Screening for bipolar disorder should be routine, experts recommend

A new report finds that the current model for diagnosing and treating bipolar disorder is failing patients

17th November 2022 about a 3 minute read
“I want to be treated like an individual by someone who really understands bipolar. Not by different doctors every time who have only just skimmed through my notes.” Patient with bipolar quoted in Bipolar Minds Matter

The NHS should offer routine screening for bipolar disorder, along with specialist training to help doctors identify the condition, a new report says.

The report from the Bipolar Commission, Bipolar Minds Matter, recommends appointing a national director of mood disorders to make sure that everyone with the condition has access to a 12-week psychoeducation course, and a specialist doctor to oversee their prescriptions and ongoing care.

Currently, the report notes, it takes an average wait of nine-and-a-half-years to get a diagnosis. More than one million people in the UK have the condition, which leads to extreme changes in mood and energy levels – yet it is believed that 56% of people with bipolar have not been diagnosed. Many spend years seeking a diagnosis, or are misdiagnosed with depression, which means they do not receive appropriate treatment to stabilise their mood. The report also found that one in three people said they had attempted suicide while waiting for a diagnosis, while those who were misdiagnosed were more likely to be repeatedly admitted to hospital.

The report is based on one-to-one interviews with more than 100 expert witnesses, as well as 7,000 responses to seven surveys sent to patients, psychiatrists and friends and family.

Having bipolar increases the risk of suicide 20 fold, and at least 5% of all suicides are by people living with bipolar, the report found. It also noted that relapse rates are high, with 98% of interviewees saying they had relapsed at least once and just over half saying they had been hospitalised. People with bipolar live an estimated 10-15 years less than the average population, partly due to the higher rates of cardiovascular disease, the report notes, while 15% of interviewees had lost their home because of their condition.

One patient interviewed for the report said: “I want to be treated like an individual by someone who really understands bipolar. Not by different doctors every time who have only just skimmed through my notes.”

Patients should have access to psychological therapy

Professor Guy Goodwin, emeritus professor of psychiatry at the University of Oxford and co-chair of the commission, said that most patients with the condition are only referred to a psychiatrist if they are seriously unwell: “Psychiatric services see people when they are acutely ill … but, once recovered, people are discharged back to the care of their general practitioner. And that model we simply think doesn’t work.”

As well as engraining bipolar screening across GP- and hospital-led services and introducing specialist training to improve diagnostic accuracy, the report recommended that everyone diagnosed with bipolar disorder should have access to psychological therapy as well as a specialist clinician to oversee their care.

Simon Kitchen, the chief executive of Bipolar UK, said: “Continuity of care is the bedrock of this model, with strong long-term relationships between individual clinicians and patients a critical factor.

“There are currently not enough specialists in bipolar in the UK, which means that the symptoms are often being missed. People living with bipolar have a suicide risk that’s 20 times higher than people without bipolar.

“Not only will these changes improve the quality of life for the million-plus people with bipolar in the UK, they will literally save lives.”

FCC Insight

This report highlights the shortcomings of the health service’s current approach to diagnosis and treatment of a serious mental disorder. It is shocking that patients wait, on average, nearly 10 years for a diagnosis of bipolar, and that a third attempt suicide while waiting for a diagnosis. A new approach is clearly needed, and this expert report, based on extensive interviews and surveys, shows a way ahead, with recommendations for routine screening and specialist training.