or getting into personal space. Do not share details about the person’s mental illness with others unless it is in the act of getting yourself or them support. 

Watch out for immediate risk:

A person with bipolar disorder will likely be coping long-term with highs and lows. This alone is not cause for immediate action from you. If however the person is speaking of harming themselves or at risk of suicide, you can take steps to connect them with care. You might notice behaviour that is increasingly erratic or worrying, or they may be actively talking about risk taking, self-harm, death or suicide. Find out more information on recognising and responding to the warning signs for suicide here.

Know when to get help:

If the person is particularly agitated, disoriented, violent or showing signs of being at risk to themselves or others, then it may be appropriate to act:

• Keep yourself safe
• In the workplace, consider contacting your EAP or escalating through workplace health and safety channels
• Encourage the person to speak to their doctor, therapist or counsellor as soon as possible
• If the person is at risk of suicide – call (or encourage the person to call) Lifeline on 13 11 14 or Suicide Call Back Service on 1300 659 467
• If life is in immediate danger call 000.

What steps can be taken to connect people with care?

Bipolar disorder can be a persistent and chronic mental illness and will usually require clinical diagnosis and care. Most commonly a person experiencing this disorder will receive a mix of treatments that include medication prescribed by a physician or psychiatrist, and psychological therapies such as counselling. People with this mental illness also greatly benefit from a supportive network of family and friends, who should receive education about the illness. Workplaces can support staff with bipolar disorder by providing an inclusive and supportive work environment, having support strategies in place, and through staff education and training. 

People who are able to manage their bipolar disorder can generally lead full lives with participation in family life, work, education and social activities. They are valued members of the community and should not be overlooked for their contribution and strengths.  

Understanding how to talk about mental health is an important skill. Many people feel uncomfortable and unprepared and this can mean the conversation never starts at all. Mental Health First Aid courses teach you how to recognise the signs and symptoms of mental health problems or a crisis such as thoughts of suicide. You’ll gain the confidence to give the most effective support you can and when and how to access professional help.

A conversation could change a life and learning the right skills can make the difference.

Click below to learn more about our full range of courses.