MHA Webinar Episode 43 : Understanding and Recognising Bipolar disorder to provide effective support

0:07 All right. Good afternoon, ladies and gentlemen. My distinguished guests. It's a pleasure to have all of you here. About 92 participants. That's pretty good. >> Um, today we have an interesting topic to discuss. understanding and recognizing bipolar disorder to provide effective support to persons with lived experience and of course our own selfcare. I need to

1:02 Yes, I'm back on now fully. Um, so yes, we are going to discuss bipolar disorder. In actual fact, uh next week Monday, 30th of March is the world bipolar day and uh because this program came earlier, we decided to have a discussion around it before the day comes up. And believe you me today we have brought together some good facilitators from different perspectives to let us discuss and deepen our understanding of bipolar disorder of the commemoration is about awareness and reducing stigma towards

1:47 this condition. So before I go on to introduce my facilitators, as usual our housekeeping and ground rules operates and still works. Remember this is a safe and a respectful space. So kindly be mindful of your language when you get the opportunity to talk or even if you have to make a comment. Um be sensitive when you get the opportunity. Uh feel free to drop in your comments as and when the program is going on and kindly put off your microphone the moment you join unless you are invited to speak.

2:34 So at this point I would go on to introduce my panelist for today's discussion and we have a psychiatrist with long experience in diagnosis and medical management. She has that strong expertise in it. She is a fellow of the Ghana College of Physicians and Surgeons and a secretary of its faculty of psychiatry. She holds an international fellowship in forensic psychiatry from day house university Canada. also a senior lecturer at the KUT medical school and also practices in

3:19 confinachi teaching hospital as a senior specialist and the immediate past and currently acting head of the psychiatry direate. She is the medical director of recovery pathways limited which offers employee assistance program to many institutions. She has won many awards in her field of practice including the 2019 international fellow of the association of women psychiatrist in San Francisco, USA and in 2025 Millennium Excellence Awards in Ghana both in recognition of her work towards women's mental health. She is a past and the first female

4:05 president of the psychiatric association of Ghana. My dear distinguished guest, I present to you Dr. Med Ruth Usu Entry. Dr. Entry, can you hear me? >> Good afternoon doctor and good afternoon to all our listeners. Thank you very much for the opportunity to join. Thank you very much for coming. We also have a psychologist specializing in therapy and behavioral interventions. He is the medical director and clinical psychologist at the university of professional studies ACRA and currently serves as the public relations officer

4:50 of the Ghana psychological association. He is also an agent lecturer with the family health medical school central university and Daniel institute ACRA as well as an accredited supervisor for interns across multiple levels of mental health training. He serves on various boards and committee for some tertiary institutions and NOS's. In addition, he provides consultancy services to a wide range of health facilities with over 25 years of public speaking experience. He is a much sought after speaker after numerous local and international conferences delivering lectures and

5:36 presentations to corporate bodies, religious organizations and educational institutions. His work extends beyond academia and clinical practice into extensive media engagements and consistent mental health advocacy both locally and internationally providing consultancy services for various media organizations. Beyond his professional accomplishments, he is a skilled creative with interest in carpentry, interior decoration and graphic design. He also serves as an iterant minister supporting various

6:22 Christian organizations. Ladies and gentlemen, I present to you Dr. Med Isaac Newman Arthur. He's no stranger to this platform just like Dr. Entry and he's a I'll call him senior. Senior good afternoon. Hello senior. Are you there? >> Hello. >> So I want to say thank you. Yeah. Thank you very very much for the opportunity to be on this call. I'm totally grateful and thank you to all all those who have joined. Thank you very much. Thank you. Thank you for coming. >> Data. Sorry. Nelson here.

7:14 >> Sure. >> All right. So, next we are privileged to have another who bring on board this discussion an invaluable lived experience that she will share with us. She's no stranger to this advocacy. She is a passionate mental health advocate, speaker and content creator, a committed Christians who considers her faith as a fool on her mental health journey after being diagnosed with bipolar disorder in 2015. I'm sharing this with you. It's a bit a little bit not too long but for you to get the picture that a person with lived experience can lived

7:59 a fulfilling life with dignity and all that. That's why I'm taking my time to share this with you. She holds a bachelor of arts degree in French and linguistics from the University of Ghana. After going through her firsthand experience with stigma and getting fired from her last teaching job, she started her YouTube channel, Mental Health Quarters. Her channel currently has over a,000 subscribers and has had over 30,000 views. On the channel, she shares her lived experience and interviews other people with lived experience with mental health conditions and disabilities. Her work as a mental health advocate began as a champion in a pilot project to end the stigma surrounding mental

8:45 health in Ghana. This campaign was funded by time to change global UA in partnership with Christian blind mission and the mental health society of Ghana in 2019. Professionally, she has served as an executive committee member representing Ghana at the global mental health peer network while working with me as their project coordinator between 2020 and 2021. She has also served as an advisory board member for Ghana Sumi Jummed Ghana participation program and a 4-year disability program in Ghana with a specific focus on mental health from

9:33 2022 from 2020 sorry to 2024. Currently, she works as a project officer for Smiles of Hope, a nonprofit organization that promotes amput rehabilitation by establishing local amput peer support groups. With these groups, amputes come together to receive education empowerment and encouragement that she loves to read and watch movies, travel for leisure. My dear guest, I present to you Miss Esam Abra. >> Are you there? >> Yes, I'm here. Hope everybody can hear

10:19 me. >> We can hear you loud and clear >> and also see me. >> Yes. >> Thank you. >> Thank you so much for coming. >> Thank you also for the opportunity and it's always a joy to be back. Good good good good good good good. So my dear guest, we are on to start the conversation. Let me start with you Dr. Rentry. In simple terms, in simple terms, we're having the discussion about bipolar. So in simple terms, how would you define bipolar? Why is it for community for us to understand the condition today? In actual fact, before

