Emergency Action Plans, and Choosing a “Referee” in the Management of Bipolar Disorder


By Darin Barry


I have had many different combinations of medications to balance my mood over the last eleven years since I had been diagnosed with bipolar 1. Over time, some medications have stopped working, or have had undesirable side effects. My psychiatrist always has another medicinal cocktail to replace the old. Then there’s the Cognitive Behavioral Therapy; weekly, monthly, or quarterly depending on how life is going for me. Cognitive Behavioral Therapy (C.B.T.) is talk therapy designed to help me see through delusional thinking that comes along with Bipolar 1 disorder. I’ve had good luck with therapists. I have gained a lot of insight from therapy. A solid psychiatrist, and a therapist who is familiar with bipolar patients are the indispensable foundation of my treatment for managing bipolar disorder.

I’ve become self-aware; I know when I am depressed, that is the easy end to figure out. At the other end is mania, which is a different monster, and one that isn’t always easy to self-diagnose because it can creep up on me.  Sometimes it’s hard for me to tell the difference between feeling really great, or if I am experiencing mania. Every bipolar person, well most, will say that they love their mania. I do. I am over-the-top creative when I am manic. I feel like I can tackle anything. But then it always ends the same –with me in rage mode, and in some sort of trouble. I have been arrested while manic, I have been unbelievably hostile when manic, and I have ended up in psych wards while manic. I can be just as dangerous, if not more so, than depression.

So, I’ve pretty much stated that I am self-aware except when I am not. In the last few years, I would say about ten percent of the time, I have not been self-aware while experiencing a bipolar episode. Luckily, I have a couple people in my life I trust enough to judge whether or not I am experiencing mania. I have found it essential to have these “referees” in my life to appraise my moods, so I can take the best action for my wellbeing when I am not myself. My brother Gordon is one of the referees. We sat down when I was without symptoms to talk about emergency planning.

In choosing my brother as a referee, several criteria points were fulfilled.  He is someone I can trust with no other motivations beside my best interest. He knows me well. He’s seen me in varying states of mind. Having read much about it, he is familiar with bipolar disorder  He is familiar with my emergency action plan.

I have personally been manipulated into agreeing to something I shouldn’t have when I have had people in my life that I had misplaced my trust with. Sometimes we find ourselves in dysfunctional relationships where our illness is the easy go to when others are trying to get their way. “What do you mean no, this is your illness talking”. We really don’t need people like that in our lives, people who have their own interest at heart, and not ours. Living with bipolar is hard enough.

I must agree to trust my brother fully when he uses the words, “Darin, you are not being yourself right now.” I must agree that no argument will come from me when my brother uses those words. Depending on the situation, I agree to take a time out from the situation, or refer to my emergency plan called a Wellness Recovery Action Plan, or W.R.A.P.

A W.R.A.P. plan is a proprietary mental health action plan that, among other valuable attributes,  comes into play when someone with mental illness is in crisis. WRAP is a self-designed action plan that includes a blueprint for getting well, staying well, and clear instruction on what, and who is involved in a crisis plan. My plan includes getting myself out of an environment of conflict, or where I feel ill at ease. Secondary is calling my therapist. Then perhaps my psychiatrist, then maybe the hospital where the instructions are to send me to the Crisis Stabilization Unit nearby. Lastly, a psychiatric hospital. My plan includes who to call, and who I don’t want contacted. It includes a release of information form so that my brother can communicate with behavioral health professionals, including my doctor.  My W.R.A.P. also lists all medications. The plan lists behaviors and traits that go along with feeling well, and what it looks like when I am not well.

My brother is the executor of a lot of responsibilities when I am not well. It’s a big job to ask of someone, but if a W.R.A.P. plan is done well, it also lists actions that keep me well, so hopefully it’s pretty rare that there is an emergency. Gordon has a really good attitude about being one of the trusted ones I consider my referee. But I am considerate about not wanting to load all responsibilities on him. Ideally, I like to have a few people share the burden of helping me out; for instance, I might ask a trusted neighbor to feed my cat while I am in a hospital. I don’t want to burn out my caregivers, or referee’s.

If you are finding a need to create an emergency plan, look towards creating your own W.R.A.P. plan.  Much can be found by a simple google search, but here is one link that is useful:  http://mentalhealthrecovery.com/wrap-is/  There is even a W.R.A.P app for your smartphone.

Bipolar disorder is something I can live with. Management, and vigilance are indispensable, and having someone I trust  to help me call the shots when I am down brings great peace of mind.