How to help someone before or during a manic episode

Being there for a loved one struggling with mental illness is challenging, but these five tips could make all the difference in giving you the confidence to do so, and ensure they get the support they need

We all want to help a friend or family member when they’re unwell. However, as with any mental illness, and in this case someone experiencing an episode of mania or hypomania, it can be difficult to know exactly what we can do to support them. We want the tools and knowledge to help, but we’re often concerned about saying or doing the wrong thing, with fears of the worst-case scenario when our well-intentioned intervention might push our loved one away and isolate them further. It can be a challenge to navigate, but there are ways to help someone before and during an episode of hypomania or mania.

Of course, first things first, if somebody shows signs of hypomania and mania, it can be dangerous for them, and they will need care and support from professionals. Make sure they are engaged with mental health services, and if not, help them access the support they need.

Beyond that, here are five tools you can rely on, from someone who has experienced it first-hand. With all of these ideas, approach them calmly and be gentle with your suggestions, so they don’t feel you’re being overly protective or critical. Your goal is to be supportive and show them you care about their wellbeing.

1. Make a plan

This is something to do before an episode hits. When your loved one is stable, they can look objectively at their own hypomania or mania, and will feel receptive to your ideas to help them when they’re unwell. Talk to them about what helps during an episode, what you can do practically – and what you shouldn’t do. Encourage them to be honest so you can more effectively help them in the future. An example could be that they find distraction helpful when they’re acting impulsively, and which distractions work best for them.

2. Focus on triggers

Again, before an episode, looking at their triggers together can help them focus on what may contribute to hypomania/mania. Take a look at their work commitments, projects, and personal life in order to try to determine what may be causing them stress. Given burnout and stress are major factors in triggering manic and hypomanic episodes, pinpointing areas in their life that are causing concern will help. Encourage them to talk it through with you, and work together to come up with a plan to ease their stress, and have tools to help manage it where possible.

3. Create and maintain healthy routines

This tip can be effective both before and during an episode. Routines can keep them healthy, especially when it comes to sleep. A constant lack of sleep can easily prompt an episode of hypomania or mania to occur, and so encouraging them to stick to healthy sleep patterns could prevent this from happening.

When someone is unwell, they may forget to eat, sleep, or look after their personal hygiene. Again encouraging them to have regular meals, and to look after their basic hygiene, will mean they will be in a healthier place when the episode ends. You can support this through things such as eating a meal or cooking together, or dropping them little message reminders checking-in.

4. Join in with their activities

During an episode, be there for them by either joining in with positive activities they’re doing, or redirecting them to activities that are less impulsive or reckless if they’re displaying signs of this behaviour. This is where the first point comes into play; if you’ve planned ahead, you’ll know which activities they enjoy and can be distracted by. So, for example, if they’re being creative, join in. It will show you’re interested in what they’re doing, and it means you can set boundaries on how long they spend on the activity so it remains a healthy outlet. If the activity is turning into a fixation or getting in the way of those basic needs and taking care of themselves, don’t force them to stop, rather gently remind them of what else they need to do in terms of eating, sleeping and looking after themselves.

5. Help with finances

With risk-taking and impulsive behaviour being symptoms of mania/hypomania, another really useful way you can support your loved one is by helping them to manage their money when they are unwell. Prior to them becoming ill, you can prepare by them consenting to you putting a site blocker on their phone or computer, that only you know the password to. During an episode, you may need to take their cards from them and have access to their bank account – obviously consented to when they are well and stable. It might feel extreme or like you’re infantilising them, but they will appreciate not being in mountains of debt when they are stable again.

Don’t forget to take care of yourself, too

When someone is hypomanic or manic, their behaviour can be challenging and difficult to understand and deal with. It’s OK to feel upset or angry about their behaviour, and to feel frustrated and powerless. Having these emotions is fine, it’s what we do with them that’s important.

Make sure you talk about your feelings and don’t let them fester. When someone is hypomanic or manic, they’re less likely to listen to reason, or see things from your point of view, so it might be better to wait until they’re stable before having that discussion though. So, while it’s going on, write down what you want to tell them. This can help you cope with your feelings, and help you to avoid reaching a boiling point. When the time comes, try to calmly discuss how their behaviour, words, or actions made you feel. Don’t accuse them of acting in a certain way; instead, focus on explaining how their actions and words made you feel and how they may still impact you now.

If, during an episode, things start getting too difficult, it’s OK to take time out and invest energy into yourself, too. You need to be well so that you can help your loved one. There is only so much you can do, and you need to be realistic about how much support, and how much of yourself, you can give. You don’t have to make grand gestures constantly in order to be useful. If you’re worried about what will happen if you need some time away, then talk to friends and family about helping out. This doesn’t have to all be on your shoulders. There will be other loved ones who can rally round and show their support as well.