Bipolar disorder is a chronic, recurrent and potentially
debilitating illness characterised by fluctuations in mood state
and energy, which is associated with significant impairments in
cognitive, social and everyday functioning. Difficulties appear
especially in the manic or depressive phase, but this disorder
allows more than half of these patients to have a normal life and
make their own decisions when no severe symptoms appear, which
is in these patients for most of their life.
a. All people have mental capacity until proven otherwise, even
if they suffer from a mental illness.
b. An important principle in the evaluation of mental capacity
is the freedom every person must make bad decisions. The fact that
a person might make an irrational decision is not proof enough of
incapacity. These facts may raise doubts but must not be decisive
in the process.
c. In order to prove inability for decision making, it is necessary
to demonstrate disability, through a diagnosis of mental illness that
incapacitates the abilities related to the decision-making process at
that moment and for a specific task that is being evaluated.
d. When difficulties in the decision-making process appear, the
least restrictive suitable and available measure should be taken. In
this sense, curatorship may be more beneficial than guardianship.
The best interest of the patients should be uppermost in the mind
of a curator. Only in some areas and when the patient is unwell, the
curator person will make decisions on economic or health aspects.
a. To determine that a person does not have the capacity to
make his own decisions, a mental disorder of enough severity to
be unable to understand, appreciate and reason about relevant
information for decision making must appear.
b. All intermediate courses are preferred rather than extreme
courses. Incapacitation must be avoided as long as it is not strictly
necessary and seek less drastic measures or support systems.
c. As medical and mental health professionals, it is always
important to check with family members and sometimes talk to
neighbors with the patient’s consent, explaining your concerns and
trying to win their collaboration for the patient’s medical follow-up.
d. There are several ways to support patients that suffer
Bipolar disorder, so that they can make the best possible decisions.
They should be adapted to the mood phase in which they are at the
moment. For instance, depressed patients should be encouraged
to carry out their daily life activities while hypomanic patients
should be encouraged to rest and be in the most quiet and calm