Failing to properly diagnose and treat people with bipolar disorder is wasting billions of pounds a year in the UK, according to new data shared exclusively with the BBC. Experts say many of the estimated million people living with this condition are “ghosts in the system”, whose lives are being torn apart by poorly managed extreme suicidal lows or manic, erratic highs.
Emma was diagnosed with bipolar disorder in her early 30s, after experiencing a mental health crisis. When she was 32 weeks pregnant, her grandmother died unexpectedly, sending her into a “deep low”. “I felt awful, but the perinatal team wouldn’t take me on,” she says. “They said my symptoms weren’t that serious.”
When she gave birth, the extreme lows of her pregnancy were replaced by an unexpected high. She felt amazing in the days after her baby was born – but she didn’t sleep and her behaviour became increasingly erratic. A few weeks later, her mood flipped again. When her baby was three weeks old, Emma took an overdose. It took a week in hospital for her liver function to return. But even after that, she was in and out of hospital for a year before finally being diagnosed with bipolar disorder, and medicated correctly. “If I had the correct care, and been listened to during my pregnancy or even earlier, I could have avoided taking that overdose – 100%,” she says.
It wasn’t Emma’s first experience of poor mental health – she’d spent her teens seeing doctors and receiving different antidepressants. No one had ever suggested she might have bipolar disorder.
Experts have told the BBC how most people living with bipolar disorder in the UK are “undertreated, undiagnosed and left to try and survive in a system that has failed them”. The Maudsley Hospital, in South London, has an intensive specialist care programme for its sickest, most regularly relapsing bipolar patients. The service aims to try and stop patients hitting crisis point. Similar to services offered in other European nations, the hospital provides group sessions for patients and their families. The classes help patients to understand when an episode might be starting and then contact the service once they spot early warning signs. They can then attend an outpatient clinic and adjust medications. The relatively cheap programme has seen re-admission rates to hospital fall by 80% as intervention takes place before a crisis.
Prof Young says costs associated with bipolar disorder could be halved with more specialist care programmes. “Undoubtedly, specialist treatment could contribute to getting lots of people back into work. And we know that work is very good for helping people recover from episodes of mental ill health.”
However, many experts say patients still face a postcode lottery about whether they can see a psychiatrist at all. Carolyn Chew-Graham, a GP and professor of general practice research at Keele University, says those who are acutely unwell will be picked up quickly by crisis teams but those with “less florid manic episodes” can miss out on referral to specialists for diagnosis. “There’s a high threshold of referral,” Prof Chew-Graham says. “People really have to be quite unwell before they are seen in specialist services”.
Prof Young says bipolar patients need long-term specialist care. “But that’s the frustration here – even though there is strong evidence that specialist care improves the outcomes for the patient, and costs the state less, there are still so few bipolar specialist facilities. It’s a tragedy.”
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