11:06 you answer the question, let me provide a little bit of data of what is happening in Ghana now with regards to bipolar disorder. For the three top regions that is Ashanti region, Greater Accra and Central, these regions have topped when it comes to bipolar condition. people experiencing it. In 2023, these three 3,219 people reported and were diagnosed with the condition. In 2024, it increased to 3,00 just 3, 381. In 2025, it dropped by over 500 to

11:55 2,720. These figures are no small figures. It means that we have a problem on hand. That is why we need to understand it and we need to support people who are living with that condition. So these are the figures and it's it's quite disturbing. So it's good that we have all of you here wanting to be part of this conversation and we take home things to live by. So Dr. Retentry back to my question to you what how would you define bipolar disorder and why is it important for us to have an understanding of the condition today considering the times that we find ourselves in?

12:47 Hello, can you hear me? >> Yes, we can hear you loud and clear. Please go ahead. >> Okay, great. Great. Um, so in a very simple term, bipolar disorder is considered a recurrent mood disorder. And when we talk about mental disorders, there are various various types. And I've always told my students during lectures that we should not assume mental disorders um we should we should not picture the person walking about maybe or kept dirty disabled as the only person dealing with mental health issue. It's very broad and

13:33 one of the groups um is what we call the mood disorders. When you come under the mood disorders, bipolar is an example or is one type of the mood disorders and one unique thing about bipolar is the fact that it is recurrent in nature. So um there is a possibility for it to go and come go and come. We call it by because we are talking about two different um moods, two extreme uh moods here. either they're very very sad or they're very very happy. So that's why we call it by but it's not even as simple as that because sometimes

14:18 people experience recurrent episodes of only the highest and we will still call it bipolar. So probably um in the simplest way I can explain it, it's it's a recurrent um mood disorder. Thank you. Thank you very much for that perception. Uh I so what what are the early warning signs that people should look out for when it comes to this condition? >> Yes. So uh thank you very much. I think just to what doctor said h so there are two extreme moods. We have the manic episode and we have the depressive

15:04 episode. So the manic episodes I term it you are on top of the world and the depressive episodes the world is on top of you. So at one point it's like you feel on top of the world at another point it feels like the whole world is crashing on you. The world is on top of you. So the manic episodes usually they have this abnormally elevated and expansive irritable mood and they are all over the place and they have increased energy and that that really never goes away and they have this inflated self-esteem of grandiosity, decreased need for sleep and they talk more than usual. You find this person at work and the person talks more than usual. I know that this one no is not the person's usual self. They may not even be aware of what is happening with

15:51 them. They have flight of ideas, racing thoughts. They easily distracted about everything and they have increased directed kind of activity and attention and they actually get involved in excessive behavior. So you think about it the day that you are really really you know uh reallyated you have a lot of energy and stuff times 10 times 20 you know you think about it that way. So in that kind of abnormally elevated expansive irritable mood you know that is the money kind of then the depressive episode you know usually they have they have low mood loss of interest and other symptoms you may have hopelessness loss of energy they have poor

16:37 concentration attention they have some sadness they have some hopelessness worthlessness they may have some suicidal ideation all the major depressive you symptoms that we may we may talk about, right? But usually you may find out that you know a lot of parents may not even understand what is happening to their kids and because they may get involved in all kinds of aggress and and crime related behaviors and things that society may do is not okay. You know usually parents would have their own perception about their kids. You are a bad boy. You are not you are not learning. you are doing things anyhow that kind of thing. So they may see all kinds of those behavior that goes and comes at some point they in their room they don't want to go

17:23 anywhere they don't want to b they don't want to learn they don't want to do any of those things then when it continues for a long time then the parents now become worried is there something more that we have to know then they bring the person to the hospital and sometimes they may have gotten involved in some school related issues disciplinary issues wherever they talk anyhow to teach whatever it is then out of that then they may want to come to also to seek some kind of help. Then when they come then we go into some conversation about whether they have some mental health related issues and may bipolar finance. Right? So the early phases of it you realize that parents may misjudge whatever is happening to the child and when they realize that now things are getting out of hand and they may go speak to a friend or speak to a

18:08 colleague or someone then some conversation will come up and say let's go to the hospital to see a mental health worker. Then around that then some diagnosis may come up. Even making that diagnosis sometimes is not that simple right because some of those activities may look normal and usually there is some m impairment in their functioning including some hospitalization and stuff like that and it may not be because they on a certain substance of abuse or some medical condition because some substances of abuse and medical condition may make people have all those kind of behaviors. All right. So basically uh that is what it looks like. So at some point they on top of the world at another point the world is on top of them and they actually swim between the two. Okay.

19:01 All right. Thank you very much. That's quite an elaborate explanation of uh some of these early warning signs. I'd wanted to ask you that for us ordinaryly ordinary lay patient uh parents how how would I be able to determine if it's a normal mood change or it has to do with bipolar but it looks somewhere in between there you able to um bring that would you would you be able to make it a bit clearer for us so I'm seeing some some mood changes in it how would I be able to differentiate that well so those changes will significantly impair the person's functioning and it may even need some hospitalization

19:47 and at some point if a parent and you observe you realize that no there's something off you will know and if you someone who has bipolar you know you will know if you are you will know >> and so um you will know that no this one is above and beyond and it may require some hospitalization before they come back to their usual self. Yes, >> thank you very much for making this clearer. Uh I would like to bring in uh Madame Essenam, a person with um with great experience of this condition. Essie, are you there? >> Yes, I'm here.

20:33 Can you please kindly share with us how it felt like before you were uh diagnosed with the condition? >> How it felt like? >> Before I was diagnosed? >> Yes. Do you mean like life before my diagnosis or when >> I life before diagnosis? >> Yes. >> Okay. So, life before diagnosis, everything was regular. I was going to school like everyone else. I had a very regular family. I went to good school.

