One of the last tasks my doctors at the psychiatric hospital made me do before releasing me to the wider world was to make an emergency health care plan for future mental health crises.
At the time, I thought this plan was stupid. I was manic and therefore invincible, and I would not be having any more mental health crises, thank you very much.
Once I came down from my high, I realized that having such a plan—with emergency numbers and the names of my doctors—in an accessible place was an excellent idea.
But how do you make a mental health crisis plan? And what is it?
What the Plan Is
A mental health crisis plan is a series of steps to take when you experience a psychiatric crisis. You write down the steps when you are well and place the completed plan in a place where you and your loved ones can reach any time you need it.
As a person with mental illness, having a crisis plan is of utmost importance. You never know when a mental health episode will strike and will knock you off your metaphorical feet.
Caregivers and crisis teams can help you best when they’ve been prepared to honor your wishes. So you need to tell them what those wishes are with a mental health crisis plan.
Making the Plan
An emergency mental health crisis plan should include:
Your contact information and directions to your home.
A description of what a crisis situation looks like for you.
Contact information for your supporters.
Phone numbers for your therapist, psychiatrist, and primary care physician, as well as any other doctors working closely with you to manage your mental health.
A phone number for the local Psychiatric Emergency Response Team (PERT). Do not hesitate to call the emergency number for your country as well.
A list of all prescribed medications and doctors who prescribed them.
A signed waiver from you giving all providers permission to speak to your supporters during the crisis, as well as giving supporters permission to speak to each other.
Anything you need to be mindful about for your health in general (e.g. allergies, dietary restrictions, etc).
Arrangements for your children should you need to be away from home.
Similarly, arrangements for your pets should you need to be away from home.
How supporters should settle disputes.
A list of all prior hospitalization dates and previous major crises.
A list of acceptable and unacceptable treatments and why (allergies, etc).
A list of acceptable and unacceptable people involved in your treatment and why.
Your signature and the signatures of two witnesses and (preferably) your attorney.
If you type a document up on a computer, you can change it whenever you like. Simply email an attached copy to your supporters. But keep a printed copy available in an accessible place in your home for your supporters as well.
If you are in a crisis, the last thing you need is to make decisions about your care. Make a mental health crisis plan today to prepare yourself and your caregivers to take care of your in a way that you find acceptable.
Self-care. It seems self-explanatory; after all, the term indicates caring for the self. But why is self-care so hard to accomplish, especially for people who suffer from bipolar disorder?
The answer is easy. When we’re manic or hypomanic, we’re usually too busy to settle down and care for ourselves. If we’re depressed, caring for ourselves is the last thing we want to do (mostly because we don’t want to do anything at all).
That must change. Caring for ourselves is putting an oxygen mask on. Self-care is crucial for our daily functioning. We must take self-care seriously to make the most of our lives. July 24th is international self-care day. Why not practice self-care?
Some people believe the self-care is limited to taking bubble baths and painting their toenails. But there are so many more ways to take care of yourself. Read on for 10 self-care ideas for people suffering from bipolar disorder.
Self-care Ideas for When You’re Manic
When you’re manic, life is go go go. In my experience, I barely slow down enough to take a breath. Here are my recommendations for self-care when you’re manic:
Pause for two minutes, and take deep breaths. I know stopping whatever you’re focused on when you’re manic is incredibly difficult and the last thing you want to do, but hear me out. Mania spends energy you don’t actually have. If you’re constantly on the go, you’re going to wear yourself out. Pausing for two minutes and taking deep breaths will help your brain reset.
Take a bath. When I’m suffering from a bipolar mood episode, my hygiene goes out the window. This is especially true during depressive episodes, but also can happen during mania. Being clean may help you feel better, and if you slow down enough to take a bath during mania, the hot water may relax you a little. Bubbles are optional.
Sleep. During manic episodes, sleep is your best friend. Aside from medication, sleep is the number one way you can reset your brain back to a non-altered state. Dim the lights, stop using screens two hours before bed, do some deep breathing exercises (see tip #1), and by all means, rest.
Limit yourself to one easy project. My mania manifests as crafting binges. I dive into embroidery or painting projects, and neglect everything around me and even myself until I produce something. I’m always rushing, so these projects never turn out well. I also bounce between projects. I highly recommend sticking to one easy project, so you’re not leaving half-finished projects lying around.
Exercise. Since you have plenty of energy to burn during mania, burn it. Put on a workout video. Run some laps. Climb your stairs up and down. Anything to get your heart rate up and tire you out.
Self-care Ideas for When You’re Depressed
Depression is a beast. You feel awful and don’t have the energy to do anything. So what can you do? Here are some self-care ideas for when you’re depressed:
Go outside. Rising from your bed is the last thing you want to do. Trust me, I’ve been there. But staying in bed all day doesn’t help. In fact, that can worsen or prolong feelings of intense sadness. If you go outside and breathe some fresh air, then your mood may lift even if only slightly.
Clean the closest surface to you, like a nightstand. Clutter deepens and prolongs feelings of depression. If you can clean the closest surface to your bed, like a nightstand, then you’ll have both a feeling of accomplishment and a clear surface to look at.
