Director of Research at Bipolar UK and Honorary Cardiff University staff member Dr Tania Gergel has been featured in a prestigious journal calling for more understanding into bipolar and suicide.
Please note that this blog contains references to suicide.
Despite a decline in global suicide rates, approximately 30-60% of people living with bipolar will make at least one attempt on their life, with 15-20% dying by suicide.
Additionally, suicide is partly responsible for the lower mortality rate of people living with bipolar, which stands at around 20 years lower than the general population.
These numbers may in fact be much larger, because not only is suicide in people with bipolar a largely under-resourced area of research, but the journey from seeking help to receiving a diagnosis takes on average ten years.
Bridging the gap in understanding
Despite an awareness of suicide risk in people with bipolar, research has shown that those living with the condition are often more severely unwell and suicidal than what their assessments with healthcare professionals show, sometimes even in the week before suicide.
This difference between clinical assessment and how people actually feel points to a lack of understanding of how suicidal behaviour presents differently from person to person, especially in those with bipolar.
Dr Gergel, who lives with bipolar, highlighted this lack of understanding through sharing her own experience:
The most pervasive and devastating feature [of my episodes] is obsessive and unrelenting suicidality, which has, all too frequently, culminated in a decision and consequent actions to kill myself.
However, Dr Gergel emphasised that because on the surface she seemed calm and articulate, nobody could recognise the ‘violence, disturbance, irrationality, and loss of control within my mind’.
This led to her subsequent release from care, as her clinical assessment indicated that she was not at risk.
Challenging this, Dr Gergel advocated for the use of Advance Choice Documents, which are written by the individual and outline what treatment and care a person would like to receive in the event of an episode, and additionally what symptoms healthcare professionals need to look out for in order to provide the best care and potential suicide prevention.
“With my self-binding document in place, I hope that I might, once again, be able to protect myself and my family from the self-destruction of bipolar suicide.”
Further recommendations Dr Gergel made include changing the language around suicide. By referring to someone as a ‘suicide survivor’ instead of by their attempt, it no longer undermines the severity and intent of their action.
Additionally, Dr Gergel calls for experts in lived experience to fill the gaps in understanding of bipolar suicide, referring to their invaluable insight as an ‘untapped resource’.
Including people with lived experience in research not only allows clinicians to recognise the multiple ways suicidality can present itself, but also promotes self-reflection of mood patterns and symptoms associated with suicidality allowing for preventative measures to be put in place.
“I am among the fortunate—first, in surviving multiple attempts to take my own life, and second, in being afforded the clinical help and external support to ensure that my suicidal intentions and risks can now be understood and managed.
Knowing that so many people are still dying grieves me deeply. Why is bipolar suicide so difficult to reduce? Why is so little targeted and effective research being done to reduce risks and increase survival?
‘Suicide and bipolar disorder: opportunities to change the agenda’ is available to read in The Lancet Psychiatry
Read more
- NCMH | Advance Choice Documents
- Website | AdvanceChoice.org