What happens when a person with bipolar disorder is off their meds?

Even if you do send them to segregation, wouldn’t you also want to send them to medical? I’d assume you’d want to find out if they’re really bipolar, and if they are, get them back on meds… for your own sakes as the jail staff, if nothing else. Why deal with someone manifesting bipolar if you don’t have to?

Why was the inmate not taking his/her medication?

I think you are asking a question that philosophers have been trying to answer for thousands of years, and we haven’t made much progress: how much control does the mind have over the body?

But that’s not very helpful in your situation.

Bipolar disorder is defined by (among other things) erratic and impulsive behavior. It seems to me that to the extent that anyone can control his own behavior, people who are going through a manic phase are on the extreme end of the spectrum. And where they are, it is much, much harder to control themselves than it is for a healthy person.

I would say most of your inmates have impulse-control problems already, so unmedicated bi-polar disorder would be exponentially worse.

I think segregation is necessary, but with the knowledge that he must be medicated soon, or he will decompensate and be that much more difficult to treat.

Can he be visited by psychiatric personnel while in segregation?

You may want to check out the answers to this question to get some idea of the range of experiences bipolar folk have when manic.

If the guy is off his meds, he’s a severe suicide risk when he crashes. 20% of bipolar folks die of the disease (by their own hand).

Why off meds? Hundreds of reasons. Maybe they can’t afford them. Maybe they don’t have any left. Maybe their prescription has run out. Maybe they forgot one day, and decided not to bother. Maybe they think they can do without them. Maybe they believe they can control themselves using coping techniques. Maybe they want to be manic.

But the primary reason for not taking meds is the side effects. I am going back on Lithium as we speak because I’m getting a bit manic. I hate, hate HATE lithium! My fingers shake. I get constipated. I get skin rashes that never go away. There are a few others, too, that bother me. And, of course, I don’t really like the idea that eventually, it will require me to get new kidneys.

Other mood stabilizers and anti-depressants can make you groggy, or lower your libido, and many other things. The meds pretty much suck.

Of course, when you’re manic, most folks tend to become much more impulsive and angry. Put those two together, and you’re likely to see a lot more aggressive behavior. Some people get paranoid and others have hallucinations. They might think that everyone is trying to get over on them. They accuse people of ridiculous shit. Some even black out and when they come to, the room is a mess, or they’re in jail, and they have no idea what happened.

I’m sure you deal with a lot of liars and lowlifes, but my guess is you can soon tell if a guy really is bipolar or just garden variety violent. The fast speech and disorganized thinking should be a tip off. They should be even more hair trigger than your other inmates.

And they will crash sometime. They will think they are worthless and awful, and they will want to die. And if they are in prison, my guess is that they probably will die, because no one really gives a shit if a prisoner tries to kill himself. Anyway, let me know if I’m right.

I have today off, so I’ll find out tomorrow how the inmate is doing. There was no indication of any problems prior to the incident while in my unit. The inmate slept most of the day, and was quiet at mealtimes. That added to my suspicion of being set-up.

@daloon Yes, we do care if someone tries to commit suicide while in custody. It’s bad enough when an inmate dies of natural causes. It’s truly horrible to see someone try to do themselves in.

I’ve become numb to some things. Strip searches, in particular, have made me sort of, “Oh well, whatever” to nudity and odors. You experience so many gross things that you find yourself discussing them during lunch, and no one flinches. But you don’t get used to death and violence when you experience them first hand.

Even the most hardened of us care much more than we may let on.

Sleeping all day, flat affect, little communication are signs of depression. You can bounce back and forth between mania and depression fairly rapidly if you are in a mixed state. Other times mania lasts for months, and depression for much longer.

Thanks, @daloon, GA. Let me just add that rapid cycling is often considered more dire.

@daloon
@pdworkin
In my few observations of rapid cycling, those people have high incidences of suicide attempts.

@hungryhungryhortence My shrink says the mortality rate for people with bipolar disorder is 20%!!! I would expect all kinds of bipolar folk to attempt to commit suicide way too much. Probably a lot of them also experience rapid cycling at some point. I did.