Drink water. Hydration is so important to a healthy body and mind. You’re not at your best when you’re dehydrated. Focus on drinking a gallon of water over the course of a day. Even if you do nothing else but drink, you’ll win the day.
Socialize with an actual person. Call a supportive friend. Check in with your family. Go out to the store and say hello to the cashier. When we’re depressed, we often isolate ourselves, which makes depression worse. Don’t do that.
Say “no” to some things. Feeling overwhelmed is common when suffering from depression. If you can, say no to some things filling your schedule. Freeing up enough space to let yourself heal is one of the best things you can do for depression.
Self-care for people who suffer from bipolar disorder doesn’t have to be difficult. Keep in mind your various struggles when you’re depressed and manic, and tailor your self-care to those episodes. Showers, sleep, and indulging in things that make you happy are crucial to your well-being.
A lot of the gifts on this list overlap with that one, but feel free to check the depression post out for even more ideas!
I’d like to preface this gift guide by saying that whomever you’re giving gifts to, keep in mind whether the recipient will actually be able to use the gift. People who suffer from depression are easily overwhelmed. You want to offer them a present which won’t overwhelm them, and you definitely don’t want to have expectations that they will use the gift.
Presents don’t have to be expensive, but if they’re thoughtful, your loved one will appreciate them. If you can, do some research to figure out what your loved one likes and is into. Look into their social media posts and find out what he or she is posting about. That can give you a clue as to what your friend or loved one enjoys.
If you are a frugal person buying for a frugal person, the best gifts you can give are practical ones. Most frugal people are content with what they have, and don’t want to fill their houses with stuff they won’t use. So the best gifts you can give, aside from time, are consumables, like food, journals, or gift certificates to places they like.
With that in mind, here are 10 frugal gifts for people who suffer from anxiety:
1. Weighted Blanket
Imagine a situation where you’re antsy and distracted. Then imagine a full-body embrace. Imagine deep pressure enfolding your arms, your legs, your chest. Now imagine a calm passing over your frantic mind.
This is the soothing feeling of a weighted blanket.
Weighted blankets have been used by occupational therapists the world over to help calm their patients, both children and adults alike. Glass beads are partitioned out in pockets and sewn together in sections.
When picking out a weighted blanket, there are two rules of thumb to follow: the chin-to-feet rule, where you use a blanket that covers your whole body, and the 10% rule, where you use a blanket that is 10% of your body weight.
Keep these rules in mind when picking out a weighted blanket for your loved one, and you’ll be golden.
2. Essential Oil Diffuser
Aromatherapy has long been a practice to soothe people. Scents like lavender and pine have calming effects on the mind.
This is due to the fact that lavender has been linked to the same neuron receptors as powerful anti-anxiety medications. Calming scents, and lavender in particular, trigger your brain to produce more feel-good chemicals.
So why not get your loved one an essential oil diffuser? They’ll love it.
3. Worry Rings
A “worry item” is something you can hold in your hands to fidget with. Fidgeting is a natural habit that helps ground people who suffer from anxiety, so a worry item can be very useful.
A worry ring or spinner ring helps take your loved one’s mind off whatever’s distressing them. They will wear their ring and think of you every time they fidget.
4. Mini Zen Garden
Raking sand and setting up stones doesn’t sound like it will relieve anxiety.
But a miniature zen garden is perfect for creating a small environment where your loved one will have complete control over the patterns of the sand. A zen garden can be a very soothing activity for your friend or loved one.
Everyone needs someone to talk to.
Depending on how your loved one feels about therapy, signing them up with a few virtual sessions with a licensed therapist may be a wonderful gift. Your giftee may benefit immensely from only a few sessions and be encouraged to continue.
But take care when giving this gift.
You must know your recipient well and be able to preempt their reaction. And don’t let the sessions be a surprise. Talk with the person before giving them therapy as a gift, so they know what your intentions are.
If you give therapy to the right person, a few sessions could really help them!
For a post on how to start seeing a therapist, click here.
6. Adult Coloring Book
Coloring isn’t just for kids anymore.
This soothing activity is now for adults in the form of adult coloring books, which show complex patterns of animals, words, and mandalas, among other pictures.
Give your loved one a box of crayons and an adult coloring book, and watch their face light up.
Journaling has been proven to reduce symptoms of stress and anxiety.
Give your loved one the gift of a journal this holiday season. A nice Moleskin is a bit on the pricey side, but Moleskin makes excellent notebooks with leather-bound covers.
If you want to make the journal very special to your recipient, purchase it ahead of the gifting and write a positive affirmation or quote on the bottom of each page.
8. Yoga Mat
Downward facing dog. Mountain pose. Warrior I.
These are all yoga poses, from a practice which has been proven to help with stress and anxiety.
Why not give your loved one a yoga mat, so they can enjoy a few virtual sessions of yoga? If you want to go all out, spring for a work out DVD or some sessions with a professional yogi.
Like therapy, only give yoga sessions/mats if you know your recipient well and expect that they would enjoy working out.