21:19 My academics were great. There was nothing really wrong with my mental health. So I was 21 and I got into a relationship that I I I tell people I don't have the regular the regular break. Kindly please mute yourself. Yes, I was. >> Please go ahead. >> Yes. I was saying that I don't have the I I was just like everyone else. I went to good schools. I had a good and supportive family. I did not um I had

22:05 good friends. I went to a good church. Everything about me was just fine. I did not have any issues at all till I turned 21 and no I was 20 at the time and I ended a relationship that um I had built my life around and so I don't have the regular breakup story where boy dumps girl and then it affects her mental health. Mine was I ended the relationship with the person I tried to go back when it was not possible. I started developing depression. I didn't even know what depression was at the time. All I knew was I lost interest in activities I once enjoyed. I was a student at the University of Ghana at the time. And for me going for lectures

22:53 became a struggle. Bing, brushing my teeth became a struggle. I couldn't even um I started withdrawing from my friends. I couldn't relate with people anymore. and my parents had no idea of what was going on till I came home. At home, you can't really hide your struggle. So that's when they knew something was very off about me. And I want to give credit to Dr. Malen. She's on this call. I always say that she and Dr. Jima are the people that when it comes to saving my mental health in collaboration with my parents, they were the ones that um really helped me and the success of my story. I really give the credit to them and God. So that

23:40 was how my life was. It wasn't anything traumatic like maybe for some other people how it was. >> Thank you. M thank you very much for for that for that. It's quite brave of you to be able to share this with us. Um so um Dr. Ani, how is this condition diagnosed? What treatment options are available? Dr. Entry, please. Are you there? Yes Dr. Treatment um for all mental conditions

24:28 from >> and what are the treatments options available? >> Can can you hear me? >> Yes, I can hear you. I was asking how is the bipolar dis and what are the treatment options available for bipolar? Yes. Yes. The diagnosis, how is it diagnosed and what treatment options are available? >> So, it's a clinical diagnosis and there is a set of criteria that is used after the um currently ICD1 although most hospitals and clinicians still use the ICD10 but largely the world is moving towards ICD 11. Um so it

25:18 is it is a clinical diagnosis that should be made by a trained mental health professional and um so you can't look at somebody and just say that hey who are bipolar I say you're showing bipolar traits we look at the person's history presentation um whether they have had previous episodes of mania and currently presenting with depression or uh they have they've had depression in the past and they are currently presenting with manic episode or they have had recurrent um manic episodes and then you can make a diagnosis of bipolar. Um not to make things complex there are two types you can have bipolar one and

26:03 bipolar two. Um bipolar one is when the individual comes with only uh manic episodes um without hypomomanic episodes and bipolar 2 is when the individual has hypomomanic episodes. Hypo is little it describes a milder form of mania. So some people don't get a full-blown mania they get only hypomomanic episodes which are milder. So they are only elated, happy, not sleeping and all that. But when people get to the full-blown manic episode, um they they become irritable, some become destructive, it affects their normal functioning. Um treatment

26:49 like all other mental disorders is after the biocschosocial model. So there's a biological, psychological and social treatment. Biological is with medication. We use anti-immanic medication for when the person is at the manic phase and then we use anti-depressants when the person is at a severe um depressive phase. But the gold standard is to use a mood stabilizer whether they are present at a manic or depressive phase because we want to keep the person um u in the middle. We want to keep the person's mood um you tim what we call normal or in the middle so that they don't swing up and down

27:35 between highs and lows and uh almost every uh or most anti-epileptics are also double as mood stabilizer. So sodium vrates is a very good mood stabilizer. carame although we use for epilepsy is a very good m stabilizer but the most effective m stabilizer is lithium carbonate it's more expensive and comes with more side effects so although it's the most effective it is not as often used as sodium valuate and then that is the biological management when you come to the psychological and social we want to know whether there are any triggers Um was was there a stressor

28:21 that triggered the episode? Was there a broken relationship, a failed job, a loss of job, a bereavement? What stressor can we identify? Academic stress, whatever. We look at that and then our clinical psychologist will handle that. Then the social is the social um living conditions, the support of the person and all of that. their home situation, their the kind of support they will have from family and friends who can help monitor the medication taken and all of that. So all these three approaches are taken biologically psychologically socially when we are managing by I hope

29:08 I have done some things. >> Yes, you've done you've done justice to it. You've done justice to it. Thank you very much. I want us to quickly run into the self-care and the support because that is the essence of this discussion. But before that, I'm pretty sure that there are some uh misconceptions about the condition within our community. So uh Ike, would you be able to uh correct some misconceptions that is in the community about this condition before we go into the selfcare and the support? >> Yeah. Well, uh generally uh most of the misconceptions are misconceptions around uh mental health issues. The first one is that is spiritual. H we may not be

29:54 able to go into spirituality that much whether they are demons or whatever but we know that there are some in terms of issues about the person's spiritual goods and their risk for mental illnesses and even generally spirituality and health. There all kinds of studies around that. But the typical mindset, demons, demon possession, God is punishing me, there's a curse on my family and all that kind of extreme kind of thing. We don't we we actually dismiss it in many ways, right? Not not to say that they are not spiritual things. They are spiritual things, but that is one of the of the misconception. So if someone has bipolar, it's not because God is punishing them or there's a curse or there's some demon or something. It is one of the mental disorders. And I'm sure we'll go into

30:40 the causes of of bipolar and stuff and that is when we we are going to know some of the the causes and stuff. Another one too is there's a misconception that um the person is intentionally doing it h because you know when they are not in a certain episode they live a very normal life and when they in the episode everything is all over the place. They say that I think in tree there is a term this one no because people really can't about you are normal you come to school you are okay in lectures we find you doing all kinds of nice now you say you are bipolar and you in a certain episode

