How can I help my loved one during a manic episode?

Note: NAMI volunteers are not medical or mental health professionals, and we cannot offer medical or mental health advice.  The material outlined below is informational and we hope that it helps provide guidance toward getting support.

Seeing someone you care about experiencing a manic episode can be difficult. Mania is a symptom of several serious mental health conditions, including bipolar disorder, cyclothymic disorder and schizoaffective disorder, that cause dramatic shifts in a person’s mood, energy and ability to think clearly. People living with these conditions can experience high moods known as mania, which differ from the typical ups-and-downs most people experience. Hypomania is a milder form of mania that doesn’t include psychotic episodes. Some people will have episodes of mania or hypomania many times throughout their life; others may experience them only rarely.

Although some individuals may find the elevated mood of mania appealing—especially if it occurs after depression—the “high” does not stop at a comfortable or controllable level. Moods can rapidly become more irritable, behavior more unpredictable and judgment more impaired. During periods of mania, people frequently behave impulsively, make reckless decisions and take unusual risks.Most of the time, people in manic states are unaware of the negative consequences of their actions. Learning from prior episodes what kinds of behavior signals “red flags” of manic behavior can help manage the symptoms of the illness.

Sometimes manic episodes also feature psychosis, a symptom that involves loss of contact with reality. People living with psychosis experience disruptions to their thoughts and perceptions that make it difficult to recognize what is real and what isn’t. They may see, hear, feel, taste or smell things that aren’t there or have strange, persistent thoughts, behaviors, and emotions

If you are concerned about a loved one who is experiencing a manic episode, NAMI can help. NAMI and NAMI Affiliates provide support and information about programs and community resources for you and your family.  You can prepare yourself by learning more about serious mental illness. You may wish to consult the Bipolar Disorder page of NAMI’s website where you will find information on mania, current treatments, and ways to support recovery.

You may want to reach out to your local NAMI affiliate to look into participation in a NAMI Family-To-Family class where you can find information and strategies for taking care of the person you love, or a NAMI Family Support Group where you can gain insight from the challenges and successes of others facing similar experiences. Also, NAMI Peer-to Peer is a free educational program where your loved one can get help better understanding themselves and their recovery, while NAMI Connection is a support group for individuals who experience mental illness.  NAMI Peer-to-Peer Classes are free, eight-session educational program for adults with mental health conditions who are looking to better understand themselves and their recovery. Taught by trained leaders with lived experience, this program includes activities, discussions and informative videos. However, as with all NAMI programs, it does not include recommendations for treatment approaches.

Additionally, you may find the following resources helpful:

Depression & Bipolar Support Alliance (DBSA), (800) 826-3632, is a comprehensive resource for more than 23 million people in the U.S. who live with mood disorders, including information on treatment, resources, and support groups. Through the DBSA  Support Group Locator you can search for in-person and online support groups that focus on support for individuals and families of those living with mood disorders.
Information on additional Bipolar Disorder-specific organizations are included on the website of Bipolar Caregivers, which provides easily accessible information on its website for caregivers of people with bipolar disorder, including information and suggestions for caregivers about treatment and management of the disorder, ways to support recovery, and ways for caregivers to support themselves when caring for a loved one with bipolar disorder. 
Juvenile Bipolar Research Foundation provides extensive information for families on juvenile-onset of bipolar disorder and fear of harm through research, education, and outreach.  Offers video conference support groups for parents and patients living with Fear of Harm.
The website of bphope.com offers an online community that strives to increase the awareness of bipolar disorder and to provide hope and empowerment to those in the bipolar community — people with bipolar disorder, along with their families, caregivers, and health-care professionals.  Provides numerous online support groups.

Helping During a Manic Episode

It can be distressing to see a loved one experiencing a manic episode, but there are some ways you can try to help.

Stay calm. Respond calmly and gently; avoid arguing with or confronting your loved one about their beliefs or behaviors.
Learn about anosognosia. People who experience mania may also experience anosognosia, a symptom of serious mental illnesses such as schizoaffective disorder or bipolar disorder, which damages the brain’s frontal lobe and affects a person’s ability to recognize that they are ill. Anosognosia is also experienced by many people living with Alzheimer’s, traumatic brain injury or strokes.
Listen. Use active listening to build trust with your loved one: “I hear you saying that you have special powers. Do I have that right?”
Be an ally. Offering empathy can build the kind of positive, trusting relationship with your loved one that may eventually help them agree to partner in their recovery.
Offer assistance. Ask if you can help. “I know you’ve been feeling restless lately.Would you like to take a walk with me?”
Quiet environment. Avoid highly stimulating environments (for example, big crowds, bright lights, lots of noise).
Let it go. Mania sometimes causes individuals to become unusually irritable or disagreeable. Try not to take things personally.
Give them space. Allow your loved one their personal space. Try not to stand too close or block their exit from the room.
Redirect. Try to delay or redirect impulses, if possible. Suggest that your loved one hold off on big life changes, sudden travel, or major purchases.
Focus on the person, not the mania. Being helpful to your loved one doesn’t mean confirming that their thoughts and experiences are real. Instead, try simple, supportive statements like, “I don’t know what to make of what you’re saying. It’s distressing to hear this, but I’m glad you’re telling me. How are you handling it?”
Reach out for help. If your loved one’s symptoms reach a point where they are a risk to themselves or others, or they’re not meeting their basic needs (e.g., not eating, not drinking, putting themselves in danger), seek urgent help.

How Can I Get My Loved One to Realize They Need Help?

Often an individual living with a mental health diagnosis – particularly one that involves a serious mental health condition (or one complicated by substance use disorder) – may not actively participate in their own recovery.  This is known as Anosognosia [Ah-no-zog-nosha], a symptom that can accompany a serious mental health condition and render the individual unable to recognize that they have a mental health condition and/or that they need to seek help.  Anosognosia can be especially troubling for families and friends who are often responsible for providing care for their loved one.

To learn techniques for communicating with your loved one, and to help them agree to partner in their recovery, we would recommend reading I’m Not Sick, I Don’t Need Help!, a book by Dr. Xavier Amador - a psychologist whose experiences with his own family demonstrated how challenging this phenomenon could be.  In his book, Dr. Amador discusses the condition of anosognosia and outlines strategies for communicating with a loved one to help them work toward recovery. Portions of the book are accessible to the public on our website here; the book is available in English and Spanish for purchase at online booksellers.

A broader discussion of the strategies of Dr. Amador’s LEAP method, including videos on how to apply the LEAP method, are available for public access here.

Being Prepared for a Crisis

Being prepared for a crisis by learning about resources and support services allows you to act fast and make good decisions.  You may find the information contained in the section of NAMI’s website on Getting Treatment During a Crisis to be particularly helpful.  You may also find our NAMI Guide, Navigating a Mental Health Crisis to be extremely informative.  Practical tips for what to do and how to react when a loved one is experiencing psychosis and in or near a crisis may be found here (insert link from comment).Additionally, the My Mental Health Crisis Plan App lets individuals clearly state treatment preferences, decide who can make decisions on their behalf, and share a crisis plan with doctors and other members of their care team.

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