10 Bipolar Disorder and Mental Health Stories from 2023
What in the world happened in 2023?
Hello,
It’s Tuesday, January 2nd, and this is Bipolar and Bipartisan.
It’s also a new year, which comes with new resolutions. I started this newsletter last year as an outlet to make a small difference, following a difficult and eye-opening personal experience with our mental health system. Early momentum to write pattered out quickly, but I resolve to publish more newsletters this year than last.
Before we look ahead to 2024, below are some stories that caught my eye from 2023 — alternating between those that give me hope and those that keep me up at night. I hope you find them illustrative of some of the challenges and opportunities on mental health we have.
Sincerely,
Tyler
1. A U.S. Senate Mental Health Caucus. A group of ten U.S. Senators formed a new bipartisan caucus in the U.S. Senate to focus on mental health policy. The caucus has four major priorities:
Improve prevention and early intervention efforts;
Expand the country’s mental health professional workforce;
Enhance our nation’s crisis response services;
Increase access to evidence-based mental health treatment and common-sense solutions for all Americans.
The caucus was founded by the U.S. Senators Tina Smith (D-MN), Alex Padilla (D-CA), Thom Tillis (R-NC), and Joni Ernst (R-IA) and would not have happened without the advocacy of nonprofit organizations including the National Alliance on Mental Illness (NAMI) and the American Foundation for Suicide Foundaiton (AFSP). The other members of the caucus are U.S. Senators Cory Booker (D-NJ), Shelley Moore Capito (R-WV), Susan Collins (R-ME), John Fetterman (D-PA), Amy Klobuchar (D-MN), and Lisa Murkowski (R-AK). Federal public policy on mental health matters a lot, and this caucus will hopefully make a difference.
2. Mass Shootings and Mental Health. Unfortunately, a good share of coverage about mental health in our country is in response to events in which mentally ill people commit mass murder. 2023 was no exception, and it’s the media’s responsibility to report on the facts.
18 people died in Lewiston, Maine after a man fell through the cracks of our mental health system. ABC News reported attempts by the murderer’s family to raise alarms to both the police and his Army Reserve supervisors, and despite an in-patient hospitalization over the summer, he clearly never got connected to the care he needed. He had experienced bouts of paranoia, one symptom of bipolar disorder and other mental illnesses.
One big public policy debate followed the shooting: if Maine had a “red flag” law, not a “yellow flag” law, could the violence have been prevented? 22 states have “red flag” laws permitting family members to petition a court to take guns away from mentally ill patients. But Maine’s 2019 law is different, and requires the police (not family) to issue a court order, and courts can only take guns away following a mental health diagnosis by a licensed professional.
3. $60 Million in Grants to 100+ Bipolar Disorder Researchers. Breakthrough Discoveries for thriving with Bipolar Disorder is a new organization with a mission to accelerate scientific understanding of bipolar disorder and advance clinical care through cross-disciplinary collaboration, data sharing, and real-time learning. The organization seeks to create opportunities for clinicians and scientists to collaborate and build on the findings of others — a seemingly common-sense idea that is actually quite rare in mental illness research. The funded projects seek to address four foundational questions related to bipolar disorder:
What are the biological pathways?
What are the genetic contributions?
Are there differences in the brain?
How can we bridge insight with precision psychiatry?
Learn more on BD2’s website and in their annual report.
4. Teen girls are at increasing risk. An 89 page study from the Center for Disease Control put a spotlight on teenage girl mental health. The stats are alarming: girls seriously considering suicide is up 60% over the last decade; more than one in ten high school girls have been forced to have sex; from 2011 to 2021, the number of girls reporting persistent sadness or hopelessness increased from 36% to 57%.
A key end result? Suicide is now the second largest cause of death among all 15-19 year olds, and the largest among 14 and 15 year olds.
5. Metformin may prevent weight gain for bipolar patients. A new study, covered by the U.S. News and World Report, found that a drug typically prescribed for preventing Type Two Diabetes can help mitigate the side effects of bipolar medications. Antipsychotics are typically prescribed by psychiatrists to patients with bipolar disorder to control for mood swings; however, these same drugs frequently increase appetites, often leading to wait gain. The problem does not stop there: once bipolar patients start packing on the pounds, they are more likely to stop taking the medications prescribed to them; the “non-adherence” rate (i.e. the share of the bipolar population not taking medication) is 20-50%.
So, the discovery that Metformin can help mitigate the side effects of antipsychotics for bipolar patients is a big deal: at the personal level it can help prevent weight gain; at the systems level it can reduce the non-adherence rate.
To come to their conclusion, the study’s authors split 1,500 bipolar patients under the age of 19 into two groups, and the scientists found the group who took Metformin benefited from modest, but statistically significant, benefits in preventing weight gain, and in some cases making weight loss more likely. Dr. Jeffrey Wedge of the University of Cincinnati said of the findings: “[Metformin] is not a drug you take and weight falls off of you, but it tends to reduce that out-of-control appetite, which we think then makes it easier for patients to adhere to a healthy diet and as they lose some weight maybe also make it easier for them to engage in more exercise.”