9. Bath Salts
One of the best birthday gifts I ever received was a gift basket from my sister containing lotions, soaps, and a set of organic, deliciously-scented bath salts.
The salts were an especially soothing gift for me, as I was able to soak my troubles away in a tub that left my skin soft and my mind calmed with the scents.
Give your loved one the gift of scented bath salts this holiday season. Everyone needs to be clean.
10. Mug of Hot Chocolate to Share
And finally, the last gift on this list but certainly not the least, is a mug of hot chocolate to share.
There are some pretty cute mugs out there, some of which are funny and others of which can be sweet. Purchase a mug and some instant, powdered hot chocolate–or DIY some of your own with a recipe you can find online.
And then offer to share some hot chocolate with your loved one. What your loved one needs most is the gift of your time.
Even during a global pandemic, you can still set aside some time to virtually share a cup of hot cocoa with your loved one, right? You may have to schedule the visit and you can’t exactly hug each other, but your loved one will appreciate seeing your smiling face and catching up with you.
Shopping for gifts for a person who suffers from anxiety isn’t difficult.
You simply have to think about what you think would soothe your friend or loved one the most. Be it a yoga or therapy session, a long soak in the tub, or time spent sharing a mug of hot chocolate, do some thinking about what gift your loved one will enjoy.
Trigger Warning: This post discusses hotlines that apply to people contemplating suicide, as well as domestic and sexual violence.
According to Our World in Data, up to 10.7% of the world suffers from some sort of mental health condition. These conditions include schizophrenia, bipolar disorder, substance abuse, major depressive disorder, generalized anxiety, eating disorders, and a whole host of other issues. That’s over 792 million people. For bipolar disorder specifically, the global incidence rate is 0.6%, or 46 million people.
Needless to say, a lot of people need help. And sometimes, people end up in a mental health crisis, which is any situation where a person’s mood and behaviors impair functioning to the point where he or she can no longer care for himself or herself or perform his or her role in the community at large. This crisis can lead them to hurt himself or herself or others, so it needs to be addressed.
If you or a loved one are in a metal health crisis and need to talk to someone immediately, pick up the phone. You can call a crisis hotline and talk to a line operator who will be able to connect you with resources to tackle your current challenge. Hotlines are available to you whether you have insurance or not, and they are private. Some crisis lines won’t even appear on a phone bill, ensuring the confidentiality of the caller. Thoroughly-trained hotline operators will be able connect you with treatment providers in your area.
What Should I Ask the Hotline Operator?
Calling a mental health hotline doesn’t have to be intimidating. Hotline operators have a wealth of information to answer your questions about your issues Consider asking some of these questions:
How do I get diagnosed? (For a post covering this topic from the Bipolar Parent, click here.)
Are there special techniques will work better for me, based on my diagnosis?
What happens if I have more than one condition?
How are metal health conditions treated?
What treatments are available in my area?
How do I know which type of doctor to see? (For a post covering this topic from the Bipolar Parent, click here.)
If you need a warmline, which is a line run by volunteer peers who will listen to you vent your troubles confidentially before you hit a crisis, please see this post on the Bipolar Parent.
In any crisis, if you are in immediate danger, call your country’s emergency line. Make sure to let the operator know that you are in a psychiatric crisis and ask for officers trained in crisis intervention.
If you are looking for support, resources, and knowledge from an highly-trained hotline operator, call one of these international crisis hotlines. If you find this list unmanageable, search for your country in the following ways:
On a desktop, hold down the ‘Ctrl’ + ‘F’ keys. This will bring up a search bar that you can look for anything.
On Safari for mobile devices, tap share icon (bottom), scroll down, select “Find on page.”
On Chrome for mobile devices, tap three dots (bottom right), scroll down, select “Find in page.
International Mental Health Crisis Hotlines Resource List
Trust Social Work and Sociological Research Centre: (2) 538194 and (2) 538197. Trust Social Work and Sociological Research Centre provides 24-hour face-to-face, phone, and letter support for people in Armenia who are lonely, in distress, in despair or having suicidal thoughts.
Domestic and Sexual Violence:
National Hotline on Domestic Violence: +374 105 428 280800 80 850
Psychotherapy Helpline of the Professional Association for Psychotherapy: +43 720 12 00 12. Daily from 08.00-22.00. Psychotherapeutic crisis therapy offered by psychotherapists. Competent, free, and anonymous.
0800 222 555 from 0.00 – 24.00. Advice for women who are victims of violence.
Coronavirus hotline of the AGES (Austrian Agency for Health and Food Safety): 0800 555 621. The AGES answers questions on the topic of coronavirus (general information about how it is passed on, symptoms and prevention) from 07.00 to 20.00, seven days a week on 0800 555 621.
Health advice hotline: 1450. If you have genuine symptoms (a high temperature, a cough, shortness of breath), stay at home and please call the health hotline on 1450 to receive information on the next steps (diagnosis). 0:00 – 24:00.
Open Counseling has a comprehensive list of hotlines that apply to Australia. Here are a few:
Emergency line: 000
Lifeline: 13 11 141. Lifeline is a 24-hour nationwide service that provides crisis support.