31:26 and you are doing something else is one of the things to meet someone with and in a manic episode and you understand what it means to have bipolar and and most of the time they are not even aware of whatever is happening with them right and so these are some of the of the basic things and sometimes also whether you've gone to do something and you are being punished for from it even African movies when someone does anything that is bad maybe goes for black magic or goes to do something very very terrible to someone and their cares the punishment that is prescribed in the movie or that they show in the movie is a mental illness you know so some part

32:11 of our brains think that mental illness are caused by some of those things and it's just a misconception right and so that those things increases stigma you know it increases stigmatization of mental disorders including bipolar so these are some of the things that readily comes Yes. >> And funnily enough, we need to recognize this condition before we are able to take step. And these misconceptions prevents us from recognizing it and we end up doing what we are not supposed to do. Delaying delaying seeking for help. Yes, it does. So h what what you may see

32:56 is that individuals or families may attempt to h to fix thingselves and they may try some disciplinary measures and that's what you may see. Don't step out don't do this learn how do this all kinds of disc measures in the house. If it doesn't work out and the behaviors are becoming a bit more awkward, then they decide to go to the h to h typically to a prayer camp or to see someone in some form of spirituality just to be able to deal with it. And depending on the knowledge of the people they go and see, they may prescribe all kinds of things. They may do all kinds of things. Even sometimes physical restraining the person in chain or something or locking the person up in the room and they will do all kinds of you know rituals and all kinds of things

33:41 and when things do not work out then some some of them are likely to come to come and seek help. So by the time they get to the hospital you know things are a bit out of hand and then we have to deal with the impact of of whatever whatever is happening with the person. Okay. >> All right. Thank you for my participants. Okay, you also feel free to to reflect and let's hear what you think about this misinterpretation of mental health and bipolar conditions. Uh is it often spiritual or personal for you? Let's let's see what you have to share with us. You share it in the comment section. Essie, let me come back to you. Essie, are you there? >> Yes, please. I'm here.

34:27 >> Good. Good. So, let's talk about support. So what what what kind of support made the biggest difference in your journey? What kind of support the types of support that you received made the biggest impact in your in your journey? Um first of all I would say my faith was like an anchor for me because sometimes when you are going through something like manic episodes, depressive episodes and there's nobody to I mean your family is there to support you and understand you just need like this. >> Can you hear me? >> Yes. Please hold on Mr. Jun. Mr. Juna please

35:14 you are really disrupting this program. >> Essie please go on. Yes, I was saying that for me my faith was one of my biggest um anchors because when you are going through a lot in your mind for me the symptoms I was going through with that have been mentioned it felt like I was going crazy and nobody understood me and so sometimes it's just praying it's just um having this faith that one day everything is going to be all right and it's Actually everything like was all right after some time and also my family when my symptoms started. I mean we we

36:02 went to church but eventually my dad was like we should seek professional help and that was one of the biggest game changers because um if it wasn't for seeking professional help I wouldn't have met Dr. May and received the right diagnosis. I mean, the doctor that saw me at first thought I had schizophrenia, but the um getting a second opinion really helped and it also helped me to not uh to come to understand that the fact that I have a mental health condition doesn't mean it's the end of the world. and um all the mental health professionals I've worked with over the years from 2015 till now um they were my

36:47 biggest support because when I go to the hospital and complain about an issue I'm having with the medication I was taken seriously I was not taken as oh you are the patients with a mental health condition so will not mind you everything I report they take seriously when I was on the the ward for admission I was taken seriously And for me, those were the things that really helped in my road to recovery. I listen to stories of some of my friends, their road to recovery or their mental health journey. And sometimes they think I had it easy. But I always say it's a combination of all these things coming together which gave me the kind of um fortitude and kind of success that I gained on my road to recovery. It isn't easy. I mean the

37:34 first year was tough because this was all new to before that I did not have any knowledge about mental health. I was comparing myself to my friends and my colleagues at the time because I didn't understand why they got to replace their regular lives in their early 20ies and now I have to be on medication. I have to sleep earlier than some of them. I have to not waste my my day time because in the night I can't like mine like them and learn and study. I can't do that. So it came with a lot of changes and for me it's just all these things coming together enabled me to get to where I am. And therapy also really helped my

38:20 psychologist. Sometimes I come to them feeling all down and hopeful and the things that they'll say to me are what push me to go on. Every psychologist I've worked with over the years, they have been amazing and sometimes what used to even shock me was when I go for my therapy sessions and they actually remember the names of the people that I mentioned without even referring to their notes. Then it makes me feel like oh I'm being seen and heard. It doesn't matter what I'm going through, but somebody is here who is trained, who is going to take me seriously. So all these things helped my friends too. Yes, I had friends who stood by me regardless of the symptoms that I had. There were things that I will say or do that will

39:06 hurt their feelings or embarrass them or things that I will say and do when I'm having a manic episode. And when I come back, apologize. They will take me back and understand that this is not you. It's the condition that made you do this and we still love you regardless. All those friends that have stood by me till this time, they are the ones I consider like a huge part of my support system because if it were weren't for them, I don't know where I would have been today. So sometimes you just need to look around you. If you need to seek professional help, do seek and then you will realize that you do not need to do your mental health mental health journey alone. the support is out there and it's it's it really works.

