The Black Hole of Bipolar Treatment


A family member has been battling bipolar disease since 1998. Other mental afflictions such as Alzheimer, dementia and depression are also serious, debilitating diseases which affect, and can destroy, many lives. However, my family has found that no other diagnosis is so quickly shunned by portions of the mental health system than bipolar. The system plunges this disease’s victims, and their families, into a dark rabbit hole of frustration.

The outlandish array of obstacles and hurdles facing those afflicted, and those attempting to help, are beyond confounding. The myriad regulations, combined with the very limited living facilities which accept bipolar residents, creates a daunting challenge making long term recovery an elusive goal.

My relative has now had five severe bipolar manic episodes requiring hospitalization in the past seventeen years. When the disease is under control this person is an outgoing, compassionate being. Unfortunately these events are occurring at a more rapid pace perhaps heading towards what is known as rapid cycling bipolar.

When hospitalized my relative is given the usual cocktail of lithium and Seroquel doses until the doctors feel stabilization has been achieved. Additionally some counseling and physical rehabilitation is included. When it is determined by the hospital staff that the patient should be released, often well before the family feels it is time, the real struggle begins.

Many times returning to the patient’s home is not the best step because bipolar victims are not good administrators of their medication and tend to rebuff family members attempts to help. Often, assisted living placement, where medication is professionally monitored, would seem the best option. However, in a Catch-22 that only Captain Yossarian could appreciate, a vast majority of assisted living facilities do not accept recovering bipolar residents. They make special accommodations for dementia, depression, Alzheimer…etc., but when you mention bipolar to admissions folks you literally see their faces become stern as they inform you that your relative is not welcome in their facility. I fully understand the concerns for other residents’ piece of mind and safety, but the vast majority of these homes just saying “No.” is avoidance not a solution.

In my family’s five experiences with the mental health system we have met many caring, dedicated professionals; psychiatrists, nurses and social workers, who do their absolute best in a system which hamstrings honest efforts.

I understand the need for patient’s privacy and rights. I agree with many aspects of the HIPAA code, but when the only criteria for keeping a patient in a psychiatric unit is that they represent a “clear and immediate danger to themselves or others” patients are released far too soon for recovery to be effective. Combine these early releases with the lack of assisted living options and it is no wonder that bipolar recidivism is at an astoundingly high rate.

While there is no one panacea, some steps seem obvious.

First, the National Institute of Mental Health should consider addressing more broadly based parameters for keeping patients on a longer more comprehensive care path. No one wants to return to the horrible practice of families dumping “difficult” relatives into institutions as was the case up to the mid 20th century, but the pendulum of patients’ rights has swung too far to the detriment of those afflicted with acute problems.

Second, there are 5.7 million adults in the United States who suffer from bipolar disorder. Savvy health entrepeuners should create assisted living facilities which cater to only bipolar residents. These homes would be staffed by professionals who specialize in bipolar treatment. Families all across the country are desperate to find such accommodations.

I write this as my family member is close to being released from the hospital. Because of all I have described above, four previous attempts to stay stable have followed the same pattern leading back to another manic episode. We are in the throes of a two pronged dilemma; first convincing our relative that assisted living is their best hope for the longest duration of stability, and second, finding an appealing, competent facility undaunted by the challenges posed by bipolar disease.

I’ve heard the layperson’s simplistic definition of insanity being doing the same thing exactly the same way over and over again and expecting different results.
Using this definition the ironic conclusion is that the mental health care system is insane.

Change is imperative.

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