I think I might have bipolar…. Tips for approaching healthcare professionals

The internet is a great way of making connections. I blog and tweet primarily because writing about how I’m feeling (even when it’s only in 140 character bursts!) helps me to deal with my experiences, but it’s always great when someone contacts me to say that what I write has helped them have a better understanding of bipolar disorder and its effects. It’s quite common for people to approach me, either on the blog or on Twitter, to tell me that they think that they might have bipolar, but that they are anxious about speaking to their doctor about it. It happened again this morning so, having been through the assessment process more times than I care to think about, I think it’s time to share my tips on how to get the best from initial contact and assessment.

The idea of approaching a doctor to say that you think you could have a mental health problem is something that would probably make most people nervous, if not downright scared. If you haven’t ever been in the mental health system before, you have no way of knowing how it works, and what it might feel like to become a part of it. Many people worry that they won’t taken seriously, while others are anxious that they might have some form of treatment imposed upon them against their will.

Most people start their journey to diagnosis by approaching their GP. Remember that GPs have to have a very wide knowledge base, and this means your doctor is unlikely to have any in-depth knowledge of mental health. What a GP needs from you, is sufficient information to be able to make a sensible decision about whether you should be referred onward for further assessment. It’s worth pointing out that the majority of people with mental distress are dealt with as primary care cases – by GPs and allied community professionals such as practice nurses, counsellors, etc – and will never need to see a specialist (secondary) mental health trust. Initiatives such as the IAPT (Improving Access to Psychological Therapies) scheme and community exercise programmes have been developed specifically to support patients in primary care, in conjunction with GP prescribing of frontline mental health medications if required.

However, your GP may decide on the basis of what you tell them that you might have a condition that needs more specialist input – and suspected bipolar should always be treated as such. The National Institute of Health and Clinical Excellence (NICE) published a guideline on the management of bipolar in 2006, which states that GPs should refer patients for an assessment and the development of a mental health treatment plan if:

–       they suspect the presence of mania or hypomania (“overactive, disinhibited behaviour”) that’s been going for four days or more, OR

–       the patient reports a history of recurrent depressive episodes and a history of overactive, disinhibited behaviour.

If a GP believes someone is either manic or severely depressed, especially if they believe there is a suicide risk, this referral should be treated as urgent. If you find you are thinking seriously about suicide, or if you those around you suggest you may be experiencing psychotic symptoms, don’t wait around for a routine appointment. Make sure you get an emergency appointment with your GP, or at night/weekends consider going to A&E. Some people hold back from disclosing suicidal thoughts to a healthcare professional, for fear they could be “sectioned.” Please don’t; your doctor really needs to know what is going on with you, and I promise that telling your GP about your thoughts will not get you “locked up”. The only healthcare professional who has the power to detain you under the Mental Health Act is a psychiatrist, and they can only do this if an AHMP (Approved Mental Health Professional) has formally assessed you and recommended that detention is necessary, and a second doctor has agreed. I’ve been in the mental health system for 18 years now, actively suicidal on more occasions than I can count, and this has never yet happened to me.

What happens after you see your GP is, to a degree, dependant on where you live, in terms of how long you will have to wait before you are seen, and who you initially see. In some areas, you will be seen by a psychiatrist straight away; others may use other healthcare professionals such as specialist nurses or social workers to determine whether or not you need to see a Consultant.

What I finds works best is when I think through my concerns, as systematically as I can, before speaking to any health care professional. Noting down my thoughts is especially helpful – not only is there less chance that I will forget something that I really wanted to say, but the process of writing thing down can also help me spot themes or clusters in my symptoms. I have learned over the years not to leave anything out that may be bothering me, even if I think it sounds stupid or that it’s probably not important. Bipolar has a huge range of possible symptoms, and that one snippet of information might just be the piece that helps a healthcare professional put the puzzle together. The more open and honest you can be, the more chance the clinician has of making the correct diagnosis.

Here are some things to think about ahead of any appointment:

1)    Try to pinpoint what it is that makes you think you might have bipolar, rather than another diagnosis. Can you recall anything you have read/heard/seen that made you think, “wow, that’s just like me”? If it’s in a book, or is something you can print out, you could highlight the parts that particularly resonate with you.

2)    When did your symptoms first start? Can you see any sort of a pattern, stretching back over weeks, months, or years?

3)    What is the impact of your mood swings on your family, your relationships, or your work? Has anyone close to you commented on your moods and, if so, what were their concerns?

4)    Have you tried any self-help measures for your symptoms? Were they effective?

5)    What has made you decide to seek help now? Have things got worse lately? Has someone said something to spur you into action?

One more thing you should think about before attending an assessment, is the fact that there is a lot of overlap between bipolar and other conditions (for example, borderline personality disorder, as I discussed here, but also diagnoses such as schizophrenia, schizo-affective disorder, clinical anxiety, and major depression). You may go into an assessment with bipolar in your mind, but come out of it with quite a different diagnostic label. It’s important to remember that the aim of the whole process is to identify what you symptoms are, and what treatments might best target them. In other words, it’s more important to get a clear diagnosis and treatment plan than it is to be right!

