Hope and Help: Managing Suicide Risk in Bipolar Disorder

People living with bipolar disorder are at increased risk of suicidal ideation (thoughts of suicide), particularly during depressive episodes or the transition between manic and depressive states. While therapy and medications can help, caregivers also play a crucial role in supporting their loved ones and mitigating the suicide risk in bipolar disorder.

By being aware of warning signs for suicide risk, opening compassionate conversations, and seeking prompt professional care, caregivers are empowered with helpful suicide prevention strategies to manage crisis situations.

Warning Signs of Suicide Risk in Bipolar Disorder

Recognizing the warning signs and indicators of suicidal ideation is crucial for early intervention. Although suicidal behavior varies, common signs of distress include the following:

• Expressing feelings of hopelessness, despair, or of being a burden or without value
• Exhibiting extreme mood swings and reckless behavior, including self-harm or heavy substance use
• Withdrawing from previously enjoyed activities and loved ones
• Making final arrangements, eg, drafting a will, giving away belongings, or writing goodbye notes

If caregivers observe these warning signs or other behaviors that seem out of character or concerning, opening a safe, non-judgmental conversation can be a valuable first step in preventing self-harm.

Compassionate Conversations

When talking with loved ones, caregivers should lead with empathy and focus on validating their concerns and feelings. It’s important to avoid minimizing their emotions or offering quick fixes, and to maintain a tone of kindness and understanding. Studies have shown that inquiring about self-harm does not make it more likely. A direct question, such as “Are you thinking about killing yourself?” could open a space for honest communication and allow for prompt support.

Professional Care for Suicide Risk in Bipolar Disorder

When the situation warrants, seeking professional care and emergency support is a vital step in preventing suicide and better managing the bipolar symptoms contributing to a loved one’s distress. If you believe your loved one is considering self-harm, encourage them to connect with their therapist, psychiatrist, or a crisis hotline like 988. The care team can help modify the treatment plan to address severe symptoms more effectively, potentially through adjustments to medication, lifestyle recommendations, and the development of new coping strategies.

In situations where the risk of self-harm is high, taking immediate practical safety measures is also crucial. This can include securing or removing any potentially lethal items (e.g., knives, medications, firearms, sharps, and cleaning chemicals), as well as ensuring the environment is free of other harmful objects. Furthermore, collaboratively developing a comprehensive crisis plan with your loved one (including emergency contacts, effective coping strategies, and involving the treatment team) can be an effective tool for managing future crises.

Responding to Immediate Danger

If you believe that your loved one is in immediate danger, your priority is their safety: contact emergency services immediately and do not leave them alone. Following a call to 988 or 911, it might also be useful to consult with your loved one’s care team to coordinate next steps. Remember, ensuring your loved one’s immediate safety and well-being is always the paramount concern. For long-term support, consider reaching out to organizations like Depression and Bipolar Support Alliance and the National Alliance on Mental Illness.

Caregiver Self-Care

As a caregiver, remember the emotional impact of supporting someone through a crisis. Prioritize your own well-being by acknowledging your feelings, reflecting on your own emotions, and practicing self-care. Don’t hesitate to seek support from a therapist or a caregiver group. By setting healthy boundaries, you can sustain your compassion and patience to build a strong and lasting support system for your loved one.

Suicide prevention in bipolar disorder is a collaborative effort. Through proactive, open conversations, implementation of practical safety measures, and ongoing partnerships with their care team, you can ensure your loved one’s continued safety and access to the support they need.

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Author

Raj Sastry is a graduate student at Harvard University passionate about mental health advocacy and the history of medicine.

 

 

Copy Editor

Johnny Kenton, PhD, is a biomedical neuroscientist and volunteer editor for Families for Depression Awareness. With a passion for clear, impactful writing, he founded Symbiotic Editing in 2024, specializing in academic editing. When he’s not refining manuscripts, Johnny enjoys exercising and spending time with his wife, their one-year-old son, and their dogs.