Professor David Castle¹, Professor Isaac Schweitzer²΄³, Professor
Leon Piterman4, Professor Michael Berk5 and Neil Cole6
¹ Mental Health Research Institute of Victoria
²University of Melbourne
³ The Melbourne Clinic
4 Monash University
5 Barwon Health
6 Consumer Consultant
beyondblue Victorian Centre of Excellence
Project completion year
Bipolar disorder is a chronic, recurring condition which is characterised by periods of elevated, high or irritable mood (mania or hypomania) and depressed mood. Whilst medication is helpful in managing symptoms of bipolar disorder, many people continue to experience on-going symptoms which impact on their ability to function in daily life. Sadly, bipolar disorder is associated with high rates of suicide, unemployment and relationship difficulties with few services available to address these issues.
In response to these serious problems, the researchers have developed a structured psychosocial program.
The program, known as MAPS, is a 12-session group intervention which enables people with bipolar disorder to:
- monitor their mood
- assess triggers and early warning signs
- prevent relapse and set goals.
- It is facilitated by two mental health clinicians, with a maximum of six participants. The program was informed by research literature regarding effective interventions and focus groups with consumers, carers and service providers.
The aims of this program were fourfold. To:
- develop a group-based intervention and relapse prevention package to assist people with a diagnosis of bipolar disorder to maintain and manage their disorder over the course of their lives
- integrate treatment interventions through the use of a Collaborative Therapy Framework (Collaborative Self-management)
- implement the project in a setting that is inclusive of primary care, general medical, and specialist mental health services, across both public and private sector
- and evaluate using a Randomized Control Trial, the effectiveness of the Collaborative Therapy Self-management package for people with bipolar disorder.
Participants in the study were individuals over 18 years of age with a diagnosis of Bipolar Disorder and under the care of a medical practitioner. Individuals agreeing to participate in the study were randomly assigned by a computer program to receive routine treatment or to receive routine treatment plus the group intervention.
This allowed us to assess whether the group intervention benefited participants by comparing their outcomes to a similar population over a period of 12 months. Random assignment of participants ensures that the researchers are not favouring the program by including those individuals that they think will do best. Participants who were in the routine treatment group were offered the group intervention once the study was completed. Participants enrolled in the study were assessed prior to commencement of the intervention to ascertain the severity of their symptoms, ability to function in daily life, as well as how often they experienced an episode of illness. At the completion of the group sessions, all participants were followed up monthly to assess any mood episodes or relapses. Further follow up assessments were conducted at three and 12 months.
84 people participated in the research project at a range of services including Barwon Health, Pathways Rehabilitation and Support Services, the Geelong Clinic, the Melbourne Clinic, Mental Health Research Institute and Swinburne University Psychology Clinic.
Preliminary findings demonstrate that immediately following completion of the group program, participants experienced fewer psychiatric symptoms especially anxiety and depression, better psychological health and improved functioning in daily life, when compared to those who received routine treatment alone.
When comparing the two groups, participants in the intervention group who experienced relapse had a better recovery rate than those receiving routine care.
Feedback from participants has been positive. One participant said: “It works! It gives you the skills to manage your illness, because you have the tools within yourself to predict, plan and minimise its impact”. Another commented: “I was very impressed with the material and the teaching. It has fine tuned my understanding of bipolar disorder so that it is a nuisance rather than the biggest thing in my life.”
Since completing the MAPS program, a number of participants have been able to return to the workforce, take up leisure activities and handle major life stressors such as travel and moving house.
These pleasing results have been disseminated widely at conferences, local and international, and through publications in academic journals
Implications for Policy and Practice
The Better Access to Mental Health Care initiative affords the opportunity for people to access group programs through Medicare. To ensure that the MAPS program is sustainable beyond the life of the research project, facilitator training workshops have been developed. At project completion, 16 mental health clinicians have been trained to deliver the MAPS program within their service.
About the Researchers
The research team at the Collaborative Therapy Unit, inclusive of senior investigators, from a broad range of professional backgrounds has come together under the direction of David Castle. The common passion is to a model of care that incorporates effective pharmacological treatments whilst specifically addressing the psychosocial needs of the person, thereby providing a more holistic approach to treatment. The focus is the involvement of the individual in managing their health over their lifetime and the development of partnerships with family and services to enable individuals to achieve optimal health and well-being.