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Family Involvement: Key Component of Care for Bipolar

Family Involvement: Key Component of Care for Bipolar

A strong family is vital for the encouragement and emotional support of someone with bipolar disorder. Local support groups, such as those run by the Depression Bipolar Support Alliance, help bipolar disorder patients and their familiesto  cope better. Similarly, the National Alliance on Mental Illness, a national grassroots mental health organization, offers an 11-week Family-to-Family Education Course for family and friends of those with serious mental illness. These programs teach patients and their families listening and communication techniques, problem solving, limit setting, handling a crisis and relapse, understanding the actual experience of people suffering from mental illness, and provide information about medications and community services.

Support Group Increases Family Participation

Participation in a relatives’ support group led to marked increases in family participation and improved consumer outcomes, in a new study of more than 220 veterans with serious mental illnesses including bipolar disorder.1 The Recovery-Oriented Decisions for Relatives’ Support intervention is an innovative protocol utilizing shared decision-making principles with those who have serious mental illnesses to promote recovery and encourage consideration of family involvement in care.

The study included relatives who had low rates of contact with the treatment staff. Up to three consumer sessions were followed by up to three educational sessions for relatives, if the consumer and relative consented.

A large majority (85%) of the 111 participants randomly assigned to the support group attended at least one consumer session, and more than half had at least one family session. This led to significantly reduced paranoid ideation among the bipolar disorder patients and increased recovery at follow-up.

Online Resource for Families of Bipolar Disorder Patients

An excellent online resource for families of bipolar disorder patients is the Bipolar Caregivers website (www.bipolarcaregivers.org). Expert clinicians, caregivers, and consumers all contributed to develop guidelines for caregivers of adults with bipolar disorder. The website provides information on how to support a bipolar person when ill, as well as various resources, such as caregiver organizations, crisis help lines, suicide prevention and support groups, drug and alcohol services, and anxiety management.

To test the usefulness of the information on the website, visitors were asked to respond to an initial online survey.2 More than 500 people responded. A month later, a more detailed follow-up feedback survey was emailed to 121 web users who were adult caregivers of adults with bipolar disorder.

The vast majority of users found the various sections of the website useful. At follow-up, nearly 93% of caregivers reported that the information was relevant to them and 96% thought it would help others. Most respondents said that the information was supportive. More than two-thirds of the caregivers reported using the information.

The Importance of Assessing Family Functioning

However, a few respondents who were experiencing complex family problems, or who cared for a person with severe chronic bipolar disorder, did not appraise the website as positively. Other evidence supports the logical conclusion that the effectiveness of support offered by families depends critically on the integrity and soundness of family relations.

Therefore, assessing family functioning is important for families of bipolar disorder patients. But how a patient and family members perceive family functioning may not be in concordance.3 It can be difficult for a bipolar disorder patient to see mood swings, but family and friends may notice them.

Simply talking to someone outside the immediate family about how difficult things have become may help open the door to improving coping skills and treatment. If family members aren’t comfortable seeking counsel from the treating psychiatrist, it may help to open up to a trusted distant relative, a school counselor, or a member of the clergy.



1. Dixon L, Glynn S, Cohen A, et al. Outcomes of a Brief Program, REORDER, to Promote Consumer Recovery and Family Involvement in Care Psychiatric Services (2014) 65 (1): doi: 10.1176/appi.ps.201300074
2. Berk L, Berk M, Dodd S, et al. Evaluation of the acceptability and usefulness of an information website for caregivers of people with bipolar disorder BMC Medicine (2013) 11:162.
3. Weinstock LM, Wenze SJ, Munroe MK, et al. Concordance Between Patient and Family Reports of Family Functioning in Bipolar I Disorder and Major Depressive Disorder Journal of Nervous & Mental Disease (2013) 201:377-383.
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