As a result of these dramatic mood shifts, people with bipolar disorder are at much greater risk for suicide, attempted suicide, incarceration, and violent acts than their peers. “If they become a danger to themselves or someone else, ideally they would be admitted to a hospital as an inpatient," says Matthew Macaluso, DO, a psychiatrist and medical director of the Via Christi Psychiatric Clinic in Wichita, Kan., and an assistant professor of psychiatry and behavioral science at the University of Kansas medical school. “They would be observed, diagnosed, and treated, all to help stabilize their symptoms.” This could take a week or last for months, depending on the individual, he says. Even if you know or believe that someone with bipolar disorder has medications that they’re supposed to take to control symptoms, remember that many people with this condition stop taking their medications without telling anyone. Also, medications occasionally stop working to control their symptoms. Effective treatments do exist, which is why it’s important to seek help from a medical professional when depression or mania appear. Some of the warning signs that a person with bipolar disorder needs to be hospitalized are:
Actions or statements that show he is thinking of or planning suicideSymptoms of psychosis, including:Paranoia — feelings of persecution or over importanceDelusions — a false belief that persists despite evidence to the contraryIncomprehensible speechDisconnected or irrational thoughtsHallucinations — an abnormal perception of one of the senses, like seeing or hearing things or people that aren’t really thereThreats or other indications that he or she may be a danger to other peopleExtreme risk-taking behaviorDepression that prevents him or her from functioning (social withdrawal, sleeping too much, avoiding work, not caring for oneself or family)Needing treatments that require supervisionSymptoms that continue to be problematic after trying the prescribed medications
If you are a family member or a loved one trying to decide whether it’s time for someone with bipolar disorder to seek inpatient care at a hospital, you already know some of the obstacles you face. People with bipolar disorder are usually in denial about the need for treatment, and you probably won’t be able to persuade your loved one to voluntarily admit him or herself. Even after years of an established pattern, many people with bipolar disorder don’t respond to early signs of mood shifts by seeking treatment. That means both the decision and the steps to implement it usually fall in the hands of others. If you want your loved one admitted to inpatient care, but he or she won’t go voluntarily, you could call his or her doctor and inquire about getting a commitment order. “Also, if you see the person with bipolar disorder is breaking down or deteriorating mentally, you could call 911,” Dr. Macaluso says. Each state allows involuntary commitment, but the laws differ from state to state. It’s a good idea to be familiar with the laws in your state ahead of time. Here are some common concerns to consider while seeking inpatient treatment for bipolar disorder:
Privacy. A health professional will not discuss with you what has happened between health care providers and your loved one (unless your loved one has signed papers allowing his or her health care providers to talk to you). However, if you contact your loved one’s doctor with concerns that his moods or behaviors are becoming unstable and hospitalization may be required, he or she can work on an involuntary commitment if needed.Length of stay. There are many options for inpatient care, ranging from a few days to a longer period of time if needed. Your loved one’s health care team will make recommendations based on how severe his or her bipolar symptoms are. Insurance coverage may also affect how much inpatient treatment your loved one qualifies for.Safety. If you can’t get your loved one into treatment and you’re concerned for own your safety, leave the situation, even if it means leaving your own home. On the other hand, if you’re concerned about your loved one’s safety as a suicide risk, you may need to stay with him or her while you wait for help, and remove any weapons or other tools of suicide.Overdose. Many people with bipolar disorder self-medicate with drugs or alcohol, which can lead to overdose. If such a situation arises, take your loved one to the emergency room immediately. After the overdose is managed, the doctor in the emergency room can help make the decision about inpatient treatment for your loved one.Future plans. Although it may be hard to talk to your loved one about hospitalization when he or she is in crisis, once he or she is improving you can talk about medical directives or powers of attorney. These steps would give your loved one the ability to make his or her wishes clear in advance of future hospitalization. Carefully following an outpatient treatment plan is one of the best ways to reduce the need for hospitalization, Macaluso says.
The decision to hospitalize someone with bipolar disorder isn’t easy, but you don’t have to do it alone. Ask for help and recommendations from medical professionals, friends, and family.