39:54 >> Thank you very much. Thank you very much, Essie. Thank you very much for sharing all that with us. Uh let's let's talk about how we all can be part of the solution. I think that we all can be part of this solution by the things that we say and the things that we do for persons living with bipolar condition. Let me start with you uh Dr. Ruth entry. What what what are some of the best ways? So the best ways we can support someone really living with the bipolar condition. What what can I do? What are the best things I can do to support somebody living with this bipolar condition? Let me start with you the you same question please. So Dr. En

40:40 please go ahead. >> First thing I would say Dr. I would say that we have to um see people with bipolar disorder with a lot of empathy and not to stigmatize against them. Nobody is their disease. The person was there before they they were diagnosed. So nobody is their diagnosis. And sometimes um we we refer to people and we say that uh they they they are bipolar and that is totally wrong. the person is an instance before the diagnosis. And so we should not um t them or stigmatize them and supporting

41:27 them over issues and then in our head we have concluded maybe their condition is coming or maybe they are relapsing or something. These are all ways we we subtly stigmatize against people with with bipolar and all mental disorders. Look, the fact that you have bipolar does not mean you do not have the right to get angry or you do not have the right to get sad on some days. It does not mean that um they have relapsed or something. So let us treat such people with a lot of empathy, respect and know that they are not their

42:14 disease. We should not um tag them and if there are people we know are going through this, we can check in with them from time to time. Make sure that they are not overbeing, they are not stressed, they are taking their medication or they adhering to their therapy sessions and all of that. and consistently remind them that they are not their diagnosis. They are so much more. They are accountants, they are teachers, they are students, most importantly they are human beings and that beef up their confidence and make them more functional in their day-to-day activity. Thank you.

43:02 All right. Thank you very much for that. I I think I'm sure you have something to add. >> So, in addition to what she said, I would also add just a few. H first of all, if you're around someone with bipolar, learn about the condition, learn about it. you know now there are all kinds of resources that you can read online about bipolar related problems. So educate yourself about it know the signs and symptoms what to do what not to do and stuff. So I think I think that also starts the the help you can give because if you don't understand you are likely to blame them or necessarily not understand or empathize the way you should. So please learn about it. H because maybe when we go to the causes

43:49 of of bipolar, we may talk about some of it. And again to help maintain routines. H what I mean by that is that you know h whatever in terms of sleep h when should she go to sleep or should he go to sleep? Can we help with that? uh going to school, h going to bath, whatever, you may have to help with the day-to-day routines because in some episode they may not be able to do that. So you need to help them with daily routines. Then again to medication and support adherence. H what it means is that you should be able to help them adhere to whatever protocols that that is available for them. If you don't do that then they may not go for reviews. Sometimes they may not take their medication that is essential to control

44:36 whatever symptoms they having. So if they have to go for therapy they need good support system. So make sure that you are helping them adhere to whatever treatment that is available for them. Then again to you need to be able to monitor signs and symptoms. H some way somehow you may have to pay attention if you are with someone like that so that you can be able to identify when they in a certain episode or not to help them because if you are not aware of it then you cannot initiate the right help that they need to be able to go through whatever you need to go through. H then again you need to be careful about what you say around the person. Don't be overly critical, overly judgmental and stuff that doesn't help. Don't use their diagnosis as a weapon against them. You

45:21 know people can make all kinds of comments. Are you the only person with bipolar? You know everything you are blaming it on V. But you need to be very very careful with the words you say around someone who is going through some kind of mental health challenges. Then again to intentionally help you know deal with the stresses around the person you know so you know clearly what the person's life is what the things that they need at what time what stresses they have in their life help remove some of the stresses you know so if it's financial or it's relationship or it's academic or is what a day to day going by day like you can intentionally to step in as and when things a bit difficult so that

46:08 their stresses are reduced because various life events or stresses can be sources of you know triggers for some episode and that is why you may have some people with bipolar and they may not come with almost all the an episode because they have social support network like that then in the technological age and social media you need to also pay attention to the person's activities social media and stuff you know I I know some people there was this lady who was very act on social media and stuff and he's living from South Africa. I had an interaction with her and she said that now she allows someone else to manage social media handles and page because sometimes in the manic or depressive

46:53 episode people may put all kinds of things out there which may not be appropriate. But if in this day and age where people can actually put all kinds of things out there, you may need some additional support, you know, so that someone can have access to your handles and your passwords and stuff to be able to help manage content on social media and if something is going off, they can be able to help. Otherwise, you have all kinds of things go out there. Equitely our environment is not empathetic or kind at all when it come to social media things. People can see all kinds of nasty things and whatever anybody puts out there it never disappears. It's there for life, right? And so if someone cannot manage the

47:41 social media activities of that person then I think it it actually really helps. Then the fact that someone has bipolar does not mean they are not functional in many areas of their life. So encourage dependent independent you know help them become independent. Don't be overly involved in a person's life as though they cannot manage things to some level. So I think that one help then probably I will add finally that it's it's a bit more difficult to handle someone who has any form of mental health issue because they may become overly dependent on you. What it means is that you need to also as a caregiver or someone in someone a person's life who has some mental health you need to be able to take care of yourself also so that you can be mentally strong to help

48:27 the person who goes through problems because it can be a very very tough job you know being around someone who has some mental health issue because they are overly dependent on you on a dayto-day basis about it. So you the person must also take care of yourself and so that you can be strong enough to take care of of the other person. You don't have to give up otherwise it can actually affect you also. Emotions are contagious particularly when you are emotionally connected to someone. You are a parent or a husband or a boyfriend or a sister or or a brother or something and you have a sibling or a spouse or someone who or a loved one who has some mental health issue. is so you know emotionally you know draining and

49:12 emotionally tough to be able to see them in a certain state. So you who are in the company of that person would also have to take care of yourself otherwise you break down or give up on the person you want to. So that is what I would I would suggest. And you're just very close, please. Essie, are you there? >> Yes, please. I'm here. >> Okay. So, with all the list of the

