• Ensure that the person has a documented care plan:
• If the person is being treated under the care programme approach (CPA), they should already have a documented care plan.
• If the person is solely managed in primary care or is not managed by CPA, develop a care plan by discussing and recording the following information, including the views of relatives and carers as appropriate:
• The person's current health status and social care needs (including how needs are to be met, by whom, and the person's expectations).
• Social supports, including family, friends, and voluntary sector involvement.
• Coordination arrangements with secondary care and/or mental health services, and a summary of what services are actually being received.
• Occupational status.
• Early warning signs of relapse.
• The person's preferred course of action (discussed when well) in the event of a clinical relapse, including who to contact and the person's own wishes around medication (this may be included in an advance directive).
• For relapse prevention, advise:
• Treatment adherence.
• Sleep hygiene and a regular lifestyle.
• Avoidance, if possible, of shift work, night flying and flying across time zones, or routinely working excessively long hours.
• Self-monitoring of symptoms (including triggers and early warning signs) and coping strategies.
• Provide information about self-help and advocacy groups (if this information has not already been given in secondary care):
• MDF, the Bipolar Organisation, has local self-help groups and its website provides practical advice (see www.mdf.org.uk or phone 08456 340 540).

In depth