Dr Sarah Russell¹, Dr Jan Browne¹ and Margie Nunn¹
¹ Research Matters
beyondblue Victorian Centre of Excellence
Project completion year
This project examined factors that enable people with bipolar disorder (also known as manic depression) to stay well. Participants were invited to share information about:
- how they stay well
- their early signs of things going wrong
- strategies to prevent an episode of illness
Rather than recruit participants through mental health organisations, the study recruited 100 people with bipolar disorder from the general community. Those eligible for inclusion were people with bipolar disorder who had stayed well for two years or longer. Although the sample does not represent all people who experience bipolar disorder, the research fills an important gap in previous Australian mental health research. By documenting how people manage bipolar disorder, this research provides important new insights.
The findings provide evidence that, when diagnosed correctly and treated appropriately, people with bipolar disorder can get well, and stay well. Although there was no “one-fix-fixes-all”, participants learnt what worked for them, and what did not work.
A key finding of this research was the role of stay-well plans in the successful management of bipolar disorder. A stay-well plan helped many participants to gain greater control over their illness. Although participants were aware that the illness could not be cured, they felt able to prevent relapses of illness. By actively managing bipolar disorder, participants were able to control their lives and stay well.
Participants described how they minimised the impact that bipolar disorder had on their lives. Participants described the importance of observing early warning signs – small changes in their physical, mental, and emotional status. Rather than wait until late signs of hypomania or depression, participants felt it was important to be aware of minor changes in mood and behaviour.
When participants experienced early warning signals, they implemented interventions to ensure they avoided episodes of illness. There were many different types of interventions. Participants’ “stay-well strategies” were based on their individual needs and social contexts.
Implications for Policy and Practice
Rather than focus only on crisis management, the emphasis of policy needs to include assisting people with a mental illness to prevent episodes of illness. A wellness approach will help to decrease stigma by demonstrating that people with a mental illness can stay well.
In addition to biomedical factors, the stay-well plan also emphasises social, environmental, and personal factors. A stay-well plan empowers people with bipolar disorder to identify their own specific triggers and early-warning signs, and to develop individual strategies to prevent episodes of illness.
The findings of this research were: shared with all 100 participants, also published in a number of journals (see below), and also resulted in the publication of a book A lifelong journey: staying well with manic depression/bipolar disorder (Michelle Anderson Publishing).
Research Matters received funding to develop two innovative Stay-Well Programs:
Stay-Well Workshop for health professionals and carers and Stay-Well program for people with bipolar disorder.
About the Researchers
Dr Sarah Russell and Ms Margie Nunn have been friends for many years, though it was not until 2003 that they first discussed their experience of mental illness. They shared their different ways of managing manic depression. This sparked their curiosity to hear how other people prevented episodes of mania and depression. Dr Russell and Dr Jan Browne have considerable experience in community-engagement processes. After being awarded a research grant from beyondblue, Sarah told Jan that she had lived with bipolar disorder for 25 years. To disclose to work colleagues, particularly academics and health professionals, is risky. However, Jan saw past the illness and saw Sarah, her colleague and friend.
Russell, S and Browne, J. Staying well with bipolar disorder Australian and New Zealand Journal of Psychiatry 2005; 39:187-193
Russell S and Browne,. J “Stay well plans can benefit people with bipolar disorder” Primary Mental Health Care Resource Centre Newsletter 2005; 2 (2): 17-18
Russell S, Browne J, Nunn M Staying well with bipolar Ausinetter: Australian network for promotion, prevention and early intervention for mental health 2004; 21 (2): 20-22
Russell S Staying well with bipolar disorder New Paradigm June 2005
Russell S “Staying well with a stay well plan” Bipolar Disorder educational program, Black Dog Institute