My Homeless Bipolar Client

A client once described to me how hard it is to communicate how the symptoms affect the mentally ill. “You don’t know you’re in it until you’re in it.” He explained that symptoms are hard to explain or understand unless you have a mental illness.

My bipolar client, Sandra, was my living experience of that. I don’t have bipolar disorder. I do have friends with the diagnosis (you’ll meet one in the next podcast), but they fortunately have a support system and a structure that helps keep the symptoms in check.

Sandra did not.

Bipolar Disorder Cycles and Symptoms

Bipolar Disorder is a mood disorder. There are two distinct moods that last for months at a time. The manic phase is a high-energy phase where the client can seem like they are ready to do a lot of things all at once with little sleep and high expectations. Hyper sexuality, extreme risk-taking, rapid speech can all be part of a manic phase. There’s usually a period of normalcy that occurs just before the depression phase. Extreme sadness, sleep disturbance (too much or too little), lack of desire to do anything fun can all take place in a client’s life. Clients with Bipolar 2 Disorder have less-intense manic phases and longer depression phases.

When I met Sandra, she was staying at a local shelter. She was getting kicked out because she was arguing too much with other clients. Sandra claimed that they made fun of her because she was bipolar and refused to make it easier for her to sleep. She wanted complete darkness and silence, which was hard to get at a shelter.

Sandra was well-dressed and looked like an average, middle-aged lady that could easily be mistaken for a school teacher. She drove a good car, despite it being packed to the gills with her belongings.

At first, Sandra gladly accepted my help. I was working as a case manager that helped homeless people with disorders get the help that they needed, to include a place to stay. Sandra was receiving enough retirement disability to make her car payment, pay for storage, and her phone bill. She also could find part-time work as a day care center assistant due to her work history.

Sandra also had access to medications for her bipolar disorder. She was a formerly married to a military man, so she was able to go to military hospitals for treatment. But that required seeing a psychiatrist regularly. Missing an appointment meant it could be months before rescheduling.

I found her a room and board that was willing to take her in. Sandra was more than happy to take the room and agreed to meet our organization’s psychiatrist. Although we couldn’t force clients to take medications, it was our program’s requirements to at least meet our medical staff for an assessment. I would meet with Sandra at least twice a week. She would tell me stories of her adventurous past, to include when she was diagnosed and some of the hard depression periods.  “I was really good at running day care centers but I had to retire after an incident. It wasn’t my fault. But I couldn’t go back permanently.” Sandra said that whatever happened was so bad it “scarred” her brain and she was medically retired.

Bipolar Disorder Treatment Options

Treatment options for bipolar disorder do include medications. They have to be adjusted depending on the presenting symptoms and the current mood. For example, a client going through a manic phase would not be taking the same mood elevators he takes during the depressive phase.

Having a structured schedule and a balanced diet also help clients with bipolar disorder. It also helps to have a support system of family and friends who can give outside perspective when a client’s mood starts to change.

For Sandra, she didn’t have many of those helpful things. Her behaviors, according to Sandra, made her estranged from her adult children. She could find places to stay, but something always happened and people were always out to disrupt her. Having to constantly leave her shelters and rooms made it even more difficult to see a regular doctor because she never knew what town she was going to be in next.

Despite finding her a place to stay, being a support person and giving her access to medications, Sandra didn’t stay long in the program. For a month or two she was okay. Sandra never broke curfew, did her required chores, and even found some part-time work. But she kept putting off the doctor’s appointment. Every week she would re-schedule. When I would go to meet Sandra, she would have a little more energy than the previous meeting. She would tell me things like “I’m working on my photography hobby” and show me pictures on her phone. “I’m sure I can sell these photos for a ton of money. Look how good I am!”

After the fourth cancellation, I reminded Sandra that she might be kicked out of the room and board if she didn’t meet with our doctor. Sandra agreed to come. We sat in the lobby and talked before her appointment. She was very friendly and engaging with everyone, but just couldn’t seem to focus her conversation on one topic.

“Why am I here again?” she asked.

“To see our psychiatrist. He can get your meds refilled and whatever prescriptions you need. Remember?”

Sandra laughed. “I don’t need a doctor. I’m doing just great right now.” And with that, she left.

Where Is Sandra now? Honestly, I don’t know.  She sent me an e-mail a week later saying she no longer wanted to participate in the program. When she “fired” me, Sandra decided to live in her car near a local park. I saw her a few months later in town. She was renting a room for a while. “I don’t know how long I’m going to stay there. The landlord has a lot of rules.” Most of the time the rules were pretty standard, but Sandra always acted too smart to be held down.

I hope she decides to get the medication support she needs.

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