Beyond Blue: 1 (300) 22 3646. Beyond Blue provides nationwide information and support regarding anxiety, depression, and suicide.
The Samaritans: 1 (800) 198 313. Samaritans is a not for profit organization working on reducing the suicide rate and promoting the importance of mental health. They are one of the only 24/7 anonymous crisis support services in Australia.
Alcohol and Drug Abuse:
Alcohol and Drug Foundation: 1 (300) 858 584. Celebrating more than 55 years of service to the community, the Alcohol and Drug Foundation (ADF) is Australia’s leading organization committed to preventing alcohol and other drug harms. They were established in 1959 to support the many post-war veterans who were suffering from alcohol dependence as a release from the trauma of war.
Drug and Alcohol Helpline: 1 (300) 887 000. Support and referral services for people with drug and/or alcohol problems.
Domestic and Sexual Violence:
Bravehearts: 1 (800) 272 831. Bravehearts sets the standard in the provision of specialist therapeutic services and support to children and young people, adults and non-offending family members impacted by child sexual assault.
1 800 RESPPECT: 1 (800) 614 434. National sexual assault, domestic family violence counselling services 24-hour online support for workers and professionals.
Youth, Pregnancy, and Parenting:
Kids Helpline: 1 (800) 551 800. A 24-hour nationwide service that provides access to crisis support, suicide prevention and counselling services for Australians aged 5–25.
Perinatal Anxiety and Depression Australia (PANDA): 1 (300) 726 306. The PANDA telephone hotline provides support and counselling to new parents who may be experiencing anti-natal or postnatal depression. Concerned partners, family, friends and health professionals are also able to call PANDA and seek their support.
Children and Youth Health: 1 (300) 364 100. The Child and Youth Health organization provides user-friendly information about many aspects of health for all those involved, including parents and caregivers.
1800 020 080 if you suspect you may have contracted COVID-19.
1800 022 222 for more general advice relating to your symptoms.
Bahamas Crisis Centre: (242) 328-0922. The Bahamas Crisis Centre offers 24/7 free counselling and services for men, women and children in the Bahamas who are experiencing any form of abuse; family, relationship or behavioral problem.
Kaan Pete Roi is an emotional support helpline in Bangladesh whose mission is to alleviate feelings of despair, isolation, distress, and suicidal feelings among members of the community, through confidential listening. The helpline is intended for suicide prevention and the promotion of mental health. You can call Friday- Wednesday from 3 a.m. to 9 p.m. and from Thursday noon to three o’clock.
1712 (Flemish). Hotline for all types of violence, domestic (any member of the family) sexual violence, honor-related violence and more, child abuse, elder abuse.
Belgium Community Help Service: 32 (0) 2 648 40 14. Belgium Community Help Service is an anonymous, confidential, 24/7 telephone service in English for children, adolescents and adults, providing information, support, and help in a crisis.
Tele Onthaal: 106. Tele Onthaal is a 24-hour support line in Belgium for people who are experiencing emotional problems of any kind.
Open Counseling has a comprehensive list of hotlines in Brazil. Here are a few of them:
AMA National Association: 90035191Hospital de Pronto Socorro Largo Teodor Herzl S/NO Primero Andar
Centro de Valorização da Vida: 188. Centro de Valorização da Vida provides voluntary and free service of emotional support and suicide prevention for all people in Uruguay who want and need to talk.
The CVV – Life Valuation Center: 55 11 31514109. The CVV – Life Valuation Center provides 24-hour emotional support and suicide prevention, voluntarily serving all people in Brazil who want and need to talk.
Bulgarian National Helpline for Children: 116 111. Bulgarian National Helpline for Children offers 24-hour services for children in Bulgaria who need someone to talk to or be with them at a difficult time.
Domestic and Sexual Violence:
Women’s Helpline: +359 2 981 76 86
Open Counseling has a comprehensive list of hotline numbers in Canada. Here are a few of them:
First Nations and Inuit Hope for Wellness:1 (855) 242 3310. 24/7 Help Line for those who are thinking about committing suicide.
Youth and Parenting:
Kids Help Phone: 1 (800) 668 6868. Kids Help Phone is Canada’s only national 24-hour, bilingual and anonymous phone counselling, web counselling and referral service for children and youth. Completely anonymous and confidential.
Parentline: (778) 782 3548. The Parent Helpline is a free telephone service to parents and others experiencing family life or parenting challenges. This nonjudgmental service provides a listening ear, support and guidance to parents and caregivers who are upset or troubled about a family issue, have parenting-related questions or just need someone to speak to.
Beijing Suicide Research and Prevention Center: 0800 810 1117 or 010 8295 1332. Beijing Suicide Research and Prevention Center provides 24-hour service for individuals in Beijing who are depressed or suicidal.
Mental Health Center of School of Medicine of Zhejiang University: 0571-85029595. Mental Health Center of School of Medicine of Zhejiang University offers a 24-hour psychological assistance to people in Hangzhou.
Guangzhou Crisis Research and Intervention Center: 020-81899120 or 020-12320-5. Guangzhou Crisis Research and Intervention Center is available 24/7 for those who need help.
