One of the most important things family and friends can do for a person with bipolar disorder is learn about the illness. Often people who are depressed or experiencing mania or mood swings do not recognize the symptoms in themselves. If you are concerned about a friend or family member, help him or her get an appropriate diagnosis and treatment. This may involve helping the person to find a doctor or therapist and make their first appointment. You may also want to offer go with the person to their first appointment for support. Encourage the individual to stay with treatment. Keep reassuring the person that, with time and help, he or she will feel better.
It is also important to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the person in conversation and listen carefully. Resist the urge to function as a therapist or try to come up with answers to the person’s concerns. Often times we just want someone to listen. Do not put down feelings expressed, but point out realities and offer hope. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your first invitation is refused.
It is often a good idea for the person with bipolar disorder to develop a plan should he or she experience severe manic or depressive symptoms. Such a plan might include contacting the person’s doctor, taking control of credit cards and car keys or increasing contact with the person until the severe episode has passed. Your plan should be shared with a trusted family member and/or friend. Keep in mind, however, that people with bipolar disorder, like all people, have good and bad days. Being in a bad mood one day is not necessarily a sign of an upcoming severe episode.
Never ignore remarks about suicide. Report them to the person’s therapist. Do not promise confidentiality if you believe someone is close to suicide. If you think immediate self-harm is possible, contact their doctor or dial 911 immediately. Make sure the person discusses these feelings with his or her doctor.
Sometimes even health care professionals have difficulty determining how close a person may be to attempting suicide. As a friend or family member, you can't know for certain either. If you sense there is a problem, ask the person direct questions and point out behavior patterns that concern you. Remind the person that you care about them and are concerned. Talking about suicide with someone will not plant the idea in his or her head. If necessary, suggest that they make appointment to see their doctor and offer to go with them if you sense they would have difficulty doing it on their own. If you believe that immediate self-harm is possible, take the person to a doctor or hospital emergency room immediately.
Among the many things you can do to help a depressed person who may be considering suicide, most involve simply talking and listening. Do not take on the role of therapist. Often times we just want someone to listen. Though this may be difficult, here are some approaches that have worked for others:
Severe depression is usually accompanied by a self-absorbed, uncommunicative, withdrawn state of mind. When you try to help, you may be met by an individual's reluctance to discuss what he or she is feeling. At such times, it is important to acknowledge the reality of the pain and hopelessness he or she is experiencing. Resist the urge to function as a therapist, which can ultimately create more feelings of rejection for the person, who doesn't want to be "told what to do." Remain a supportive friend and encourage continued treatment.
If you can explain particular ways a persons’ behavior has changed, this may help to get communication started. Try to help him or her overcome feelings of guilt. Compounding the lack of interest in communication may be guilt or shame over having suicidal thoughts. If there has already been a suicide attempt, guilt over both the attempt and its failure can make the problem worse. It is important to reassure the individual that there is nothing shameful about what they are thinking and feeling. Keep stressing that thoughts of hopelessness, guilt, and even suicide are all symptoms of a treatable medical condition and reinforce the person’s good work in keeping with their treatment plan.
Never promise confidentiality if you believe someone is very close to suicide. Keep the person’s doctor or therapist informed of any thoughts of suicide. If possible it is best to encourage the person to discuss it with doctors themselves, but you should be ready to confirm that those discussions have taken place. This may involve making an appointment to visit the doctor together or calling the doctor on your own. Be aware that a doctor will not be able to discuss the person’s condition with you. You should only call to inform the doctor of your concern.
Whenever possible you should get permission from the depressed person to call their doctor if you feel there is a problem. Otherwise it could be seen as "butting in" and may worsen their symptoms or cause added stress. Of course, if you believe there is a serious risk of immediate self-harm, call their doctor. You can work out any feelings of anger the person has towards you later.
Many people find it awkward to put into words how another person's life is important for their own well-being. Emphasize in specific terms the ways in which the person's suicide would be devastating to you and others. Share personal stories or pictures of past events.
The person may express anger and feel betrayal by your attempt to prevent their suicide or get them into treatment. Be strong. Realize that these reactions are caused by the illness and should pass once the person has received the proper treatment.
A person who has thought about or attempted suicide will most likely have feelings of guilt and shame. Be supportive and assure the person that their actions were caused by an illness that can be treated. Offer your continued support to help them recover.
It is not uncommon for friends and family members to experience stress or symptoms of depression when dealing with a suicidal person. You can only help the person through their own treatment with encouragement and support. You cannot get better for them. Do not focus all of your energy on the one person, ask friends and family to join you in providing support and keep to your normal routine as much as possible. Pay attention to your own feelings and seek help if you need it.
If someone is threatening to commit suicide; if someone has let you know they are close to acting on a suicidal impulse, or if you strongly believe he or she is close to a suicidal act, these steps can help you manage the crisis.
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