49:59 support strategies that we can the best ways somebody like me, I can help a person with bipolar conditions. Listening to all of them, how does that remind you of the challenges that you've we've faced in managing your condition? What are some of the major things as challenges in managing your condition when it comes to this kind of support? >> Well, I think the biggest challenge for me is um the cost of my medications. So, every month I spend like um,400 CDs which is a lot because I take um a lot of mood stabilizers. The um milligrams I'm on is very high. So it's not been easy um getting

50:48 um financially it hasn't been easy. Yes, it's been very very expensive and I have to always make sure that I get the medications early because sometimes you you will not find it everywhere. So you have to make sure that you get it early because you might not find it at your local farmers. And then also um basically I've gained a lot of weight because of the side effects of my medications and that has come with um body shaming. People meet you in in town. Sometimes they are people you know your okay let me not say my family my friends or sometimes strangers or people you know from school they meet you hey you are growing fat so like they are not even kind about it or anything. They

51:35 just feel like used to be this how come you are big like it's not understanding that sometimes this massive weight gain is as a result of um the medications and also some there were times in my life years ago when people body shame me like that I will have thoughts like you know what this medication maybe I don't need to take it cuz the more I take it the more bigger I go but I will discuss with my therapist and she's like you know what just check your diet and add um exercise to it and you'll be fine. But it hasn't been it hasn't always been easy. And another thing too, another challenge I would like to say that has been quite um troubling for me is stigma. I have been fired from my job

52:21 because of my diagnosis with bipolar disorder. I have um I haven't publicly come out to call out centing people for discriminating against me but there are people like that in my life whom I will talk about one day that's like because of my condition they stigmatize and discriminated against me and I've just come to understand that it sometimes we think that people stigmatize and discriminate are just people who are uneducated or who are not literate but there are some educated people who still stigmatize and discriminate against people and I think it should end. the advocacy and the awareness must continue. And also um please hold on

53:08 and also I think that um we must start we must go to schools and do a lot of advocacy early because sometimes people stigmatize and discriminate not understanding they don't understand what is going on for years. they feel like oh this is the right thing to do or the right thing to say not understanding that by calling somebody sometime I go somewhere and the terms that they use even people within the mental health community still use very wrong terms which I think by now everybody should know but it's still happening and sometimes I find it insulting and discriminating against like people within our community so these are some of the challenges that I've had to face and I hope that um as time goes on

53:55 things will get better. >> Thank you so much Essie. Thank you so much for that powerful and courageous insight into your life. I mean it really it really humanizes the discussion that we are disc we are having. We are all human and any of us could face this condition and this difficulty is possible. Um h let me read let me read a few of the comments that have come up then we'll continue with the questions. Let me um

54:42 let me start from here. Okay. Wano Kofi says, "How long does it take to detect this condition in the individuals?" Okay, we would answer that during the testing time. Can bipolar be treated? Does a person have to take medications for the rest of their lives? Would answer that. Can our facilitators align cardinal signs of bipolar disorder that has been done already? Uh me, what is the prognosis of bipolar and being on medication? Okay, says thank you for the kind words. Emmanuel Osborne one of the major challenge that delay early seeking for

55:29 professional help is that self stigmatize the victim believing that if seeking professional help people will see me as a mad person stigma from the society seeing the victim as a mad person there is nothing like a mad person so even in your language Emmanuel They are not being helpful here. There's nothing like mad person. The right word to use is an unwell person. A person is not well. And I think that we would all understand mad. We don't use that word anymore. Please Samsung whatever doctor please due to network issues I couldn't hear the name of the

56:14 drug of the drug most effective for mood. Well if you have any issues see your professional please. Helloam, I'm so impressed with your bravery to come out and let some of us have insight into your condition. Thank you Susi for that comment. Thank you very much from Essie. Pamela says the stigma must stop. Yes indeed, the stigma must stop. That's the essence of this educative program that we are having. And I'm so so happy that a lot of you were able to take time off your busy schedule to join. Ike said that we should learn about it and we are all here to learn about it. Yeah. Adubi at what age or how young can

57:01 one be diagnosed of the condition and at what age should we be looking out for symptoms in our children? Okay. Okay. So during question time we would respond to some of this. I want us to uh I can Dr. I want us to look at self care strategies because they also they also do play a crucial role in this exercise and so let me start with you Dr. that what practical self-help uh self-care strategies can individuals adopt to take care of themselves?

57:49 >> Yeah, thank you Dr. So basically these self-care strategies apply to all uh to everyone. It it's not limited to bipolar, but it's it's it applies to all of us. It applies to all of us. Yes. Um and the goal of these self-care strategies is to make sure that we keep our stress levels at manageable levels. And um I would have to quickly add that there is no acceptable stress level. It's very individual based and so what you would

58:38 be able to accommodate may be different from what I will be able to tolerate or accommodate. And that is why it's important that as individuals we know our our stress levels and our stress limits what we can take know the signs that will tell us that we probably are going overboard and so we should slow down but in health care prevention is always better than cure and so selfcare strategies will help us prevent our stress levels for moving from use stress to distress. Distress is the bad stress. There is some normal or acceptable level of stress that as human beings we can accommodate. It keeps us going if you're

59:25 going to write an exams. It is that little stress that would push you to learn and prepare. If you don't care, you can't be bothered and there's no urgency and no pressure to prepare and all of that. You're going for an interview. that bit of anxiety or stress will push you to prepare better and all of that. But when it goes beyond that, then it's a problem. It moves to what we call the distress. Um strategies, the first strategy I keep hammering on is our sleep. We we we downplay sleep a lot and mental health professionals will tell you how important I put a lot of premium on sleep. As simple as sleep is, it is one of the strategies that can

1:00:10 help us remain in good mental health and take good care of ourselves. H most of us take it for granted h that we go to bed and we fall asleep spontaneously. But many people struggle to fall asleep. And when that keeps going on and on and on, you are putting your brain and your whole body at a state that it is unable to recoup and to to distress and we will go the day going about our studies, our work, our daytoday activity. The God has designed that at a at a certain point in time on the 24-hour clock that he has given us or time frame he has given us, we should rest and and be able to

