Bipolar treatment isn’t one-size-fits-all. Here’s how six levels of care helped one woman find the right support as her needs changed.
Living with bipolar disorder can feel overwhelming, especially right after a diagnosis. The process of seeking treatment may feel daunting, but understanding how the treatment system works can help ease that anxiety.
I’ve been through a mix of inpatient and outpatient treatments. While each has its own challenges and benefits, they’ve all helped me find my footing in managing my condition.
Inpatient care gave me a structured, supportive environment when I needed it most, providing immediate help during my most severe episodes. It was a safe space where I could stabilize with professional help around the clock.
Outpatient care allowed me to build on that foundation with more flexibility. It includes regular therapy sessions and medication management, plus connections to resources like support groups, which have been a lifeline for me.
Understanding Levels of Care for Bipolar Disorder
In mental health care, “levels of care” describes the intensity of support, supervision, and time commitment a program offers. Clinicians often compare treatment to a stepladder. If your symptoms escalate or daily life becomes harder to manage, you step up to a higher level of care for safety and stabilization. As your symptoms improve and you regain balance, you step down to a less intensive level of care.
How to Decide What Level of Care You Need
When deciding what level of care you need, focus on your current symptoms and how they affect your daily life, not just your diagnosis. Consider these questions:
- Are you able to manage everyday tasks like sleeping, eating, and taking care of yourself?
- Do your symptoms make it too hard to work, go to school, or feel safe at home?
- Do you need someone to check in with you every day to help prevent severe mood swings or deep depression?
If your symptoms are mild or moderate and make daily life harder, weekly outpatient therapy or an intensive outpatient program can help. If you are struggling with severe depression or mania that makes it hard to stay safe or function each day, a partial hospitalization program or inpatient care is often the safest option.
Each person’s journey is unique, and finding the right combination of treatments can pave the way for better management of bipolar disorder. Here are the six options that have helped me:
1. Outpatient Talk Therapy
In my experience, outpatient talk therapy is often seen as the go-to treatment for many psychiatric disorders, including bipolar. Typically, you meet with your therapist once a week for a 50- to 60-minute session.
In the session, you’ll explore the thoughts, feelings, emotions, and behaviors that are a part of your bipolar experience. While you’ll likely share the struggles you’re having, you’ll also share what’s going well. If you’re dealing with a co-occurring diagnosis, like generalized anxiety disorder, the sessions can also become a space to learn better management strategies.
For my own journey with bipolar 2 disorder, outpatient therapy has been invaluable in addressing negative coping mechanisms and replacing them with healthier alternatives. I’ve picked up general coping and relaxation techniques that have made a significant difference.
One critical discovery I’ve made with my therapist is the importance of routine in managing my bipolar disorder. With her help, I’ve maintained a stable daily schedule for months now — something many in our community can relate to.
While outpatient talk therapy is one common treatment option for managing bipolar symptoms, I am living proof that, sometimes, it’s not enough. This really depends on the individual. For example, when I’m experiencing acute mania or depression, I’ve found that more intensive treatment becomes necessary.
2. Outpatient Medication Management
Unlike psychologists, psychiatrists can prescribe medication to help treat bipolar disorder. Personally, I’ve been trying medications since the fall of 2021, and I’ve only recently settled on the correct combination and dosages. When I say “correct,” I mean what works effectively for my needs. It’s common to experience some trial and error while figuring out which medications work best for you.
My previous psychiatrist prescribed an antidepressant and a drug to treat my attention-deficit/hyperactivity disorder, which unfortunately triggered a manic episode and led to a hospitalization. Now, I’m on an antipsychotic and a mood stabilizer, and I’m doing well on them.
From my experience, outpatient psychiatry works best when used in conjunction with outpatient talk therapy. It’s also crucial to be open and honest with your psychiatrist about your symptoms to ensure that they can tailor the right treatment combination for you.
3. Genetic Testing for Medication Compatibility
Genetic testing is an innovative approach that complements outpatient medication management. Sometimes, if a provider finds it challenging to land on the correct medication, they might suggest genetic testing. This test can provide insights into how your body metabolizes various psychiatric medications. It categorizes treatments into three groups: guided treatment options, standard options, and options that should be avoided.
I underwent genetic testing after I came out of the hospital because my provider and I were struggling to find a medication that both lifted my depression and calmed my mania. Once we received the test results, it became clear that I needed an antipsychotic and a mood stabilizer, as my body processed those medications well. Switching to these specific medications brought me significant relief, and I’m very grateful that my doctor suggested genetic testing.
4. Intensive Outpatient Programs (IOPs)
IOPs offer a step up in care from regular outpatient therapy and can be an extremely effective treatment option. They provide moderate intensity without a full-time commitment, usually meeting three to five days a week for a few hours a day.
In IOPs, participants engage in group therapies, where they learn a variety of coping skills in a highly structured and supportive environment. Often, therapists incorporate techniques from cognitive behavioral therapy and dialectical behavior therapy.
It’s important to note that not everyone in an IOP has bipolar disorder, so treatment isn’t tailored specifically for bipolar. But in my experience, a specific focus on bipolar disorder hasn’t been necessary. I’ve gained a deeper understanding of my condition and new ways to cope with every hospital treatment I’ve participated in.
5. Partial Hospitalization Programs (PHPs)
As you might infer from its name, a PHP is similar to an IOP but offers a higher level of care. While IOPs require a few hours a day, a PHP functions like a full-time job for your mental health, meeting five days a week for about six to eight hours daily.
This type of program is a good treatment option if you’re seeking a highly structured environment with a significant level of care but don’t require the constant monitoring that residential treatment provides.
If you’re actively manic or acutely depressed, residential treatment might be more appropriate. But it’s always best to speak with your healthcare professional to determine the most suitable options for your needs.
It’s also worth noting that attending a PHP more than once is possible. I’ve been through it twice, and knowing it’s available if I need it again is reassuring. To make the most of your time there, I suggest participating in the group therapy sessions when you feel that you have something to contribute, without feeling pressured to speak all the time.
If you’re an introvert like me, it may help to remind yourself that the other people in the room are also focusing on their own wellness. They are not judging what you say — their focus is not directly on you (even though it may feel like it when all eyes are on you).
6. Inpatient Psychiatric Hospitalization
I believe that inpatient hospitalization represents the highest level of care available in the mental health field, offering 24/7 medical supervision and crisis containment when safety is the top priority.
Many people have heard of involuntary hospitalizations, which can be scary, but my hospitalizations have been voluntary. Both times I was hospitalized, I chose to go because I knew that my bipolar symptoms were escalating, and I recognized that I needed more intensive care.
If you find yourself feeling severely depressed or anxious to the point where your symptoms seem unmanageable, considering the hospital can be a wise decision. Simply going to any emergency room can initiate the process of voluntary hospitalization. When you voluntarily admit yourself to a psychiatric hospital, you retain more rights, compared with an involuntary commitment. Additionally, if you sign a 72-hour hold, the hospital is required to release you within that period.
The benefits of a psychiatric hospital include constant monitoring, daily group therapy sessions, and weekly consultations with a psychiatrist. Medication adjustments can often be made more quickly in this setting than with an outpatient provider.
Before you sign your 72-hour notice to leave the hospital and return home, be sure to fully utilize the hospital’s psychological services. Meet with the psychiatrist to discuss any potential changes to your medication and attend the optional group therapy sessions. While they might seem insignificant at the time, I can almost guarantee that you will learn something valuable to take home with you.
UPDATED: Originally published on July 12, 2024