Shenzhen Mental Health Center: 0755-25629459. Shenzhen Mental Health Center offers free professional counseling available 24/7.
Plavi Telefon: (01) 4833-888. Plavi Telefon- Blue Phone provides support to people in Croatia for issues such as depression, alcoholism, drug abuse and suicide that traditional centers might not accomplish. 24/7 national hotline.
Domestic and Sexual Violence:
Women’s Help Now – SOS Line for Women and Children Victims of Violence:
S.O.S. Amitié: 09 72 39 40 50. SOS Amitié offers 24/7 service in France for anyone who needs to speak anonymously and confidentially. They have 1,700 trained listening volunteers that can listen to your malaise.
Lesbenberatung: 030 – 215 20 00. The “Lesbenberatung” center offers counselling to lesbian and bi-sexual women of all ages, transgender people and all women in crisis or conflict situations irrespective of age, nationality or cultural background.
Site Niebuhrstraße: 49 (030) 233 690 70. Schwulenberatung Berlin Niebuhrstraße 59/60 10629 Berlin. Open: Monday through Friday from 9:00am to 08:00pm.
The Governing Mayor of Berlin – Senate Chancellery: 030 / 90 28 28 28
Ministry of Social Protection’s Sexual Offenses and Domestic Violence Policy Unit: 640-1011
Ministry of Public Health:
de Luisterlijn: 09000767. de Luisterlijn offers 24-hour telephone emergency service throughout the Netherlands. When you are in pain or worry about something, they can provide a listening ear, and you can easily tell your story anonymously.
113 Zelfmoordpreventie: 0900-0113. 113 Zelfmoordpreventie offers 24-hour anonymous and confidential talk that can help you to share your thoughts if you’re in distress or having suicidal thoughts. Their crisis telephone number is accessible for people calling from within the Netherlands.
Domestic and Sexual Violence:
Velig Thuis: 0800 2000. For victims of domestic violence and child abuse.
0800 1202 (or +31 850 659 063 if you’re calling from a foreign phone) to arrange for coronavirus testing for adults and children younger than 12. For children 12-17, call the same number, but they will have to consent over the phone.
Suicide Prevention Services: 00852-2382 0000. Suicide Prevention Services provides beneficial friends and other suicide prevention services to people in Hong Kong who are suicidal, desperate and emotionally distressed
The Samaritans, Hong Kong: 00852 2896 0000. The Samaritans Hong Kong offers 24-hour unconditional emotional support to anyone in distress or at risk of suicide throughout Hong Kong.
Domestic and Sexual Violence:
Harmony House: 2522 0434 (24 hour hotline for women), for men, call: 2295 1386
Wai On Home for Women: 2793 0223
Serene Court: 2787 6865
Les Corner (lesbian victims of domestic violence): 5281 5201
Rainbow of Hong Kong (gay victims of domestic violence): 2769 1069
Centre for Health ProtectionHotline:
HKSAR Government COVID-19WhatsApp Helpline: 9617 1823
Alcohol, the social lubricant. Some people drink because alcohol relaxes them in social situations. The drink isn’t called “liquid courage” for nothing.
But alcohol is an addictive substance, which has great potential to be misused, especially by people who also suffer from bipolar disorder.
The Connections Between Alcohol Use and Bipolar Disorder
Studies have shown that people who abuse alcohol are more likely to have bipolar disorder. According to a 2013 review, up to 45% of people with bipolar disorder also have alcohol use disorder (AUD).
Overwhelming feelings of sadness from bipolar depression make people more likely to self-medicate with substances like alcohol. And self-medicating makes it more likely for people with bipolar disorder to not stick to their medication regime or attend therapy sessions.
Alcohol also affects people with bipolar disorder in different ways than the neurotypical population.
A 2006 study showed that people with bipolar disorder are adversely affected by even small amounts of alcohol, which may both trigger and worsen manic and depressive symptoms.
Mania is known to increase impulsiveness. Because alcohol reduces inhibitions, consuming alcohol during a manic episode may encourage risky and irrational behaviors.
Alcohol, a central nervous system depressant, also contributes to lethargy and sadness during depressive episodes. The symptoms of depression triggered by alcohol are increased when people first stop drinking, so recovering alcoholics with a history of depression may relapse in the first few weeks of dealing with withdrawal.
People who suffer from psychosis triggered by manic episodes are also adversely affected by alcohol. Consuming alcohol during psychosis contributes to both long-term and short-term complications. Alcohol also complicates the treatment of psychosis, contributing to dangerous medication interactions.
How Alcohol Affects Medications
Medications that are part of your treatment plan are strongly affected by alcohol.
Valproic acid, known commonly as Depakote, is often prescribed to treat symptoms of bipolar disorder. Similar to alcohol, Depakote is a central nervous system depressant which affects the liver. Combining alcohol and Depakote increases the chance of liver damage.
Similarly, consuming alcohol with lithium, which is frequently prescribed to treat symptoms of bipolar disorder, can contribute to liver disease. Lithium has side effects such as gastrointestinal problems, lethargy, and tremors, all of which alcohol can increase.
