Learning to Care for Someone With Bipolar I Disorder

PATIENT PERSPECTIVES

My first exposure to bipolar disorder (BD) was through my husband’s aunt. What I saw was someone whose illness significantly disrupted her daily life. Until my husband, Smitty, was diagnosed with bipolar I disorder (BD-I), that was my perception of the illness. That understanding changed once I learned more about what it is like to navigate BD when the right support is in place. I have seen the impact treatment, including medication and therapy, can have on a person living with BD, as well as their loved ones and care partners.

Looking back on Smitty’s life leading up to his diagnosis, there were long stretches when he barely slept so he was highly productive. At the time, it looked to me and others like he was driven. It was not until a severe episode landed him in the hospital that we began to understand something more was going on. That first hospitalization followed an acute episode of psychosis and it was frightening for our whole family. Over the years to come, there were additional hospital stays as his symptoms evolved, and doctors tried different medications, always with the goal of finding a treatment plan that worked for him. Watching him live through those treatments, including managing various adverse effects, contributed to my understanding of the complexity of BD-I. All these experiences also influenced how I learned to show up beside him as an involved and dedicated care partner.

Learning to Notice What Others Do Not See

Being a care partner is not something most people think about or know how to prepare for. It is also a role that changes over time. What I knew and how I was able to support Smitty was much different at the beginning of his journey than it is today. For example, I have learned a helpful approach to recognize the small changes. I call it the “3 Cs”: catch it, check it and change it.

First, I have to catch what does not feel right—whether it is a change in behavior, mood, or energy—especially after a medication adjustment. Throughout this process, I have learned what those early changes usually look like for Smitty. For him, sleep and an observable change in his energy level are often the first signs of a shift. These signs—even when they are small—have taught me when to pay closer attention and when to reach out for help.

Second, I check it. That might mean asking questions, calling Smitty’s doctor or continuing to monitor his behavior. With Smitty’s awareness and support, I have an open line of communication with his doctor and will reach out directly with questions or concerns. It is not about taking Smitty out of the conversation, it is about helping each of us stay informed and engaged in his wellness.

Finally, we act together to change something that is not working as designed or expected, whether that is a dose, a routine or the treatment plan, based on what Smitty’s health care providers recommend. It may not be a permanent change. Sometimes, small dosing adjustments can be helpful to get us through particularly busy or stressful periods of life. The priority is being proactive and working together to plan for those moments.

Smitty adds a fourth C: communicate. Without it, nothing works. We have worked hard to build routines, establish trust, and develop care team relationships so we can be proactive rather than reactive.

Balancing Care Partner Responsibilities

Part of the role I have taken on for myself is to help keep up with all Smitty’s medications and ensure that I know his routine, including dosage and schedules. If that routine slips, I have learned the warning signs that tend to follow. That consistency has become part of how we, individually and as a family, stay well.

When his behavior changes, my role as his care partner changes accordingly. If he is feeling more mania or depression, that influences how I respond to support him. For example, during periods of mania, spending can increase and I will remind him, “We need to slow down. We still have bills to pay.”

Those conversations are hard because I am his wife and I do not want to feel like I am managing him. But I also know when something does not feel right. Finding the right balance between these 2 roles has taken time and been one of the hardest parts to learn. I still think about where being a spouse ends and where being a care partner begins. I have had to learn when to step in and when to step back. Sometimes that means speaking up when something feels off. Other times it means trusting that he knows himself and can lead his own care.

Caregiving Changes the Care Partner

Through my husband’s journey and experience living with BD-I, I have come to learn more about myself as well. For a long time, I would say, “I don’t feel good,” because I did not know how to express what my "not feeling good" was. Before, I did not know how to acknowledge or name it. Now I know and am comfortable saying that I have experienced depression myself.

Seeing a trusted health care provider helped me work through this diagnosis. Even having a name for it made a difference. Knowing there were treatments that could help also made a difference. For a long time, I did not know there were medications that could help me, similar to how there were medications to help Smitty. I had assumed I simply needed to push through the stress and fatigue I was feeling, without realizing that care partners can struggle too and deserve support as much as the person living with the disease does. An important realization for me has been knowing that care partners’ needs deserve their own awareness and support—I cannot help Smitty if I am not taking care of myself.

