The Bipolar Family Treatment Center at Beth Israel Hospital involves the families of our bipolar patients at every stage of care. We refer to this approach as Family-Inclusive Treatment (FIT). Our program is dedicated to improving patients' outcome and quality of life, and also protecting family members - including children - from the pain, frustration, isolation, and misunderstanding that are the norm.

FIT is an alternative to the common psychiatric practice of limiting information about the patient’s medications, psychotherapy or other treatment - to protect the privacy of the patient. Contact with family and close others is often restricted until the patient is in crisis.

Excluding family and close others can have severe consequences. Here are three reasons why:

• Close others are the prime source for accurate information about how the bipolar person they love and live with is behaving on a 24/7 basis. When they are excluded from the treatment process, the doctor has to rely on the patient's often unreliable assessment of his/her state of mind, and timely corrective treatment initiatives may not be taken. Given this lack of reliable information, a crisis becomes inevitable.
  
  Excluding close others shuts down a very reliable early warning system. When caregivers are included in their loved one's treatment, they learn to recognize and report early symptoms of mania and depression so that appropriate steps can be taken and hospitalization can be avoided.

• Loving and living with someone who has bipolar disorder is like being on a roller coaster. If you don't know what's happening or why, the stress and unhappiness may drive you, the close other, to get off the roller coaster in order to save yourself and your children - even though you may still love this person, and even though getting off the roller coaster may mean divorce and splintering the family unit.
  
  Having a parent with bipolar disorder is very hard on children, especially when no one tells them what's wrong, what's going on, what to expect, and how to act and react. Breaking up the family is not the optimal solution.

• When a bipolar patient experiences a crisis and has to be hospitalized, his or her prognosis worsens. This is unfortunate, as most crises can be avoided by educating and involving close others in the patient’s care.
  
  This may be one explanation for the high suicide rate in bipolar disorder. Isolation - and, worse, alienation - from loved ones dramatically worsens the prognosis for successful recovery and a chance to enjoy the future.

Finally, bipolar illness is, in part, hereditary. Under stress, children of a bipolar parent are at increased risk of having a depressive or manic episode. As you have probably experienced, stress often either originates in the family or can be relieved by family support. For both of these reasons family participation is critical for the delivery of the best possible care and can improve prognosis.