1:00:55 revitalize and re-energize and save the day ahead of us. But some of us um are unable to get that opportunity. Sometimes it is it is selfinflicted and sometimes it is through no fault of ours. We need support to be able to stay. Some of us stay on our phones, on our gadgets on several screens, working through deep into the night, um beating deadlines just so that we we we will be able to make it in life, survive and make more money and all of that and forfeit our sleep. Some of us decide that the daytime we'll do other things. Some of us are doing about three, four, five jobs and so we spend some of the night doing some of the jobs for our sleep. But at the end of the day we are

1:01:42 building our stress levels to the extent that one day the last straw the very little stressor will be is what will topple us over into a mental breakdown. So please we recommend that every adult should get at least 7 hours of sleep at least four nights in the week. Uh we have previously um promoted eight hours of sleep daily for every adult but current studies are telling us that if you're able to do seven hours about four of the seven days in a week it is still good enough to keep your stress levels down and in check and that is not to say that for four of the days you get seven hours and then the remaining three days

1:02:28 you don't sleep at all you'll be okay that is not what I mean this is the minimum that is expected of us and so doing more is always better and then the other thing I'll talk about is exercising. How many of us are able to exercise uh routinely um as among all the um the the the things we need to do to keep ourselves in good mental health. The the one I have not been able to achieve 100% is with my exercise. I'm still working on it. But I would admonish all of us that exercise is one of the good ways uh to live well to keep your mental health in check. If you can do about three exercises in the week or three times in the week, maybe 30 to one

1:03:16 hour at a time. But the key is that do it to the point of perspiration, to the point that you are sweating. Then you would have been able to reach that level that the exercise will will break down your stress levels down and destress you. And so exercise will be the second one. And eating healthily. eat at least two hot balanced meals a day. Two hot balanced meals a day. How is our feeding like? How is our meals like? Do we just hop onto maybe some plantain chips, meat pie and Coca-Cola, pastry, snacks and all of that and we think we are eating, we come home late in the evening and that is when we are coming to take a big bowl of maybe rice ball or something. That will be a poor

1:04:02 eating habit. Um if you cannot get to buy or it's expensive then carry your meal in a food flax uh to work and one of the key things with our meals is that it should be hot and it should be balanced. A balanced meal the nutritionist will usually tell us that should have a minimum of uh four or three or four colors. So you should have your vegetables which is one color, your pro protein which is one color and then maybe your carbohydrate which is one color so that it is well balanced for it must be warm. At least two of such meals in a day h should be helpful. And there are other things like allowing ourselves to sleep in a in in a more hygienic

1:04:47 environment with fresh air. And those who are a bit elite are fond of driving in an air conditioned car, sleeping in an air conditioned bedroom, staying and working in an air conditioned office. We never get opportunity to breathe fresh air. And that in itself can suffocate our brain because we we limit the amount of oxygen the the the the clear oxygen that can get to our brain so that our brains can work effectively. And the last thing h self-care I will mention is the ability to rest and chill from time to time. Look, we are human beings. We are not machines. Even machines break down. And so as human beings after we work and work and work, it's important that we take a leave. Some of us sell

1:05:34 our leave so that we can get paid leave. Some of us because we do our own job, never dream of going on leave. If you operate a shop or you operate a private business, you never think of closing it for two weeks and saying telling all your customers that hey or my clients that hey I am on leave for the next two weeks. You never dream of it because hey how would we survive during that time but it's very important that we take breaks from time to time and during those those breaks don't go and do other businesses we are in some are in what do you call it government institutions when we go on break that is a time we want to go and work on our farm in our village or go and do that side business. So at the end of the day there is no rest at

1:06:21 all. So when you take your leave, please rest for real. Go on a vacation. Uh chill, pamper yourself and come back more refreshed. It's like you went to empty your stress level. You went to empty yourself of the stress that is in you so that you can have enough space h work better and and h be more productive. So please the last thing I want to add and stress on is our ability to take leave and this rest if you can add some chilling to it save towards it even if it's 50 cities you put down every day h do that at the end of the year middle of the year h somewhere along the year you take your leave go to some remote place to the north h to qu

1:07:06 to the beach somewhere in cape coast h go and hide a room rent a room or just decide This week I'm eating a buffet breakfast only from Golden Tulip or Lancaster or um somewhere. Pamper yourself. I'm going for a manicure. Those things are very good uh to distress us and to make um our mental health improve from time to time. Thank you. >> Thank you very much Dr. Ruth entry for for that. Uh, let me ask Ike. Is there something you'd like to add? >> Oh, I just want to say that or a guy. >> She knows. She knows what's up. She

1:07:52 knows what's up. >> H, she knows what's up. Well, let me just two things. H I think that one of them is have realistic goals and expectations and when your goals are too big h it actually affects you. You are you are you overly do things so I'm >> you said I was saying that people should have realistic goals smart otherwise otherwise you you increase your stresses right so smart goals and again also learn to say no when you are tired you

1:08:38 are tired you know sometimes you want to help everybody else but ourselves and we get lost at at some Then probably I'll add that mind your own business. It's it's a good self-help or selfare tip. When you learn to mind your own business and not to get involved in many things, poke your nose into everything. H be particular about everything and sometimes you just have to allow things to be. Then prayer and meditation, fasting helps. There all kinds of research about prayer, meditation and fasting. They are all very very good self-care practices that helps. And for married couples we advise intimacy. During intimacy all kinds of neurochemicals are in dopamine we have serotonin things all kinds of things are that helps improve on the