For more information on diagnosis of bipolar, check out Mind’s guide: http://www.mind.org.uk/help/diagnoses_and_conditions/bipolar_disorder_manic_depression




About purplepersuasion

40 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards
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25 Responses to I think I might have bipolar…. Tips for approaching healthcare professionals

  1. Hi, i’ve been through the mental health system myself as well quite a few times. There have been difficulties at time obtaining a diagnosis, because I seem to be borderline on various disorders.

    My most recent formal diagnosis which I only discovered by accident during a well being nurse’s visit to my home, was something of a surprise. “Mixed Anxiety and Dispressive Disorder” sounds like something they’d just put people in as they don’t know how else to classify it. I’ve been trying for a review of my diagnosis for about 2 years now, and am hoping, fingers crossed, that my diagnosis can be updated to something that seems to be more applicable to this point in time, rather than a few years ago.

    I think you’ve given some great advice there, and just wanted to say I genuinely think this is a great blog post.

    All the best

    • Thanks so much! Very nice of you to stop by and leave me such positive feedback 🙂 I often mean to write more stuff like this – for people who are new to the whole thing – but then there’s always something interesting and new that seems to get more of a look in. I think diagnosis is such a tricky thing, a lot of id really does depend on which psychiatrist you see. Good luck and I hope you get your review 🙂

  2. shelley says:

    this has been fantastic to read before approching my gp. great ideas for me to look at and the jotting down my moods and thoughts will really help me out thanks so much for this. what a big help:)

  3. Pingback: This Week In Mentalists – *insert witty and insightful title here* edition « The World of Mentalists

  4. showard76 says:

    I want to present you with the ‘Strong Person’ award you can read the details here – http://showard76.wordpress.com/2012/08/24/strong-person-award/

  5. Emma Bloomfield says:

    Hi, both my dad and brother have Bipolar disorder as well as a number of other mental health illnesses and Im now beginning to struggle coping Im 25 and moved back home to help my mum as with their other health illnesses they can both be very violent. I just dont know where to turn my self and my mum are struggling in every way possible I just wondered how your family has coped and how you feel towards your family on highs and lows etc

  6. kaydee says:

    Hi there I was wondering I could speak with u privately through email..as I find it easier to write how I feel and what I fear, rather than say the words, when I try to say the words, I find myself not being completely honest and delibrately missing things out. I feel my doctor doesn’t understand and make me feel uncomfortable. Thanks for your time.

  7. Jose l says:

    hello, i stumbled across.this site in search of answers/help. this page really helped me get on track on what to do, but im not sure what type of doctor im suppose to visit and how to go about about it… im ruining.relationships with family and friends.and.i.just.wanna stop :/

  8. kirsty says:

    I came across this blog while searching google. I have for the second time approached my gp today.. as the last time was in 2011. When asked “why now?” I replied with the fact my rapid crazy angry bursts have made me lose someone very close to me they didnt seem to take me seriously.. as im just a young woman who has over active emotions. Apparently.. I have been refered to a psyc now and hopefully she will be more understanding. Its just getting past the low lows now till I can see her. I need this treating now.. to take it seriously!

  9. Rehanna says:

    I have recently had issues shaking my depression. It’s getting so bad that I almost start to cry leaving for work. I’ve looked into bipolar symptoms and I fit all of them as early as 3yrs old. I will go to see my GP and find out more. Thank you for your insight.

    • Good luck! I always feel it’s worth getting the possibility checked out – even asking and being told you don’t meet the criteria is better than having that question/worry in the back of your mind. And for me, as many others, getting the correct diagnosis is a route to better treatment and self-understanding.

  10. ashley says:

    Hi not sure where to start never been through any of this but ever since I was a teen age I noticed that any little thing I would start to freak out about then after the freak out I would just sit and cry about nothing then over the past year all that has gotten worse like someone would walk up to me and say hi how are today and I just snap even tho they did nothing wrong but I’m scared to talk to my Dr a out this its starting to really cause problems in my marriage so something needs to be done thanks for you post ☺

  11. denika says:

    Hi im 13 and for a few months ive been taken bipolar tests and i know that doesnt mean ive got it
    but on pretty much all of them i hve taken have come back very positive to having it my at school i can be rellyhappy and hyper then for no reason at all hae a major outburst wich results in fights punching walls throing chairs egs so etimes i can be in a really good mood and do loads of work and other times the complete opposite i have almost all the symptoms to it and recently a high up behavior team spoke to me because afew of myteachers were worrid because of my major mood swings i dont know weatjer to speak to th school about it or go to my doctor but i hope it could be this as i could get help as ive pushed my fmily away through my behaviour andi never no thereasons forit please help

