Health Policy September 5, 2019
Why a ‘whole society’ response is required to help patients with bipolar

By Simon Kitchen - Accountable Care Journal

Now that NHS England has published details on its’ long-awaited Long Term Plan, it is vital that Simon Stevens continues to embrace his vision for the NHS to become a ‘social movement. ’ This could be particularly beneficial for people with severe mental illnesses like bipolar disorder.

There are currently 1.3 million people living with bipolar disorder in the UK, 70,000 of whom, it is estimated, will commit suicide. Reducing this extreme suicide rate will require a ‘whole society’ response. At the heart of this response sits the NHS. The health service must start by getting the basics right and underpin all efforts to address this.

The Adult Psychiatric Morbidity Survey (2014) reported that 3.4 per cent of 16–24-year-olds screened positive with bipolar compared with 0.4 per cent of those aged 65–74. It is crucial that we understand what lies behind the difference in these prevalence rates and develop effective strategies for treating each individual. However, before treatment plans can be implemented, a diagnosis is required. Currently, it takes an average of 9 years for people with bipolar to get a diagnosis and, as a result, 6 in 10 living with bipolar aren't in receipt of any medication or treatment for the condition. This is a major challenge that must be overcome to improve outcomes for people living with bipolar disorder.

The next challenge is that basic prescribing is not happening. Despite one-third of people with bipolar responding well to lithium, recent studies suggest that only five per cent of patients are receipt of it. Inpatient care also remains a traumatic experience for patients with run-down facilities, lack of privacy, boredom, abuse and even violence all too common.

The NHS Long Term Plan has a long way to go to reform and improve services for those people with bipolar. However, if the outlined investment in mental hospitals is properly targeted, we could see vastly improved inpatient experiences. More money for crisis support is also very welcome but unless the NHS prioritises earlier diagnosis and more effective prescribing, it will continue to spend its time fire-fighting.

Perhaps most positively in the Long Term Plan, buried under the jargon of patient activation, is increased acceptance of the role of patients and self-management. It is the individual and their immediate friends and family who are truly on the front line of the mental health crisis and it is with them that many of the solutions lie.

The component causes of bipolar are roughly 74 per cent genetic and 26 per cent environmental. Environmental factors play a vital role in helping people with bipolar manage their condition and prevent/reduce manic and depressive episodes. This includes changes in lifestyle, diet and even peer support. Strikingly, in a survey of people affected by bipolar, 40 per cent of respondents said friends and family were indispensable to managing the condition, compared to 20 per cent who said Psychiatrist and 15 per cent who said GP.

This provides a helpful perspective on the role of the NHS and highlights the opportunity of bringing health care professionals, patients and friends and family together to develop common solutions to the suicide crisis for those with bipolar disorder.

Bipolar UK is partnering with King’s College London to improve mutual understanding and develop joint action plans for a range of challenging topics; from genetic research and pregnancy and bipolar. This gathering of people impacted by bipolar is set to take place on 17 November in London.

To join the Bipolar UK Annual Conference, register here

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