Community Matters

Another thing I have learned on this journey is that community is critical. For years, I was part of a National Alliance on Mental Illness (NAMI) support group. It helped more than I expected. Listening to other care partners share their experiences helped me realize how many of us feel alone in this journey. We would share our stories, sometimes without even knowing each other very well, and it made a difference simply to be heard.

Being in that group helped me understand, and then continued to serve as a reminder, that I was not the only one trying to figure things out day by day. Everyone in that room understood what it meant to love someone living with a serious mental illness. Connecting with support is something I recommend to anyone in a care partner role. It does not have to be NAMI or another formal support group, but seeking out individuals and connections that support your needs is critical and has truly helped me.

Why Clinicians Matter So Much

Smitty and I are so fortunate to have a psychiatrist we trust deeply as part of Smitty’s care team. I have his cell number and he knows that if I call, it is for a good reason and I am asking for his time-sensitive guidance or intervention.

The ways we work with the psychiatrist, either individually or together, vary. Sometimes Smitty will talk directly with his doctor. Sometimes we go into the office together. There have been times when he is literally seated us on opposite sides of the room to help us communicate better. More than once, I have reflected on his role in this whole experience and why his involvement has had such an impact for us.

The answer is simple: this is where a trusted clinician’s training and experience help bring patients and care partners together in a shared partnership, guiding them through a complex and deeply personal process.

We are grateful to have had such a connected and supportive health care provider and I understand that is not everyone’s experience. I believe that anyone navigating an illness like BD-I deserves a similarly involved team.

Insights From an Expert

Kevin N. Williams, MS, MPAS, PA-C, a psychiatric clinician with expertise in BD-I treatment, emphasizes that care partners are an important connector between what happens in the office and what happens at home. Having an engaged and committed care partner can help the prescribing clinician be more aware of changes in sleep, behavior or daily functioning that may not be evident during short in-office appointments.

At the same time, he cautions that the patient’s voice still needs to be directly represented. When care partners begin to speak for patients or override their experience, trust can break down. In his practice, the most effective care happens when clinicians invite care partners into the conversation with clear boundaries, creating a shared understanding of what to watch for and when to intervene. That partnership helps patients feel supported rather than monitored and allows care teams to respond earlier, before symptoms escalate into crisis.

He notes that when care partners feel respected and included, patients are more likely to stay engaged in care and trust the treatment process. This kind of partnership allows care teams to respond earlier, before symptoms escalate.

While we have not worked with Kevin during Smitty’s treatment journey, in my experience, his observations are accurate. It makes a difference when clinicians ask what I am seeing at home and help me understand what changes matter most. Knowing when to call, what to watch for and how to share concerns makes me feel like part of the care team instead of standing on the sidelines.

Learning as We Go

At the beginning of this experience, my learning curve was especially steep, but for me the learning has never stopped. I read constantly. I look things up. I print articles. I bring questions to appointments. Advocacy often looks like education, not just for the person living with a serious mental illness, but for the care partner, too. Understanding the illness became one of the ways I learned how to help.

If there is one thing I wish newly diagnosed individuals and their care partners understood, it is this: self-compassion matters. People do not choose mental illness any more than they choose cancer or heart disease. Medications are not always right the first time and it is important to stick with it to find the right treatment plan. Compassion, for yourself and for each other, helps in each step of the process.

Smitty once told me that, in a strange way, his illness brought us closer. We had to learn how to work together, with his doctor, with our family, and with each other, to keep him well. It became something we faced together rather than something he faced alone. I have learned that stability does not mean perfect days, it means believing that things can be better. And I have learned that help exists and hope persists.

Ms Smith is a retired professional whose career included work in marketing and public service. She lives in Mississippi with her husband of 30 years and has been an active care partner throughout his journey living with bipolar 1 disorder. She is passionate about supporting families navigating mental health challenges and has been an active member of her local garden club for more than 35 years.

Acknowledgement: Ms Smith wrote the article with insights from Kevin N. Williams MS, MPAS, PA-C, the lead clinician at OnPoint Behavioral Health.