    • Hi Denika. Sorry it’s taken me so long to reply. I was on holiday when you posted your comment and I didn’t have the time I thought your comment deserved. I had bipolar symptoms since the age of twelve and I didn’t know what to do about it either. I would say approach whoever you felt the most comfortable with and felt would take you seriously, be it school, doctor or parents. Maybe with your family make it clear that you know your behaviour has been weird, or even maybe unacceptable, but that you think it has a reason and you want help dealing with it? That way you are showing you are taking responsibility – and deciding there is a real problem looking for treatment is THE most responsible thing you can do really. Feel free to print this post out and highly the bits you think you most relate to. I would guess a doctor or school counsellor would eventually wanted to involve your parents given your age but I would say to start with someone you trust. I hope that helps and agin I’m sorry it’s taken me so long to give you a decent reply. C x

  12. Kc says:

    I’ve never been through anything with mental health systems but over the past year I’ve noticed I’m having a lot of bipolar symptoms. I’ve tried not to let them get in the way of things but they’re really affecting me negatively. I want to tell my doctor but I feel like she might not take me seriously since I’m only 14..
    I don’t want to ask if I can go to the doctor since my dad will worry about me more than he already does and my sister will make fun of me about it.
    Your advice on what to tell the doctor is great (if I ever go there)
    But do you have any advice for me on how to bring up he subject?

    • Normally I would never advocate lying to your family, but is there a way you can maybe tell a little white lie to get yourself to the doctor? Longer term if you don’t think your family will be supportive it will be difficult for you to (if your GP thinks you need to) attend Child and Adolescent Services (CAMHS) appointments if they don’t know what’s going on. But maybe is you have a supportive doctor they could try and help your family understand. Sadly I have et quite a few young people online who struggle to get their family to take their issues seriously. I wish I knew what the answer was!

  13. Helen Broughton says:

    Hi I think I have bipolar I’ve researched it and o have all the symptoms I have done online tests and my family are worried about me as I seem to be getting worse. I went to gp who referred me for mental health assessment. The mental health nurse seems to think it’s just my personality.. im not a bad person I do things when I’m hyper which I wouldn’t do when I’m down it makes me ashamed. I’ve got myself into money problems cant stick in any relationships… The nurse has made me feel stupid and even more inadequate. Should I go back to my gp? I’d really appreciate your advice. Thank you x

  14. darren says:

    Hi, I feel a lot of the typical symptoms may apply to how I and act, at work I am at times over exaggerated in the way act and present myself but at times I feel over frustrated to the point of crying, when at home I enjoy being with my wife and daughter but cannot bear to be with for long periods of time, but alone I begin to think too much and at times hate myself, I work in an environment of care and really enjoy my job, but am at a point that I don’t really know what to do with my own mental state, I have dealt with stress and depression in the past and really don’t want to drag my family through it again especially my 9 year old daughter, she couldn’t understand that before I was poorly as she couldn’t see any symptoms as you do with common illness, I also fear losing my job, as you may understand I am really confused and worried about my state of mind/future…

  15. battlingalone says:

    I have been having treatment for depression for nearly 10 years now, and having more intense treatment through different therapies for the past 18month after having a severe anxiety attack which i was taken to A&E for. I have a CPN and CBT therapist aswell as my GP, but i feel that i cant really talk to any of them properly about things. The biggest reason is that i wont be taken seriously, its not the 1st time its happened. Unfortunately ive gotten to the point of painting the smile on for the very people who are there to help me through fear of being rejected if i tell them everything thats going on in my mind and body

    • That’s really hard, when you’re dismissed/knocked back so many times it’s hard to put yourself out there and trust that someone will listen. I can’t offer any advice… I struggled for years and years to get meaningful help… I can only offer my sympathies and hope this changes for you one day x

  16. Ant says:

    Is there anyway to avoid the gp part ? I really can’t talk about this with someone I know. I’ve been managing for years so if I have to see the gp I probably won’t go. I know they won’t judge you and all of that but I wnot be able to be fully honest about it with someone I know and I know people say it doesn’t make you weak but that don’t stop me thinking it. Tbh I was under the impression everyone had mood swings thought it was normal, just thought it was depression and as long as I avoided long periods on my own and kept active it didn’t happen too much. But after accidentally reading a bipolar thing I did notice I also gets massive spurts of energy, I don’t know if it’s even worth being diagnosed if I’m honest. I’ve missed a couple days of work here and there maybe become a bit distant but there only brief moments like a few days or something. Is it worth having bipolar on your record if it’s not a massive problem ?

    Sorry if that’s hard to read writing on a phone lol and thank you

  17. shelley says:

    Hi,i have been up and down quite abit in life but its been really bad over the last year and half few weeks,days or even hours manicly up then back down for no reason what so ever.My best friend has been saying for a while now I have bipolar but we have just been laughing off.We went and did some training last week on mental health as we are carers and bipolar came up it was uncanny some of the things the trainer was saying.I am curranly under a neurological specialist as I am having some kind of seizures they think it could be epilepsy.i am wondering if anyone else with bipolar has seizures.They feel more like oras abit like am not there but I know I am,i find hard to have conversations and to concentrate during them.This has been going off for the last 8 month and I still have no idea whats actully going off with me.I have even lost my driving licence because of it.I am thinking should I mention bipolar to specialist when I go on the 19th of august.Thank you for reading

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