---
title: "Insights from a Qualitative Study by Social Worker: Dr Ilse van der Walt"
description: "Caregivers of bipolar disorder (BD) patients are affected by the illness and the associated stigma. It is difficult for caregivers to take on the responsibilities and roles of the patient, which..."
url: https://zwavelstreamclinic.co.za/insights-from-a-qualitative-study-by-social-worker-dr-ilse-van-der-walt/
date: 2026-09-23
modified: 2026-09-23
author: "Zwavelstream Zwavelstream"
image: https://zwavelstreamclinic.co.za/wp-content/uploads/2026/09/bipolar-3.jpg
categories: ["Article", "Bipolar", "Blogs/Articles"]
type: post
lang: en
---

# Insights from a Qualitative Study by Social Worker: Dr Ilse van der Walt

**Caregivers of bipolar disorder (BD) patients are affected by the illness and the associated stigma. It is difficult for caregivers to take on the responsibilities and roles of the patient, which affects their social functioning. **

**Introduction**

Patients suffering from BD and their relatives are confronted with a lifelong disease which has significant consequences for their lifestyles. BD is associated with a considerable degree of illness-related morbidity, profound suffering, occupational impairments and social burdens (Goossens, Van Wijngaarden, Knoppert-Van der Klein & Van Achterberg, 2008:303). Hayden and Nurnberger (2006:69) agree, saying that the frequent manifestation of BD, in conjunction with suicidality, psychiatric comorbidity, and pronounced impairment in psychosocial functioning, exacts a great toll on patients and their families. Even with adequate treatment by way of a mood stabilizer, one-third of bipolar patients relapse within 3 years. It has been observed that bipolar patients are frequently readmitted to hospital, even if they have been compliant with their treatment regime, perhaps demonstrating their vulnerability to stress in their lives. 

Nobody welcomes a diagnosis of BD. It is a serious illness that has the potential to devastate individuals and wreak havoc in families (Last, 2009:9). Bipolar disorder (BD) occurs in 1% of people; globally, this seems to hold true for any population investigated (Hunt, 2005:23). Comparable to many chronic illnesses, BD afflicts one but affects many in the family. It is important that all those affected receive the help, support, and encouragement they need (Mondimore, 2006:258). As suggested by Ogilvie, Morant and Goodwin (2005) there is, therefore, a need to understand caregivers’ views and perceptions of the stresses and demands arising from caring for someone who has BD.

It is important to consider the family or marital context when understanding the symptomatic fluctuations and functional consequences of BD (Miklowitz, 2010:443). If nothing else, BD creates havoc and emotional pain for family members, to the point where they develop health and mood problems themselves. The compromised emotional state of some caregivers can have a negative influence on the patient’s course of illness. On the other hand, a spouse or parent who develops an understanding of the nature, course, triggers and treatment of the disorder may help create a milieu which helps protect the patient against recurrences.

From years of experience of working in a psychiatric hospital it has been observed that the multi-disciplinary team (MDT) focuses mainly on the patient, whereas the partners, families or caregivers are often neglected. An important role that the social worker in a psychiatric hospital play is to reach out specifically to the significant others, because they are the secondary sufferers of the mental illness. If their needs are addressed, the patient also benefits. 

There were various reasons for considering undertaking this study as worthwhile. Dore and Romans (2001:48) state that studies on how family factors influence the outcome in BD are scarce. Ogilvie et al. (2005:25) concur, explaining that despite the extent of the impact of BD, very little work has been done to more precisely define the caregiver’s burden associated with this illness. This fact indicated a knowledge gap pertaining to caregivers in this regard. 

As hospitalisation of psychiatric patients has become increasingly brief (nationally and internationally) and as patients are discharged in quite unstable clinical states, the burden on the caregivers has become rather considerable. In this environment, caregivers need support, education and advice in coping with the patient’s ups and downs (Miklowitz & Goldstein, 1997:5). To elaborate, this burden may consist of illness-related symptoms such as insensitivity, shifting responsibility for their own actions to others, violent behaviours, withdrawal and dependence (Lam, Donaldson, Brown, & Malliaris, 2005:432). 

The goal of this research was to conduct an exploratory descriptive study of the needs of the caregivers of individuals diagnosed with BD. The research question for this study was: **What are the needs and challenges of the caregivers of individuals diagnosed with BD?**

BD poses many challenges that are demanding for anyone, except those suffering from it, to understand (Miklowitz, 2011:313). BD often leads to chaos when it is out of control, and this inevitably affects the caregiver. The risk of relapse may then be heightened. As one participant stated:

 “So it (the illness) impacts on so many different levels.”

Participants felt they were obliged to adapt to the patient’s needs and could not be themselves.

It was clear that expectations (from the patient as well as other sources) were sometimes overwhelming for the caregivers. People in the midst of a manic or depressive episode may say insulting, dismissive and hurtful things (Haycock, 2010:227). 

Participants indicated that there were times when they did not think they would be able to carry on. Financial issues and lack of security were experienced on different levels by the various participants. They experienced losses of different kinds. A caregiver might experience that the person is “absent” when ill and that the relationship is “temporarily suspended” (Last, 2009:227).

Caregivers should be helped to see the positive during a very difficult situation, because this will empower them. Some participants were able to reflect on the positive results of having a family member with BD. 

The researchers found that most of the participants reported on the challenges they face. Some even felt that their own well-being was threatened and that the expectations and stresses they are exposed to, could become unbearable.

