Bipolar Disorder: A Guide for Care and Support Staff

The NHS describes bipolar disorder as a mental health condition in which a person has extreme mood changes. It cannot be cured, but it can be managed with treatment. People with bipolar disorder move between periods of very high mood and periods of low mood, and they may have times in between when they feel well. For care and support staff, knowing what the different phases look like makes it easier to notice change early and respond with kindness. This guide is general information, not clinical advice.

High moods: mania and hypomania

The NHS explains that high moods can be severe, which is called mania, or milder, which is called hypomania. Symptoms listed by the NHS include:

• feeling very happy and excited, or sometimes irritable
• having lots of energy
• racing thoughts and fast speech
• increased sexual drive
• impulsive behaviour, including spending money
• in some cases, hallucinations or delusions

A person in a high phase may sleep very little and take on many projects. They may seem confident and fun to be around, and not see that anything is wrong. Staff may notice sleeplessness, talking fast, taking risks or making large purchases.

Low moods: depressive episodes

Low moods share symptoms with depression. The NHS lists feeling sad or upset, losing interest in activities, tiredness, disturbed sleep, appetite changes, low confidence, feelings of worthlessness, difficulty concentrating, withdrawing from other people and, in some cases, thoughts of suicide. Take any talk of suicide seriously. Follow your organisation's procedure and our guide to suicide and self-harm awareness for care staff.

Psychotic symptoms can occur

During severe episodes, some people experience hallucinations or delusions. If you support someone who does, see our guide to psychosis and schizophrenia for how to respond.

How treatment works

The NHS says treatment includes medicines to help stabilise moods and talking therapy such as cognitive behavioural therapy (CBT). Some medicines need to be taken continuously, while others are taken only during flare-ups. The NHS emphasises that people should not stop medication without their doctor's approval. In practice, that means supporting the person to take medicine as prescribed, noticing side effects and reporting them, and never encouraging someone to stop or skip doses.

Supporting a steady routine

The NHS recommends lifestyle approaches that help manage bipolar disorder: keeping a regular routine, getting enough sleep, eating healthily, exercising regularly and managing stress. It advises avoiding recreational drugs, smoking, too much alcohol, shift work and too much caffeine. Staff can help by:

• keeping daily routines consistent where possible
• supporting good sleep habits and noticing changes in sleep
• encouraging activity the person enjoys
• being alert to the effect of alcohol and other substances. Our substance misuse awareness guide may help
• recording changes in mood, energy and behaviour so the team can see patterns

Spotting early warning signs

Many people learn their own early warning signs, such as sleeping less, speeding up or withdrawing. If a person has told you theirs, share them with the team, with their consent, and write them into the care plan. Acting early can prevent a full episode.

When to get urgent help

The NHS notes that support is available if you or someone you know is having a mental health crisis or emergency, and that hospital admission or support from a crisis team may be needed if there is a risk of self-harm or suicide. Know your organisation's escalation procedure and who to call at any hour.

Respect, capacity and consent

Having bipolar disorder does not mean someone cannot make decisions. Capacity is assessed for each decision at the time it is needed. In a manic phase a person may take risks they would not take when well. Staff should balance the person's right to make choices with their duty to keep them safe, and should follow the Mental Capacity Act where relevant. See our guide to Mental Capacity Act and DoLS training.

Supporting families and carers

Relatives can feel worn down by cycles of high and low mood. With the person's consent, share information, explain who to call in a crisis and encourage them to look after their own wellbeing. Families often know the person's early warning signs better than anyone, so listening to them can prevent a relapse.

Recording and reporting

Keep factual notes on sleep, mood, energy, spending, risky behaviour and anything the person says about how they feel. Note the date and time and what was happening beforehand. Clear records help clinicians decide whether treatment needs reviewing, and they help the person see patterns in their own moods.

Avoiding stigma

Phrases like "she's so bipolar" for ordinary mood changes are unhelpful and hurtful. Describe a person as having bipolar disorder, not as "a bipolar". Treat people as individuals with strengths, goals and a life beyond their diagnosis.

Training for staff

Mental health awareness training helps staff respond with confidence and avoid stigma. Our mental health first aid guide is a good place to start, and our CPD courses include further options for care teams.

Key points to remember

• Bipolar disorder involves extreme mood changes, with high and low phases.
• It cannot be cured, but treatment with medicines and talking therapy can manage it.
• Support regular routines, good sleep and medicine as prescribed. Never encourage stopping medicine.
• Take any talk of suicide seriously and follow your escalation procedure.
• Assess capacity for each decision and respect the person's choices.

Sources

• NHS: Bipolar disorder, overview (nhs.uk), accessed October 2026