Personally, I take Metformin for exactly this purpose. I take 1 gram of Metformin at both lunch and dinner, and I do believe that the drug is effective at countering the 500 mg of Seroquel I take each day.
6. The mentally ill are being held in solitary confinement. As a Colorado resident, the headline “Boulder County Jail struggles to implement Colorado mental health law limiting solitary confinement” got my attention. A 2021 Colorado law was supposed to set new standards in how jails treat inmates with mental illnesses, but implementation of the law has gone awry, according to advocates. The law sets some basic standards, like mandating jails with at least 400 beds to give inmates at least two hours per day outside their cells and requiring jails to get a court order to hold a patient in solitary confinement for more than 15 days, a threshold that the United Nations considers torture.
In Boulder, over half of inmates have a mental illness according to jail officials, who say they do not have the staff capacity nor space to comply with the new law. Of course, long-term isolation will only further deteriorate inmates’ mental health, creating a doom loop hard for jails to escape.
7. Devi Lovato speaks about her bipolar diagnosis, again. When high profile individuals disclose their mental health diagnosis, they have the power to destigmatize the disorder, improve public understanding, and create a sense of normalcy for others who are diagnosed. Lots of famous people have bipolar disorder; musicians and artists may even benefit from the creative juices that can come during periods of hypo-mania or mania.
Lovato was diagnosed with bipolar disorder more than a decade ago, and shared her diagnosis in 2011. Lovato spoke publicly again this year about her experience, saying that finding out about her condition brought her relief:
“I was so relieved that I had finally had a diagnosis…I had spent so many years struggling, and I didn’t know why I was a certain way in dealing with depression at such extreme lows when I seemingly had the world in front of me just ripe with opportunities.”
While diagnosis of bipolar disorder can be confusing and scary, they can also be clarifying and set people on a path to getting the treatment they need.
8. My Son Poses a Threat to My Safety. Should I Evict Him? That’s a question posed to a New York Times ethics columnist by a mother who is torn about what to do when her brilliant son diagnosed with schizoaffective disorder refuses to take his medication. Two of 12 jurors in a recent trial found the man could not be forced to take medications. The man is not taking medications now, and as a result he poses a safety risk to his mother; she cannot stomach making her son homeless, a state that will likely only make his recovery less likely.
The ethicist responds: “One way of abiding by [the court’s] decision would be to tell him that he can stay with you only while he’s on his meds. You wouldn’t be evicting him; you would simply be putting reasonable terms on his accommodation.”
Supporting people with bipolar disorder and other mental illnesses is really hard on friends, and especially family. The National Alliance on Mental Illness has highly recommended family to family programs to facilitate shared learning and understanding.
9. Can bipolar disorder be managed without medication? Experts weigh in. The Los Angeles Times published an important essay on an issue raised frequently by those with bipolar disorder. Often, patients do not want to take their medications because they can make them feel “flat” and not feel like themselves: further, those who have experienced mania sometimes seek the thrill of the highs again.
Yet, the conclusion of a survey of existing research and interviews with bipolar experts is definitive: very few people can manage bipolar disorder without long-term and consistent medication. This is especially true of people with Type I bipolar, the more severe form of the disorder.
Personally, I grew up very averse to taking medications from a very early age, and the acknowledgment that I would need to take them every day was hard for me, but I’ve gone to peace with the fact that they are an important component to my care, alongside other treatments including therapy, exercise, sleep and diet.
The open to the LA Times article compelled me to read on:
“Bipolar disorder is one of the most stigmatized and misunderstood mental health conditions in Western culture. As a result, being diagnosed with bipolar disorder can be overwhelming. Stigma — and the shame and isolation that come with it — adds a layer of difficulty to a condition that in and of itself can be very painful.
The good news is that people with bipolar disorder can lead happy, fulfilling lives if they get the right support. Yet, the treatment of bipolar itself can also be a minefield of misinformation and stigma, particularly when it comes to the use of medications.”
10. Mainers rejected giving the mentally ill a right to vote in their Constitution. In an indicator of how far we need to go to shift public opinion, 53% of Mainers voted on a ballot initiative this year to keep a provision in their state constitution that says citizens under guardianship for mental illness cannot vote for governor, senators, and representatives.
The vote is both significant and inconsequential. Inconsequential because the provision of the Maine Constitution that bars the mentally ill from voting has previously been struck down in U.S. Federal Court: federal courts have played an instrumental role in guaranteeing Americans’ right to the franchise, even when state law has sought to take it away. At the same time, the vote is significant because it gives us a snapshot of how voters feel about the issue; it’s saddening to think that some Americans think a mental health diagnosis should take away our Constitutional rights.