![bi polar](https://zwavelstreamclinic.co.za/wp-content/uploads/2026/09/bi-polar-1024x576.jpg)

**Psychosocial challenges for patients**

It must always be remembered that the patient also faces challenges. During the interviews it was reported that the issue of work is a concern. Maintaining a stable mood is essential to functioning well at a job (Miklowitz, 2011:300). It was also mentioned that patients experience losses, such as having no friends, as indicated by this participant. 

“I think he also lost with his illness a lot of friends, you know colleagues at the work who also does not understand it, I think he is a very lonely person due to his illness because people will think, ‘o dit is ‘n ongeskikte man daai’.” (That is a very rude man)

**Recommendations from participants’ practical experience of what works for them**

During the interviews participants reviewed which resources they find helpful in dealing with this difficult situation. It was clear that the participants possessed strengths that they could utilise. Different strategies were reported by the participants. Participants were very resourceful and were able to offer practical ideas about what works for them. If they were to share these ideas with others this would also be empowering for them. These recommendations can be used in future with other caregivers, because they were made by people who daily find themselves in a similarly difficult situation. Other caregivers might benefit from these suggestions.

**Strategies that participants mentioned included: **

development of insight, sense of humour, giving each other space/ time out, support from friends, more knowledge from website and books, creating a calm environment, support group, patient must have own interests, counselling, support when patient consults with the doctor, alternative placement, order, structure and routine, better communication, read, being creative, support from God, inner strength, focus, positive self-talk and self, knowledge, treating yourself by doing what you like, keeping a diary, avoid negative input, educating the public, adequate sleep, routine, do not argue

![bi polar2](https://zwavelstreamclinic.co.za/wp-content/uploads/2026/09/bi-polar2-1024x590.jpg)

**The Rights of Caregivers of People with The Diagnosis Of Bipolar Disorder**

It is important to remember that caregivers possess rights. Some of these include: 

- the right to be treated with respect by the patient, MDT and the community; 
- the right to information about the illness and skills regarding how to approach it; 
- the right to feel safe and not tolerate any threats from the patient; the right to ask for help; 
- the right to be recognized and acknowledged; the right to be listened to; 
- the right to have needs and dreams; 
- the right to become tired and even angry; 
- the right to feel emotions; the right to a break; the right to have choices; 
- the right to support; 
- the right to also have an opinion regarding the patient’s symptoms and treatment; 
- the right to decline or limit contact with someone who makes one’s life unbearably difficult.

**Conclusions**

- The integrated biopsychosocial model, within an ecological systems perspective, served as an important theoretical basis for conducting this research.
- BD can create havoc and emotional pain for significant others to the point where they develop health and mood problems themselves. BD affects family relationships, and family relationships affect BD. Families’ lack of understanding of the mental illness and how to deal with it, affects the rehabilitation outcome negatively. It has been the researchers’ experience that the significant other, be he or she the parent, child, spouse or other relative, also has to deal with the multiple losses that accompany the illness.
- Caring for a relative with bipolar disorder poses both objective burdens (such as increased expenditure of time and money) and emotional burdens (such as worry, tension and grief). It is more the exception than the rule that the mental health service has developed routines for taking care of the family, who often feel overlooked and forgotten. Available data suggest that the caregiver burden is high and largely neglected in BD and is a matter of increasing clinical concern.
- There is a growing understanding that BD should be treated as a family condition. It is therefore important to adopt a broad view, as is provided by the integrated biopsychosocial framework. 
- Caregivers must remember their own needs, should share responsibilities with others and stop BD from taking over family life.
- Burnout is a serious consequence of caring for someone with a severe illness. The caregiver should establish his / her own limits and make time for himself or herself.
- Caregivers are also influenced by the stigma which exists about being mentally ill. 
- Twenty years ago, patients were kept in psychiatric hospitals for decades, but now the emphasis is on acute treatment, stabilization and discharge. This too, puts more strain on the caregivers. Although hospitalization can be traumatic for caregivers, discharge of a loved one may also challenge the caregiver and the patient.
- There is a marked lack of equipped community resources to which mentally ill patients and their families can be referred in South Africa, especially in the more remote areas. This sometimes results in caregivers giving up, while families become less vocal – they just become silent.
- Caregivers also have rights.

**Recommendations**

- An important role of the social worker in a psychiatric hospital is to reach out specifically to the patient’s significant others, because they are the secondary sufferers of the mental illness. If their needs can be addressed, the patient will also benefit.
- Recognise the caregivers’ needs and then the patients will also benefit. 
- Mental health care professionals should not emphasize the pathological but instead recognise the strengths of a family – the empathy and cohesiveness that still prevails within the system. A non-blaming stance broadens the possibilities of working with families as partners.
- The caregiver should not be so consumed by the illness that he /she ends up losing her /himself. 
- Every patient should receive comprehensive care that focuses on the person as a whole (biopsychosocial model).
- Each patient should be encouraged to have a well-being plan. It may range from a private decision by an individual to adopt a certain strategy, through to a formal document drawn up by an individual to consult family, friends and health professionals. The researchers are of the opinion that suicide prevention could form part of the well-being plan. It is also important to develop an advance directive relapse plan. This could empower caregivers and it may help them to feel less guilty should the patient relapse, because it was decided in advance that the patient should also take responsibility for his/her own life.
- Caregivers must be informed about resources in the community.
- Caregivers should feel part of the MDT. It is important to contract with the caregivers in terms of their roles and responsibilities.
- The social worker must know his/her role within the MDT and be visible. He/she should be assertive and not allow abuse by others e.g. being used just to handle practical problems, like applying for grants and identity documents and finding accommodation. Aspects such as these can also be undertaken by an auxiliary social worker and patients should be empowered to do things for themselves. A social worker should never encourage dependency.

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