Keeping The Balance: helping people to manage their bi-polar

It’s estimated that as many as 90,000 Londoners have bipolar disorder and the capital’s health services have responded with a variety of innovative services and treatment methods to support people living with bipolar to better understand and manage their condition.

The Keeping The Balance Group, run by the Camden & Islington (C&I) NHS Foundation Trust’s Rehabilitation and Recovery division is one such service.

At first Frank was feeling down because of pressures at work.

"Three or four years ago was the first time I experienced a sort of depressive episode. I used to be a youth worker in Bradford, West Yorkshire, and I was working with some difficult young people doing sports and exercises with them. I was new in doing the job and one of my colleagues had to take sick leave. I began feeling despondent because of the workload. I was preparing activities which the kids would throw back in my face and it was the first time I felt I was failing at something.”

However, things began to pick up.

“I moved to Oxford with a new job, I got married and everything was great. But a year later, whilst everything was still supposed to be fantastic, I got another depressive episode. This time there was less rational reason for it - all the different areas of my life were going well.

“I kept feeling like a failure and like I was letting everyone down. I lost of lot of confidence and felt very anxious about the future. ”

This is when Frank decided to visit his GP and seek some advice. Although he was offered medication, he wanted to get through it with a change of mind set and eventually he thought he was OK again.

“Coming out of that depressive episode was the first time I think I had a manic episode and I was very, very high. At first I thought I was back to myself, I had that zest for life again and felt like things were really on the up. But a few people at work noticed I was a bit more erratic, a bit more hyper than normal and I wasn’t paying as much attention to detail.”

Around March 2014 Frank began to feel very low and for the first time began to experience suicidal thoughts.

“I started my own business doing personal training. It was good for the first six months or so but there were financial problems and again through the winter I was very down. It was the first time I felt suicidal. I live close to a bridge on the A1 and as I drove underneath it I would think it would be easy to jump off. I used to think about that a lot. I managed to finally tell my wife about these thoughts and she advised me to speak to my GP again.”

That summer Frank had a real wake-up call.

“I got another job whilst I was doing my personal training working in a school. Although I felt like everything was on the up, in hindsight I was very hyper, really chatty, very scatty and I lacked self-control in areas like spending. The head teacher called me into his office and I wound up getting fired. That’s when I realised something wasn’t right.”

After doing some research, with the support of his wife, Frank went back to the GP and discussed the symptoms he was experiencing. He was seen by a psychiatrist and diagnosed with bipolar affective disorder. Frank’s psychiatrist then referred him to the Keeping the Balance Group, which is run by C&I’s Rehabilitation and Recovery Division (R&R).

Dr Marigold Hayes, Clinical Psychologist, explains, “The group is a treatment option for people who are experiencing bipolar. It is a psycho-education based group and the aim is to help people to understand their diagnosis better and be able to find ways to better self-manage their condition. Frank attended the group that ran from the beginning of June 2015.”

Frank explained, “I think the group was very valuable for me. At first I wasn’t convinced this was the right thing for me. There was such a diverse range of people in the group and some people had, had the condition for 20 years whilst others had it for the past few months.”

There are 10 two hour sessions which take place over a number of weeks.

He added, “The structure was helpful. The first hour, you’re understanding the biological factors, the science behind it, potential hereditary symptoms. The second half is about practical triggers and early signs you can be aware of. I think I have already started to put these into practice. The other day, for example, I felt like I didn’t want to be around anyone.

“This time, I didn’t beat myself up about it, I thought I’m feeling low and so went and had a bit of time on my own and felt much better for it. I didn’t feel guilty about it.

“Prior to the sessions I would’ve felt like I needed to be in the situation and it almost like a failing if I couldn’t be sociable. Now, I think about it more practically. I know it’s better to have an early night, or have some time just me and my wife, instead of forcing me to go and do something which might make me feel anxious or bad about myself.”

Marigold added, “The first half of a group session is theory. We introduce a topic and we will give a presentation and do a small group task around that subject matter , for example ‘life style factors’ , the second half is an open discussion facilitated by two psychologists and the other team member. There is an opportunity for group members to talk about their experiences of having bipolar.”

Dr Emma Williams, a Clinical Psychologist also involved in running the service, added, “People say it feels like these sessions have helped to empower them because they feel better equipped to deal with having bipolar. They know how to weigh things up a bit better, and they can ask for what they want more.

“Often people coming to the group might be newly diagnosed or they may have been diagnosed for a longer time and it can be really difficult to accept the diagnosis and to feel hopeful about the future. The sense I have got from running the group is, in some ways, hearing others who’ve had similar experiences to you makes you realise you’re not alone and helps people to be more accepting of their diagnosis. That’s a powerful step in recovery. 

The support group members get from each other is a really key part of the group”.

Dr Sarah Buchanan, Clinical Psychologist, added, “The reason we run this group is because the NICE guidelines have highlighted that psycho-education groups are an effective way of helping people with bipolar affective disorder. There is research to suggest they are an effective means of reducing the severity and likelihood of relapse. We’re glad to find it really is making a difference to those that we have been able to run this group with.”

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