by Katrina Miller

Created on: September 30, 2007

As bipolar illness is associated with a twenty percent mortality rate, it is critical to make the right decision when one observes that a person is having "an episode". If the patient gives any indication that he or she intends on killing themselves or someone else, the observer should immediately call an ambulance. A person who intends to harm themselves or others may be articulating their intention or may be involved in behaviors demonstrating that intention. The call for an ambulance may need to be done in a place or manner where the patient is not aware that the call is being made.

Most of the time, however, the imminence of the danger is not readily apparent. The need for intervention, however, is apparent, and one may not know what to do next to help the patient.
Any time that a person's behavior is such that one questions whether or not to hospitalize that person, the observer should contact someone who has expertise in assessing risk. The sources of experts who can help determine the level of risk and the next course of action include the following:
1. The patient's therapist, psychiatrist, or physician.
2. A suicide crisis line (1-800-Suicide)
3. A care manager associated with the patient's insurance. A care manager can be contacted by dialing the number on the person's insurance card associated with mental health precertification.
These experts will first make an assessment of risk, based on the following criteria:
1. Is the bipolar person at risk for suicide or harming others?
2. Is the bipolar person able to function independently?
3. Is there social and emotional support for the bipolar person available at home?
Often, the person is not an imminent risk of suicide. However, it is apparent that the patient requires some intensive intervention in order to reach the level of functioning that is customary for that person. This is the kind of decision that care managers are most prepared to assist with.
For example, the patient may benefit from intensive therapy that meets approximately three times a week for three hours at a time. This level of care is called "Intensive Outpatient Therapy". It is especially suited for people who have a relatively low risk of harming themselves or others, but are not functioning well because of their bipolar illness.
A more intense alternative is "Partial Hospitalization". Partial Hospitalization is a treatment arrangement that typically meets Monday through Friday for six to eight hours a day. This form of treatment is also

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