Self-management is built on the principle that people with bipolar disorder can become experts on their own health. If we are able to recognise the early triggers and warning signs of an impending episode and implement ‘coping strategies’ then we can gain greater control. Examples of coping strategies include reducing stressful activities, using relaxation exercises, maintaining a regular sleeping pattern, exercising and using cognitive therapy techniques. Lifestyle regularity is important in maintaining wellness. Another useful tool may be keeping a mood diary which can provide early warning of mood changes and can also help to identify any patterns to episodes.

People who self-manage may wish to develop a Wellness and Recovery Action Plan - WRAP (Mary Ellen Copeland 2002). This lists their own specific coping strategies that can be put into effect if triggers and warning signs should start to appear. This is important because different strategies will work for different people.

There are five key concepts that provide the foundation of effective recovery work. They are  :

• Hope: With good self-management, you will experience long periods of wellness.
• Personal Responsibility: It’s up to you, with the assistance of others, to take action and do what needs to be done to keep your moods stabilised.
• Self Advocacy: Become an effective advocate for yourself so you can get the services and treatment you need, and to make your life the way you want it to be.
• Education: Learning all you can about bipolar disorder allows you to make good decisions about all aspects of your treatment and life.
• Support: While working toward your wellness is up to you, receiving support from others, and giving support to others, is essential to maintaining your stability and enhancing the quality of your life.

Beginning the journey
As you begin your recovery journey, there are two important things you need to do for yourself:

1. Get good medical care. At least once a year, and whenever your symptoms change or worsen, have a complete physical examination to determine if there is a medical problem which is causing or increasing your symptoms.

When you go to see your doctor take a complete listing of:

• All medications and health care preparations you are using
• Any new, unusual, uncomfortable or painful symptoms

2. Manage your medications carefully. Learn about your medications, how they work, what to expect, possible side effects, and dietary/lifestyle restrictions. Take them only as prescribed.

• Use a daily reminder/pill saver system to ensure regular use
• Get rid of medications you are no longer using – return them to the pharmacy for appropriate disposal so that they cannot be used
• Don’t expect medications to fix a bad diet, lack of exercise, or an abusive or chaotic lifestyle

Symptom monitoring and response system
Through careful observation you will learn: the things you need to do every day to keep yourself well; external events that may trigger an increase in symptoms; early warning signs of an impending episode; and symptoms that indicate you are in trouble. With this knowledge, and by using the tools listed here, and others you have discovered for yourself, you will be able to develop a symptom monitoring and response system (Wellness Recovery Action Plan) that will help you keep your moods stabilised. This system would include listings of:

• Those things you need to do every day to keep yourself well, such as eating three healthy meals and getting a half-hour of exercise
• External events that could trigger symptoms, such as an argument with a friend or getting a big bill, and responses that might keep this event from causing or worsening symptoms
• Early warning signs – such as irritability or anxiety – that indicate your symptoms may be worsening, and a response plan
• Symptoms that indicate the situation is getting much worse, such as reckless behaviour or isolation, and an action plan to stabilise the situation
  

Wellness toolbox
Use the following tools as part of your symptoms monitoring and response system to reduce symptoms and maintain wellness.

• Talk to a supportive person
  
• Attend a support group
  
• Talk to your counsellor, doctor or other health care professional
  
• Peer counselling – share talking and listening time with a friend
  
• Structured focusing exercises
  
• Relaxation and stress reduction exercises
  
• Fun, affirming, creative activities
  
• Journaling
  
• Daily planning
  
• Exercise
  
• Exposure to light
  
• Dietary improvement – avoiding caffeine and sugar
  
• Increasing or decreasing the stimulation in your environment
  
• Stop, analyse the situation and make a thoughtful decision on how to proceed
  

• Validates your experiences
  
• Empowers you to take positive action on your own behalf
  
• Helps you establish connections with other people
  

Suicide prevention
Up to 15% of people diagnosed with depression or bipolar disorder (manic depression) end their lives by suicide. Make sure that doesn’t happen to you by:

• Seeking treatment early
• Setting up a system with others so you are never alone when you are deeply depressed or out of control
• Having regularly scheduled health care appointments
• Throwing away all old medications and having firearms locked away where you do not have access to them
• Keeping pictures of your favourite people in clear view at all times
• Instructing a close supporter to take away your credit cards, cheque books and car keys when you are suicidal
• Always having something planned to look forward to

[Material in this section has been adapted from the work of Mary Ellen Copeland (2002)]