Antidepressants and antipsychotics may not work as well when combined with alcohol. Side effects can be increased, and you may feel more depressed and anxious.
You may decide to skip your medication in order to drink. This is a bad idea, as your symptoms of bipolar disorder may return quickly, triggering an episode. Stopping your dosages of medications without tapering off under the guidance of a professional is detrimental to your mental and physical health.
Alternatives to Alcohol
Alcohol can help you relax and socialize. Cutting down on alcohol can be difficult. It may be helpful to replace some of your drinking with relaxing habits.
Some alternatives to having a drink are:
Getting a massage
Attending a yoga or taekwondo class
Taking a warm bath
Drinking responsibly takes on a whole new level when you suffer from bipolar disorder. You not only need to be aware that drinking, especially to excess, triggers and worsens manic and depressive episodes, but also that your medication may interact poorly with the substance.
I’m not saying to cut all alcohol out of your life if you have bipolar disorder. If you are a responsible adult, there is no reason you can’t drink. But be aware of the complications alcohol brings to your life. You may find it easier to abstain.
Medication interactions are serious business. You could take two medications which counteract each other, which could make you sick enough to end up in the emergency room, or even die. October 21st is National Check Your Meds Day in the US. Making sure that you’re safely consuming the right combination of medications is important for everyone who takes them. This is true for any condition, but especially so for those who suffer from mental illnesses like bipolar disorder.
On National Check Your Meds Day, you can take your medications–including prescription drugs, supplements, and over-the-counter medicines–into a pharmacy for a review. You can then ask a pharmacist for advice on medication combinations, and adverse reactions of side effects.
How Will Checking My Meds Help Me?
The purpose of this review is to check whether your medications are interacting properly. If your psychiatrist and rheumatologist both prescribe medications for you and don’t talk to each other, then you may end up with two different drugs that don’t interact safely. In addition, prescribing drugs in the mental health field is incredibly patchwork and subjective; two psychiatrists looking at the same patient might prescribe a completely different cocktail of medications. And people on your mental health team often don’t talk to each other either, unless you insist.
A Consumer Reports study found that, in 2014 alone, nearly 1.3 million people visited an emergency room due to prescription drug interactions or overdose issues, which cost over $200 billion to the people visiting the ER. The steep cost of ER visits is in addition to any costs incurred due to missed work and health insurance changes. The price of medication interactions is substantial.
There is also a human cost. In January of 2000, the Institute of Medicine reported that up to 98,000 deaths occurred from medical errors on a yearly basis. Up to 7,000 of those deaths were due to adverse drug interactions. That doesn’t seem like much, but to put this in perspective, keep in mind that 6,000 Americans die annually from workplace injuries.
This problem is easy to mitigate. Any experienced pharmacist will be able to inform you about the side effects are of your medicines, especially if you’re taking two or more medications that might contradict each other.
History of National Check Your Meds Day
With the passage of the Durham Humphrey Bill in 1951, all drugs were classified as over-the-counter medications or prescription drugs.
After the Consumer Reports study found that so many people were ending up in the ER due to medication interactions, the study’s editors collaborated with the US Department of Health and Human Services to create a holiday where people could address this issue. Then, on October 17, 2017, National Check Your Meds Day was born.
Other Services the Pharmacist Can Offer You
Other services the pharmacist can offer when examining your medications include:
Sometimes, doctors prescribe drugs to manage your side effects when a lifestyle change will control those better or just as well. The pharmacist can suggest ways for you to talk to your doctor about reducing your reliance on prescription drugs.
Check if your dosages are potentially too high or too low. This advice will not replace a qualified doctor’s, but can give you a starting point to talk to your doctor about lowering or raising a dose, or stopping a medication.
Encourage you to talk to your doctor about refills lasting 30 to 90 days.
Getting your meds reviewed by a pharmacist on Check Your Meds Day is a good idea. If you have medications that don’t work with each other, addressing that will safeguard your physical and mental health, and save on costs. Your pharmacist can even advise you on whether you’re taking the right prescription drugs and give you ways to talk to your doctors if you want to change your meds. Your pharmacist is there to help you. Call your local pharmacy to see if the business is participating in National Check Your Meds Day, on October 21, 2019.
Child abuse comes in many forms: physical abuse, emotional abuse, medical abuse, sexual abuse, and neglect. When we’re suffering from depression and dealing with the inability to take care of ourselves, we are at risk of neglecting our children. This risk must be mitigated in order to prevent seriously harming our kids.
It’s all well and good to say so, but how does one prevent child abuse when they have depression? Here are 4 crucial tips to parenting with depression.
Tip #1: Practice Self-care
You’ve heard the analogy of the oxygen mask on the airplane. Before you tend to your children, you must put your oxygen mask on first.
Self-care is that oxygen mask.
Self-care may seem like just another item on the to-do list. But it’s actually crucial for you to function. Self-care is taking responsibility for your physical and mental well-being. If you don’t perform some self-care on a daily basis, you’ll not only neglect yourself, you may start to neglect your kids as well because you’re burnt out.
