CREST.BD and the Daymark Foundation have published a new report on the future of bipolar disorder care in Canada, titled: Charting a New Course: A Roadmap to Improve Psychosocial Care for Canadians with Bipolar Disorder

Approximately half a million people live with bipolar disorder (BD) in Canada, yet estimates suggest only 50% of people living with BD in high-income countries receive any treatment for their condition. Medications are often foundational to wellness for people with BD. However, many patients who take medications will still experience relapse into mood episodes, often experiencing poor quality of life (QoL) between or after their mood episodes are resolved. Interventions that optimize QoL must therefore complement medications. Examples of these include evidence-informed psychological and social (“psychosocial”) treatments such as psychoeducation, cognitive-behavioural therapy (CBT), among others.

Unfortunately, despite the strong evidence supporting positive impacts of psychosocial care for BD, treatments and care are often not readily available, accessible, or culturally appropriate in Canada. There is also a lack of agreement on priorities and strategies among patients, clinicians, researchers and health system leaders on advancing psychosocial care for BD.

To begin addressing these challenges, CREST.BD, under the leadership of Dr. Erin Michalak, and the Daymark Foundation collaborated on the Roadmap for Bipolar Disorder Psychosocial Research and Care project between January 2023 and July 2024. The findings are detailed in a newly published report: Charting a New Course: Navigating Towards Improved Psychosocial Treatments and Care for Canadians with Bipolar Disorder

What did the project seek to do?

The project aimed to build consensus on two central questions:

  1. What are the main priorities for advancing psychosocial treatments and care for people with BD in Canada?
  2. What are some promising directions for meeting these priorities?

The research method the research team used is called “deliberative dialogue,” a technique developed to build consensus in which diverse groups of people exchange and weigh ideas and opinions about a particular issue in which they share an interest. Over several deliberative dialogue groups and an online survey, the team:

  • examined the evidence for psychosocial treatments and care for BD available
  • reflected on whether this evidence was being put into action in Canada and, if not, what barriers prevented its implementation
  • generated ideas to improve psychosocial treatment and care for BD in Canada
  • prioritized the top ideas generated

This work was informed by a variety of people with experience of BD, including people living with BD; their family members, supporters, and loved ones; healthcare providers; mental health policymakers; and, representatives from community mental health organizations.

What did they find?

There is a mismatch between current research and treatment priorities and the interests of people with BD.

“I’m just waiting for the research to catch up to my reality.”

  • Even though psychosocial care is important to people with BD, it is not reflected as a research priority.
  • Current BD treatments are overly focused on medication management and acute care, without enough attention to psychosocial treatments.

Psychosocial care is important, but needs improvement in Canada.

“In the 40 years I have been navigating the healthcare system, not one clinician has asked me about trauma.”

  • Despite evidence that psychosocial treatments can improve QoL, there is limited assessment of QoL in clinical care and support for people with BD to implement self-management strategies.
  • Many Canadians with BD lack access to care because of multiple intersecting barriers, with some communities such as low-income, rural and remote, Indigenous, racialized, and 2SLGBTQIA+ communities being particularly underserved.

Health and care system investments and improvements are critical.

“Frontline providers cannot do it all.”

  • Funding must be increased to expand and enhance care services tailored for BD.
  • Improving and building additional capacity within primary care – such as being able to effectively screen for BD – should be prioritized.

Family members—in their broadest possible definition—are critical to the psychosocial health of people with BD.

  • Family members of people with BD need their own support to care for their loved ones.
  • We need to improve liaison between family members and healthcare providers – and involve family members in ongoing communications and care plans.
  • Family members in rural or remote areas of Canada face particular challenges in accessing supports.

What are some promising directions for change?

After identifying and prioritizing several concrete solutions for improving psychosocial care for people with BD in Canada, both CREST.BD and the Daymark Foundation commit to further exploring the following ideas:

  • Developing a guide for people newly diagnosed with BD to help with system navigation and recovery.
  • Creating a central online information repository for people with BD and their supporters to access existing resources.
  • Supporting patients to find healthcare providers specializing in BD.
  • Developing educational resources for diverse knowledge users.
  • Creating a pan-Canadian, non-partisan, BD-focused organization for people with BD, their family members, and healthcare providers.

The project team

This project is a collaboration between CREST.BD and the Daymark Foundation aimed at charting a course for better psychosocial treatment and care for people living with BD in Canada.

CREST.BD specializes in the inclusion of lived experience of BD in research, designing self-management interventions, measuring QoL, reducing stigma, and developing digital mental health interventions.

The Daymark Foundation is a Canadian philanthropic organization focused on improving mental health outcomes, with bipolar disorder as one of two priority areas.

Team members:

A version of this story was originally published on the CREST.BD website