1:09:24 person's mental wellbeing and so those things to thank you. >> Thank you very much. Thank you very much. That was a good top up. As for Dr. Ruth, she knows what's up. In fact, you guys, you know what's up. I mean that's why you are here. You help us with giving us the support to survive you know. Yeah. >> Yeah. Let me let me let me go let's do some questions from our distinguished participants and let's see um Abu Bak so true is asking please is it appropriate for an employer to lay an employee off from work because of their medical or mental

1:10:10 health condition that I can say is an emphatic no but Ike what do you say to the law? >> Well, is no h is no. And so there are various steps. There are various steps that helps. What happens is that when you have an employer with some mental health issues, first of all, we need to have a diagnosis. We need to initiate the right treatment. We need to look at the person's functional capacity, right? Because some mental health issues, they may not be able to function at a certain level. to look at the functional capacity and based on that you're able to modify their work to be able to help them. H but unfortunately there are some very very severe mental health issues that may not be compatible with dayto-day work uh dayto-day work. So

1:10:59 that one you may have to consult the mental health worker to take a decision about that particular patient and their capacity to work. So it's not an absolute no for some mental health issues depending on their severity they may not be able to work and so you may not be able to employ them. It's also there but before that decision is taken. Every work environment should have a policy on mental health. Unfortunately a lot of work environments don't have it. So they don't know what to do and that creates a lot of problems. And before any decision is taken, the person should have some proper evaluation by mental health or recommendations will be sent before some decision should be taken.

1:11:45 >> Thank you very much. And in actual fact, I'll add I'll let Dr. talk about it because she's been able to establish an employee assistance program uh for some organization and it's very key because uh if an organization has an employee assistance program institutionalized within the organization some of these things would not happen. So Dr. what do you have to say to this question? What's how would you talk that? So it is illegal for any employer to say that based on your mental condition I am dismissing you without um any request to the person's mental health professional report from

1:12:31 the mental health professional saying so or backing. There are like Dr. New Man said there are some times that we will need to modify your job. Like if you're in the mining sector and your medications that are likely to make you drowsy, we may want to bring you from underground to the surface and all of that, but not to dismiss you. Okay? Um some people by virtue of the fact that they ever got diagnosed they are they have been laid off and there are now people are becoming very much aware of the law and all that. If if you go to legal aid they will not charge you any legal fee. You can take uh those

1:13:18 companies on so that your course will be will be fought for you and your your rights will be upheld. If for any reason you cannot keep your job, your employers must take that decision together with you and your mental health care provider for us to arrive at that decision. But no employer should take that unilateral decision because guess what? They are not health professional and they would not be able to say that your health condition will affect your work or not. It would take the health professional to do that. So it's it's it's um a threepronged um decision. The patient, the employer and their care provider are the three

1:14:05 people. Sometimes we bring in their family members uh to arrive at that decision. But once it is taken unilaterally it is wrong and I see that those that do that are institutions that do not know much about mental health care. So when it rises up in the institutions we take care of it's an opportunity to increase awareness right from HR we start with the managers the supervisors and all that and before you realize they themselves realize that hey they they may be living with anxiety disorder >> yes they all need help a close family need help and then you realize that a an environment that was initially toxic

1:14:52 sudden become so supportive and all that. So it boils down to the awareness question as Esam was mentioned that we still have a lot of work to do but in any institution that is mental health friendly it has it did not happen overnight. It took a lot of work in creating awareness and making people supportive and not dismissing people h just because they have mental health challenges. Thank you. >> Thank you very much. Thank you very much Dr. Entry. In actual fact, this discussion that we are having, I missed I missed an important step in the discussion and I've been reminded about it. So I think we'll quickly do that that is the causative

1:15:39 factors of bipolar. So I let me start with you. What what causes bipolar? Can you hear me? Yes. Okay. So, there there are several it's multi- kind of things. Several. So, you can have biological issues, you have some psychological problems, you may have some environment related problems. So biological issues. I'm thinking that it's the belief in the agent is what prevents us from

1:16:26 recognizing it and that also contributes to the stigma. So know how >> you you respond to that for me please. >> Yes. >> Yes. So so there are biological when we say biological factors issues that with the body itself and how the body functions. So uh so we have genetic issues and bipolar related issues has high you know heritable kind of relationship. So what it means is that h there are some multiple genes for it. Again also if you have a strong family you know background with bipolar you are likely to have that. So probably a third degree relative a parent or a sibling or something your risk goes up right and I said the genes is usually polygenic. You

1:17:12 have multiple genes that are are involved. And then again to we look at brain and brain chemistry and how the brain function. You know there are certain chemicals in the brain we call neurotransmitters. We have dopamine, serotonin and all that changes with that can actually increase a person's risk for that. Then again to some brain changes. So your brain itself is what helps you to interact, communicate with your environment and stuff and there can be problems in there and all that. Then again we can look at you know some uh issues about psychological factors. People have you know they overly sensitive to things they impulsive and all that their personality and all that increases risk for that. Then psychosocial issues like stresses of

1:17:58 life not life events like loss or trauma you know or transition you know when you are transiting from one stage to the other of life of moving from one point to the other with your life it can actually create problem for you chronic stress you have to deal with some stresses all the time it can be work related stress related stress relationship stress marital related issues and conflict every stressor of life actually be a risk or a trigger for some bipolar related issues Then early life early life related problems like childhood traumas and abuse sexual obstacle verbal emotional abuse neglect and all that and all that substance use related problems can also influence. So there are multiple factors biological issues social issues

1:18:43 psychological problems can actually you know influence things like that. Yeah. But when it comes to spirituality, it's a broad concept. And when people have unhealthy belief systems, they have an increased risk of mental health related issues. When they have unhealthy doctrinal basis, particularly doctrines that has to do with God is angry at me, God is judging me, I'm not good enough, God doesn't love me. Depending on how they doctrinal basis, all those things

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