Bipolar Disorder

What is it?

Everybody experiences mood shifts (changing between feeling happy or sad) in daily life. Bipolar disorder, in the past called manic depression, affects a persons mood in a much more dramatic and abnormal manner. It affects about 1 in 100 people, starting generally in young adulthood. There are periods or ‘episodes’ of depression, when the person feels very low, and mania, during which the individual feels very high (milder episodes of mania can be called hypomania). Episodes may last for several weeks.

How does it affect people?

The pattern of mood swings in bipolar disorder varies widely between individuals. Some will only have a couple of episodes in their lifetime and be stable in between, others may experience many episodes. During episodes the mood will be sufficiently abnormal to interfere with normal activities. The symptoms are:

Depressive episodes

Low self-esteem or self-worth
Pessimistic view of life/the future
Reduced energy levels and activity
Feeling hopeless or helpless
Poor concentration and memory
Lack of confidence
Self-harm or suicidal thoughts.

Mania episodes

Feeling very happy, elated, or euphoric (overjoyed)
Talking very quickly
Full of energy, not able to sleep
Full of self-importance
Full of ‘great’ new ideas and having ‘important’ plans
Being easily distracted
Being easily irritated, or agitated
Being delusional, having hallucinations and disturbed or illogical thinking
Not eating
Doing pleasurable things which often have disastrous consequences, such as spending large sums of money on expensive and sometimes unaffordable items
Lack of recognition that they are behaving abnormally.

How is it treated?

People with Bipolar Disorder will be under the clinical supervision of a psychiatrist. Treatment is usually:

Preventive medicines to stabilise mood and reduce the risk of episodes of mania, hypomania and depression, taken every day on a long-term basis
Medicines to treat the main symptoms of depression and mania should they occur
Learning to recognise things that might ‘trigger’ an episode
The individual, or close family members, learning to recognise the early signs of an episode.

How might it affect work?

The majority of people with Bipolar Disorder are able to control their condition with medication and are able to function and work as normal. During an episode their ability to work and their behaviour will depend on the nature and severity of the mood swing. Recovery from an episode may necessitate a return to work plan to build up their hours over a period of a few weeks and reduce the demands placed upon them.

The condition is long term so will require regular clinical monitoring. This should not significantly interfere with work activity.

There may be concerns about a safety risk to the sufferer, colleagues and others. Provided the condition is well controlled this is rarely an issue. However the individual must inform the DVLA of their condition as it may have implications for driving.

What do I need to do as the Manager?

Given the variability of the condition, you may want to ask the employee how their illness affects them to understand whether work is likely to be affected. Clearly this will be sensitive information and you should regard it as confidential. If you have concerns, or if the individual prefers, you may refer to OH for their advice.

If you are concerned that the individual is not behaving normally, talk to them about this as soon as you notice things going wrong. It is much better to treat an episode early and the individual themselves may not be aware of early signs. You and your work colleagues are well placed to notice early changes.

Encourage them to seek help from their GP, their psychiatrist or the community mental health team. You may also have internal support services in your organisation, such as an employee assistance programme, which may be able to offer you support in talking to someone with this condition.

Returning to work following an episode may require short term modified duties. Talk to the employee about any problems they have with work tasks or work durations. Review their duties weekly.

Examples of modifications that could help include:

Reduce demands of the role
Reducing hours
Modifying duties if they are having difficulty with a particular task, such as dealing with the general public
Moving from night shift to day shift.

It is likely the individual will experience an increase in the severity of symptoms as they increase their activity levels, this is normal and does not mean that they have caused themselves harm or will relapse further.

Key points to consider when managing an employee with bipolar disorder

Most people with Bipolar Disorder are able to control their symptoms with medication and will be able to work normally
Be aware of changes in behaviour and encourage the individual to seek help as soon as possible if you observe these
Focus on supporting the employee; if they are well enough, help them to remain at work or to return to work as quickly as possible
Employees do not need to wait until they are completely better before they return to work.