Some people think self-care is limited to bubble baths and painting your nails. That’s not true. Taking your medications and attending therapy are forms of self-care. So is getting enough sleep, target=”_blank”>eating well, and drinking enough water. Spending time outside and with other people also falls under that umbrella.
If you put your oxygen mask on and practice self-care on a daily basis, then over time you’ll be in a much better position to care for your children. Avoid burn out. Prioritize self-care.
Tip #2: Seek Professional Help for You and Your Child
When you’re a parent suffering from depression, the bond with your child may suffer. You might neglect your duties at home and spend a lot of time in bed, ignoring your babies. This is frightening and confusing to a kid, who needs you to be a consistent presence in their lives.
Before the situation gets that bad, seek professional help. Find a therapist you can trust for yourself, and talk about your feelings with him or her.
But don’t forget to find a therapist for your child as well. He or she may need help understanding why your depression affects you the way it does. Your kid needs a trusted adult to be a comforting presence. A therapist can teach your whole family coping skills.
For a post on how to start seeing a therapist, click here.
Tip #3: Communicate with Your Child
As I’ve said before, parental depression can cause unusual behaviors in you which are scary to your child. Nip that in the bud and communicate with him or her as much as possible about your depression.
Let your kid know that your mental illness, while not going away, is not his or her fault. Explain that you have a chemical imbalance in your brain, and you’re doing your best to cope with it. If you are taking medication, tell your child that you are taking steps to circumvent the depression and its effect on him or her.
Don’t be afraid to let your kid know how you’re feeling that day, be it tired, sad, or even and especially happy. Don’t make him or her responsible for your emotions, but do share them with your child.
For a post on how to communicate with your children about your mental illness, click here.
Tip #4: Forgive Yourself for Mistakes
You cannot be the super parent every day of the week when dealing with depression. Setting too high of expectations for yourself and your children can be dangerous, because if you fail, it can trigger overwhelming feelings of despair.
Recognizing that you deserve forgiveness for mistakes, especially while suffering from depression, can be one of the hardest things you’ll do. But you must forgive yourself if you mess up, because you’re setting an example to your child to forgive you and others.
Know that “good enough” parenting is really good enough. Allow your kid some leeway when it comes to screen time. Offer them a cheese and celery and tomato plate instead of a full dinner, but only occasionally, when you really can’t cook. (For a post on 22 easy meals to make while depressed, click here.) And don’t cut back on your kid’s activities; get him or her out of the house as much as possible, so he or she can be around other people.
Parenting while suffering from depression is one of the hardest things you’ll ever do. Neglecting yourself comes easily; neglecting your children is just the next logical step. Don’t get there. Practice self-care, seek professional help for you and your child, communicate with him or her, and forgive yourself for your mistakes.
These practical tips will help you foster a more positive environment for you and your kid. Eventually, if you continue taking care of yourself, your depression will lift, and you’ll be able to say that you did a good job parenting while suffering depression.
Are you feeling stress? Stress exacerbates your bipolar disorder. Learn how in this post on the Bipolar Parent!
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Stress affects everything in your body, from your shoulders to your hormones, from your immune system to your mental illnesses. Stress is a physical issue, just like bipolar disorder, as both mess with your feel-good chemicals.
There are different types of stress. There’s good stress (also called eustress), which can motivate you to make dinner on time and meet deadlines at work. Good stress is infrequent, usually not repeated, and short-lived, leaving you better off than you were before you encountered the stress.
Bad stress, on the other hand, lingers. It lasts a long time and repeats frequently, leaving you much worse off than you were before.
But stress is even worse for people who suffer from mental illnesses, like bipolar disorder. People with mental health conditions tend to be unable to handle stress as well as neurotypical people. For people with bipolar disorder, even small, inconsequential decisions can stress us out. If we feel stress during everyday decisions, then the fact that stress exacerbates bipolar disorder symptoms makes sense.
Bipolar disorder and stress, especially bad stress, are a nasty combination. Stress is a known trigger for both hypomanic and depressive episodes–and sometimes even mixed episodes.
My Experience with Stress
Different types of stresses affect me in different ways. Before a long road trip or a flight, I get riled up and anxious without fail. I definitely have racing thoughts and other symptoms of hypomania, minus the euphoria. Sleeping becomes difficult, which only exacerbates the manic feelings.
On the flip side, feeling stressed about my messy house depresses me. The link between clutter and depression is very real, as having items on the floor focuses me to make decisions about them (specifically, whether to put them away or leave them there) every time you walk past them. After a full day of making many, many decisions and (usually) not taking any action on the items, I suffer decision fatigue, which for me leads to depression.
When I’m stress-depressed, I often berate myself for my inability to pick up the house. I know rationally that my laziness isn’t really laziness, but is a problem called executive dysfunction, which stress also makes worse.
Executive dysfunction is the inability to prioritize tasks, and determine the order of actions. Stress makes prioritizing and deciding on which actions to take very difficult, which is common for those of us who suffer mental illness.
(For a post on the link between bipolar disorder and executive functioning, click here.)
