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Kehler Counseling Blog

The Bi-polar Experience - When to Get Help

Low 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’
Irritability is obvious to others, may include verbal abuse
Irritability is inappropriate – now angry and violent.

Desire to be impulsive:
Using drugs –more of legal or illegal
Speeding/ Reckless driving
Sexual acting out

Medium Risk/ Symptoms Obvious:
Following through with impulsive thoughts:
Spending on credit cards, borrowing to cover costs
Trips to casinos
More lottery/ scratch off tickets
Internet gambling
Internet shopping
Buying items that above budget or ability to care for
More alcohol consumption
Drug abuse
Extreme sports
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.
  • Pressured, non-stop talking – unable or unwilling to stop.
  • “Drunk Texting”
  • 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, distraction.
  • 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 follow through.

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 consumed.
  • Manage Medications as directed.
  • Use pill boxes to improve compliance.
  • Have another person monitor.
  • 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 absence.
  • 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 person.
  • 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 out.
  • Have chaperones for events that may be high risk for sexual acting out, heavy alcohol/drug use, high risk driving. 
  • 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 job.
  • 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.  

When is hospitalization required?
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 without permission.
  • ·         Allows for both full detox from illegal drugs, alcohol abuse, incorrect medications or starting from scratch or over with new medication ‘cocktails.’ 
  • ·         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 consistent/reliable transportation.

·         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 denials. 
                Partial Hospitalization – may start with 2-7 days overnight stay then visit facility 2-3x weekly for group and physician sessions.
  • ·         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 consistent attendance.
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 week/month/ year. 
·         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. 
What 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:
·         Daily contact with a medical professional, with a specialty in mental illness/addiction.
·         Individual and Group counseling sessions throughout the day/evening.
·         3 meals – that may be served in a common area, cafeteria or at your bed.
·         Counseling 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 changes.  
·         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 perspective.

  • 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! 






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