Risk / Symptoms Present
Loss of sleep
Not able to sleep 24 hours
Staying up and out late despite other responsibilities
Not able to sleep 2-3 days
Feel and stating they feel ‘wired’
is obvious to others, may include verbal abuse
is inappropriate – now angry and violent.
Desire to be impulsive:
Using drugs –more
of legal or illegal
Sexual acting out
Medium Risk/ Symptoms Obvious:
with impulsive thoughts:
Spending on credit cards, borrowing to cover costs
Trips to casinos
More lottery/ scratch off tickets
Buying items that above budget or ability to care for
More alcohol consumption
Infidelity/high risk sexual activity
Increased conflict with others as they try to rein in the ''out off control" behaviors.
High Risk/Danger to Self & or Others:
Impulsivity that has
legal, criminal or injury.
High speed racing and road rage
Stealing to cover bets/drug use
Taking off to other places without notice
Violent actions using weapons
Increased intensity in:
- Speech - that may or may not make 'sense' - there may be themes of paranoia, religion including belief that they are a religious figure, have special powers, influence, skills or capacities.
- Initiative - Intense desire to start and work on projects, programs, goals - hobbies, work, home improvement - regardless of time, cost, or ability.
- Demands on self or others - expecting others to partipate, keep up or listen without regard to their ability or time.
- Use of social media-compulsion/obsession to contact, comment, share and check.
- Use of phone-needing or obsessive checking, calling, using phone without regards to time of day, length of call, or how many times called.
- Late night or early morning phone calls (inappropriate times)
- Use of stronger
substances - more or harder liquor, drugs, or mixing both. Stronger drinks, shots, drugs.
non-stop talking – unable or unwilling to stop.
- Unable to calm, slow down or stop
activities. Require physical
restrictions, isolation, safe environment until stabilized.
- Increased conflict and confrontation at home/work
- May be related to
real stressors but slightly more magnified, louder, or intense than usual.
- Conflict is obvious
and not appropriate for situation.
- Difficulty with insight, being able to calm, switch topic,
- Verbal violence
- Physical violence towards others or objects.
- Conflict has become
harmful, threatening, dangerous to self and/or others.
- Use of violence with or without weapons.
Feelings of hopelessness/ helplessness
Fleeting thoughts of wanting to ‘escape’
– no established plan, means, real desire to follow through
Suicide is considered, has means, access
and plan. Has history of previous
attempts, medicated for depression, made obvious call for help or threat to
What to do . . .
Minimum "Threat" to Safety:
- Increase monitoring of sleep pattern, moods, number of phone calls/texts, time on
computer, time shopping, time out socializing, amount of alcohol /drugs
- Manage Medications as directed.
- Use pill boxes to improve compliance.
- Have another person
- Call Regular
Physician for medication adjustment.
Schedule or keep
scheduled appointment with counselor/group.
- Have an ‘outsider’
dispense medications – remove extra from household.
- Remove all but 24-36 hour supply – to require monitoring of
deterioration or improvement.
- Contact and see
Physician for next level of care – get appropriate referral to outpatient
or inpatient facility.
- Secure children/
pets/home while absent.
- Notify Workplace of
- Call 911 if MD not available
- Restrict access to credit cards, bank accounts and lines
of credit to reduce risks of overdrafts or excessive use.
- Remove access to credit cards and bank
accounts – put stops on accounts.
- Shift responsibility to a safe person.
- Notify financial institutions or use
Internet to maintain finances. Shut
off credit cards and lines of credit if necessary
- Minimize access to alcohol - restrict buying, secure supply, lock up and limit invitations to events that have easy access to alcohol.
- Minimize access to deadly weapons - guns, hunting knives, explosives, toxic chemicals and potent medications. Secure in alternative places, lock up, remove completely and don't buy more. Separate ammunition from guns including remove to another location. Notify anyone who may invite the person into their home - if they can't provide a 'safe house' then instruct them to contain the visit to a safe area- porch, deck, single room, outdoors or public area.
- Talk out issues that stress, worry or increase anxiety with a ‘safe’ and supportive
- If still feeling
magnified levels of stress, worry or anxiety talk it out with professional.
- Use professionals in
Outpatient or inpatient setting to re-establish reality of situation.
- Abstain from any use
of alcohol/drugs - everyone should stay aware of their own ability to make good decisions for those who can't. If a caretaker is also impaired - the household is NOT safe.
- Monitor social activity that may encourage sexual acting
- Have chaperones for events that may
be high risk for sexual acting out, heavy alcohol/drug use, high risk
- Restrict outside activities with
others until symptoms are stabilized.