When I’m stressed, my ability to handle my responsibilities falters significantly, which only leads to more stress. I am reduced to a ruminating mess, turning in circles and chasing my own tail. Bad stress makes me completely incapable of acting like a functional adult.
Take Care of Yourself: Destress
If you want to improve your bipolar disorder symptoms, you need to manage your stress levels. Being constantly stressed, especially with bad stress, will lead to a mood episode.
Sometimes you can make big changes, like getting a new job or finding a new living situation. Diet also plays a role in how well you’re able to handle stress, so a lifestyle change like eating healthier foods may help you fill up your tank.
Even small changes can help. Starting a yoga or taekwondo class can help you relax. Deep-breathing techniques may also reduce your stress.
Talking to a therapist is also a good idea. You can learn coping techniques and tools for handling stress throughout the rest of your life.
Above all, practice self-care. Self-care is taking responsibility for your physical and mental well-being. That’s it. Don’t neglect to eat regularly, get enough sleep, go outside, socialize with people face-to-face, drink enough water, and exercise. If you do most of these big six tenants of self-care on a daily basis, you will be better off.
Bad stress affects me in a lot of negative ways. I’m not the best at handling stressful situations. So I plan ahead for them. I make massive to-do lists, outlining each tiny step that I need to take in order to conquer the issue. And I practice self-care.
Bad stress may affect you despite your best efforts. You may end up living through many, many stressful situations throughout your life, like moves, marriages, and births. You need to lean on your coping tools during these times.
Plan ahead. Take the times when life is relatively calm to assess your ability to handle stress, and plan how you’ll respond to changes. If necessary, you can get a prescription for anti-anxiety medications that you take on an as-needed basis.
Effectively managing your stress will help you suffer less from your bipolar disorder.
A version of this post first appeared here on the International Bipolar Foundation’s website, here.
In 2015, the Washington Post conducted the first ongoing tally of officer-involved shooting deaths of the mentally ill. Nationwide, at least 25% of people who are shot and killed by police officers suffer from acute mental illness at the time of their death. People with untreated mental illness are 16 times more likely to be fatally shot during an encounter with police than people with their mental illnesses under control.
According to the Post’s 2018 tally, 1,165 civilians were fatally shot by police. Of those, more than 200 were confirmed to be mentally ill. Someone needs to be paying attention.
Unarguably, mental illness isn’t the only factor involved in fatal police encounters. Race is one that is often talked about. But the link of mental illness to police brutality doesn’t have the same publicity.
In 2015, the New York City Police Department responded to more than 400 mental health calls per day, more than 12,000 per month. But why do the police respond to mental health crises, and not EMTs? Historically and correctly, law enforcement has been paid to transport people suffering breakdowns to hospitals. And for many mental wards, police involvement is a requirement for involuntary admittance. In Washington state, for example, “under almost all circumstances police involvement is the primary factor in determining whether referral will result in commitment” (Carr, Durham, and Pierce 1984). This happens often enough that the state of Oklahoma’s mental health department includes a budget line item specifically for reimbursing police to transport patients.
The perception of people suffering mental illness as violent and dangerous is another reason police are called. Officers are the only people often perceived by the public to be able to deescalate mental health crises. According to the American Psychiatric Association, most people with mental illness are not violent, but using the law enforcement as a blunt instrument contributes to the stigma that they are. In fact, people with mental illness are more likely than others to be victims of a crime, not perpetuate them.
Restore the mental health system so that people who suffer from mental illnesses will be treated before they end up in encounters with law enforcement;
Accurately count and report all situations involving deadly force by police officers;
Identify the number of times those with mental illnesses are fatally shot in an official report, so lawmakers can’t ignore the impact of police fatalities related to mental illness.
Since that study, there has been marginal progress. The 21st Century Cures Act, passed by Congress and signed into law by President Obama in December 2016, mandated that data on the role of mental illness in fatal police encounters be collected and reported. Soon after, the Bureau of Justice Statistics started using a new methodology in reporting arrest-related death statistics. Using the new methodology, the number of arrest-related deaths that were verified and reported to the Department of Justice doubled.
But the act is not as robust as it could be. According to the Post’s tally, police killed about two dozen more people in 2017 than in 2016, and even more in 2018. The numbers don’t lie; things have not improved much, despite more accurate reporting.
What Can I Do?
Progress is slow, and this may feel like an insurmountable problem. But there are things you can do to help. Contact your House representative and let them know that you are concerned about fatal police shootings. Read books like Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, which describes why psychotic patients need involuntary commitments. Champion police body cameras and mandated government reporting of the role of mental illness in shootings. Advocate for mental health funding at all levels of government. If you are a police officer, rely on your crisis training to deescalate crises involving the mentally ill.
Fatal police shootings, especially of when they involve people suffering from mental illness, are not new or rare. Nor are they going away. But there are things you can do to help. We’ve got to stop this trend. With consistent pressure on our lawmakers and law enforcement, we can fix this.
Durham, Mary & Carr, Harold & Pierce, Glenn. (1984). Police Involvement and Influence in Involuntary Civil Commitment. Hospital & community psychiatry. 35. 580-4. 10.1176/ps.35.6.580.