Quality statement 2: Personalised care plan

Quality statement

Adults with bipolar disorder have their early warning symptoms and triggers of relapse, preferred response during relapse and personal recovery goals specified in their care plan.

Rationale

Bipolar disorder is a long‑term condition that involves periods of wellbeing that may end abruptly because of relapse into mania, hypomania or bipolar depression. It is important for adults with bipolar disorder to have a personalised care plan in which they specify the care they want to receive, particularly in a crisis. It is also important that their care plan is focused on maintaining wellbeing, preventing relapse and achieving recovery goals. Specifying early warning symptoms and triggers in the care plan allows health and social care practitioners and carers to be alert to these and to intervene early to prevent or prepare for a crisis.

Quality measures

Structure

Evidence of practice arrangements and written clinical protocols to ensure that care plans specify early warning symptoms and triggers of mania and depression relapse, preferred response during relapse and personal recovery goals.

Data source: Local data collection.

Process

a) Proportion of adults with bipolar disorder who have a care plan that specifies early warning symptoms of mania and depression relapse.

Numerator – the number in the denominator who have a care plan that specifies early warning symptoms of mania and depression relapse.

Denominator – the number of adults with bipolar disorder who have a care plan.

Data source: Local data collection.

b) Proportion of adults with bipolar disorder who have a care plan that specifies triggers of mania and depression relapse.

Numerator – the number in the denominator who have a care plan that specifies triggers of mania and depression relapse.

Denominator – the number of adults with bipolar disorder who have a care plan.

Data source: Local data collection.

c) Proportion of adults with bipolar disorder who have a care plan that specifies preferred response during mania and depression relapse.

Numerator – the number in the denominator who have a care plan that specifies preferred response during mania and depression relapse.

Denominator – the number of adults with bipolar disorder who have a care plan.

Data source: Local data collection.

d) Proportion of adults with bipolar disorder who have a care plan that specifies personal recovery goals.

Numerator – the number in the denominator who have a care plan that specifies personal recovery goals.

Denominator – the number of adults with bipolar disorder who have a care plan.

Data source: Local data collection.

Outcome

a) Adults with bipolar disorder who feel enabled to self‑manage their condition.

Data source: Health and Social Care Information Centre GP patient survey and local data collection.

b) Health‑related quality of life for adults with a long‑term mental health condition.

Data source: Health and Social Care Information Centre GP patient survey and local data collection.

c) Frequency of relapse rates among adults with bipolar disorder.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as secondary care services, GP practices and community mental health services) ensure that systems are in place for adults with bipolar disorder to specify in their care plan early warning symptoms and triggers of mania and depression relapse, preferred response during relapse and personal recovery goals.

Healthcare professionals collaborate with adults with bipolar disorder to develop a care plan that specifies early warning symptoms and triggers of mania and depression relapse, preferred response during relapse and personal recovery goals.

Commissioners (such as clinical commissioning groups, NHS England local area teams and local authorities) commission services that ensure that adults with bipolar disorder have a care plan that specifies early warning symptoms and triggers of mania and depression relapse, preferred response during relapse and personal recovery goals.

What the quality statement means for service users and carers

Adults with bipolar disorder have a care plan that specifies what to look out for that might mean they are becoming unwell again or things that might act as a 'trigger' to becoming unwell, what the person would prefer to happen if they become unwell again and their personal recovery goals.

Source guidance

  • Bipolar disorder (2014) NICE guideline CG185, recommendations 1.3.2 and 1.9.4.

Equality and diversity considerations

Some adults with bipolar disorder may find it difficult to express their needs and aspirations. They may also find it difficult to understand bipolar disorder and what options they have for living well with the condition. Healthcare professionals who develop care plans with adults who have bipolar disorder should ensure that they support these adults to understand the condition and the options available, using carers, interpreters or advocates if needed.