- Shut off phones/ block calls/ texts
- Secure phone or
begin to monitor more often – increasing to 24/7 if necessary to prevent
or reduce negative behavior/activities.
- Secure in safe
facility away from access to people, phones, inappropriate activities
that are harmful to self and others.
- Consider time off or time away from high conflict, high
stress, or intense environmental situations.
- Contact workplace for time off, vacation
or need for medical leave.
- Follow through with longer term
disability payments through employer.
- Use Federal Family Leave Act to secure
- Contact safe person at workplace to cover while off from work/ projects.
- Work with Human
Resource Dept. to secure proper benefits: Medical and Time compensation.
- Secure documentation
to secure time off, changed assignments, lower stress position or
responsibility. Allow Physicians and professionals consent to communicate and collaborate to keep everyone safe.
There are 3 levels of hospitalization:
Highest/Most secure: Residential –
extended stays 3 or more days. Person
has been deemed a danger to themselves or others, actively suicidal,
pathological in their previous history, psychotic (disconnected from reality),
threatening violence or lacks real supportive people or environments.
May require intervention by criminal justice system:
Local police may require an ‘involuntary admission’ or ‘302’ that must be
approved by a local ‘on call’ judge or magistrate. Person is then required to stay 36
hours. Most have choice after
- · Most restrictive environment.
- · May also address other medical
illnesses/injuries simultaneously. (suicide attempt injuries)
- · Local/regular known Physician can arrange for
admission in advance (avoiding ED wait).
Most common if manic than depressed. (more contact with police)
- o Person
in full manic state will usually resist hospitalization or leave facility
Allows for both full detox from illegal drugs,
alcohol abuse, incorrect medications or starting from scratch or over with new
Observation in a safe environment allows focus
to be on getting well.
Allows ‘vacation’ from external stresses that
may have activated imbalance: high conflict relationships, abusive environment,
child care responsibilities, work related pressures.
Best used when person has limited access to
KNOW INSURANCE RULES IN ADVANCE – on the
back of your card there may be a separate contact number for ‘Behavioral
Health’ – insurance companies will contract with facilities in advance to
reduce their billing costs – if you use their pre-arranged providers you will
often avoid extra charges for co-pays, deductibles, ‘out-of-network’ or full
Partial Hospitalization – may start
with 2-7 days overnight stay then visit facility 2-3x weekly for group and
Allows for closer monitoring without going
longer term inpatient
Reduces costs and allows supports in place to
become part of the solution.
Combines ‘safe and supportive’ environment with
reality for practice.
Best for higher functioning clients that can
handle changing environments.
Requires good transportation support for
Outpatient/ Day Hospital – may be held in an outpatient setting or
in conference/counseling department of residential hospital/facility. You may attend group, individual, educational
meetings and physician meetings all on one day - or spread out through a
Allows for stream-lined coordination between
different types of support. May be
combined with addressing medical issues.
Allows for observation of prescribed medications
– and faster attention to making adjustments.
Can also include physical therapy, dietary,
stress management and alternative therapies.
will happen to me in the hospital?
The best case scenario is that
you have already been through a tour or visit of the chosen facility so you are
aware of how it is designed, what the facilities mission or style of care will
be and what your room will look like. You
will also have family/ spousal/peer support who will also want to participate
in what will support your wellness.
If you are ‘fast tracked’ and
have little idea where you will be staying these are the basics expected of all
government regulated facilities:
contact with a medical professional, with a specialty in mental
and Group counseling sessions throughout the day/evening.
3 meals –
that may be served in a common area, cafeteria or at your bed.
that should cover: Life issues, relapse prevention, post-hospital life.
Hospitalization will also help
you to ‘regroup’ and reflect on what led to your heightened state. It will give you time to think through what
is/was working and what wasn’t and what you need to do to make positive
It may also give you needed distance from
relatives, which you may need from
time to time.
Agreeing to hospitalization does NOT signal the
end of your control over your own life.
It can provide a needed break from daily
stresses and family conflicts and give you a chance to gain a new, more helpful
- Know the triggers and warning signs of deterioration or alert to a episode change.
- Educate supportive others so they can support and help effectively.
- - symptoms can change quickly and safety concerns can override ability to think clearly - have easy access to help.
- Rather than act in the midst of an emergency - ask about facilities, professionals and take tours of them in advance. Evaluate when the situations are CALM and you can determine what would be best - location, atmosphere, staffing, meals, recreation, style of interventions and approach to reducing 'disorder.'
- Treat 'bi-polar' as a chemically based illness that it is - follow medication regime and report symptoms openly to professionals - so that effective management can take place.
- Getting all family members counseling can also be an important supportive measure - caretakers need their own support too!