Listen and observe
If the person refuses to treat their bipolar disorder, listen and observe to try and understand why they refuse. Possible reasons include when the person:
- Has difficulty accepting that they have bipolar disorder or need treatment
- Does not wish to be connected with the stigma sometimes linked to bipolar disorder
- Enjoys hypomania or mania and does not want to treat them
- Is too ill to realize they need treatment
- Worries that if they take medication they may get side effects
- Does not want to become reliant on medication
- Finds that medication blunts their moods too much
Take appropriate action
Try to assess if the person is very ill or not. Does the person have severe bipolar symptoms that affect the way they function at home, work or socially? Are they in a bipolar crisis? Consider the 4 different situations below:
1. People who are very ill sometimes do not recognize their severe symptoms or the need for treatment. If the person is too ill to recognise they need treatment:
- It can help to develop an advance directive or plan with the person when they are relatively well about what treatment they prefer to receive when very ill (see planning for times when the person is severely ill).
- Gently let the person know that you think they need treatment.
- Offer to assist them to access treatment.
- Contact the person’s clinician, mental health team or if necessary get emergency help in a bipolar crisis.
2. If the person who refuses treatment is unwell but can still discuss things (e.g. they are not too severely manic or psychotic to follow the discussion):
- Consider clarifying with the person the reasons they have for not accessing treatment (see also what to do if the person wants to stop or reduce their medication ). Try to use good communication skills to prevent arguments.
- Suggest that they at least have an assessment with a clinician to see if they might benefit from treatment.
- Mention how treatment might help in terms of what is important to the person (e.g. treatment might help to reduce symptoms the person finds unpleasant, make it easier for them to achieve a valued goal, or prevent negative consequences).
- Suggest that the person discusses their concerns about treatment with someone who knows a lot about bipolar disorder.
- Discuss what behavior (e.g. spending sprees) you are not prepared to tolerate, as the person may seek treatment to reduce this behavior once they know that you won’t put up with it.
- Let the person know what boundary they have crossed (e.g. caused financial debt when manic), and the consequences if they don’t try to manage the illness (e.g. you will not pay off the person’s credit card).
- If they are finding it hard to function, offer to assist them to get treatment.
3. If the person who has been well has warning signs of illness but refuses treatment:
- Let them know that treating warning signs of mania early can prevent relapse.
- Keep an eye on them to see if they develop more symptoms or get worse.
- Try to negotiate with them to agree to get clinical help if things don’t improve or get worse within a set time.
4. If the person who refuses treatment is relatively well:
- Be patient, supportive, and when appropriate, encourage the person to seek treatment.
- Try to negotiate with them to get treatment if they develop symptoms.