Purposeful prescribing in bipolar I disorder care

Bipolar I disorder (BD-I) is a chronic mental health condition characterised by shifts in mood, energy, and activity levels. Individuals may experience episodes of depression or mania, often with significant variation in symptoms and severity. Given this complexity, treatment decisions require careful consideration. Purposeful prescribing offers a framework for making those decisions with one aim in mind: tailoring care to both clinical needs and the lived experiences of each patient.

Purposeful prescribing is the idea of making thoughtful, patient-centred decisions about medication – choices that reflect not only the diagnosis, but also what the patient is going through, what matters to them, what they can realistically manage in terms of daily routines, side effects and treatment requirements, and what kind of support they have (or may need).

Devising a patient-centric plan

To understand their experience, I start by asking questions like: What are they living with? What are they worried about? What do they want from treatment? With that information, we can make decisions that reflect the whole patient – not just their diagnosis, of course, but also their lifestyle, their support system, their financial situation, and their willingness to engage in treatment. Ultimately, it’s about the intentionality of devising a patient-centric plan.

Centring the patient in treatment decisions may seem like a basic principle of care, but in practice, and especially in mental health, it’s not always how things go. BD-I is particularly complex; there’s no “typical” patient and few treatment journeys follow a textbook. Symptoms can vary widely from person to person and so can the challenges they face outside the clinic. When we overlook that context, even well-meaning treatment plans can do more harm than good.

Purposeful prescribing

I had a patient come in not long ago who was severely depressed and cycling quickly between manic and depressive episodes. He was clear about what he needed: fast relief, no drawn-out process, and something that wouldn’t leave him with intolerable side effects. I listened carefully, explained the benefits and risks of different treatment options, and together we chose a medication that matched his needs and gave him a clear plan. Two weeks later, he returned and said it was the first time in two decades that treatment had felt like it was working. I didn’t do anything revolutionary. I simply took him seriously and prescribed with intention.

Purposeful prescribing extends far beyond symptom control. It requires seeing the obstacles that patients may face outside the healthcare provider’s office. Lifestyle, comorbidities, and socioeconomic status all shape a patient’s journey. I care for many patients who face overlapping challenges, including housing instability, trauma histories, and lack of insurance. These factors all influence treatment decisions. Take, for an example, one of my patients who is self-employed and uninsured. She lives with Post Traumatic Stress Disorder (PTSD) and anxiety, in addition to BD-I. Her work schedule is unpredictable and she can’t afford frequent visits. For her, purposeful prescribing means taking her whole life into account to get her care that meets her where she is and that is sustainable.

When people talk about social factors, it can sound abstract. But in practice, they show up in very real ways. A patient might not be able to take a pill at night because they work two jobs and fall asleep on the bus home. Another patient might need to be seen every week, but can only afford to come once a month. These aren’t excuses, they’re realities, and if I don’t adjust to those realities, the care I’m offering won’t stick.

A process rooted in progress

Another important element of purposeful prescribing is setting attainable goals. When a patient starts medication, there should always be a goal: maybe it’s reducing manic symptoms, improving mood, or getting through the day without spiralling. Whatever it is, it needs to be realistic and achievable. If the goal isn’t met, we reassess, whether that means adjusting the treatment plan, making a medication switch, revisiting expectations or identifying new barriers to progress. And when we do reach a goal, we don’t stop – we set a new one. That might mean aiming for six months of mood stability or being able to return to work. We work toward it together, thoughtfully and safely. Staying goal-oriented gives people a sense of purpose and direction, helping them see what they’re working toward and keeping the process rooted in progress.

I didn’t always think this way. Early in my career, I had a narrower set of medications I felt most comfortable using. In my prescribing practice, I was more focused on what I knew and less on the why behind a medication choice. Over time, through trial and error, and listening more closely to my patients, I began to realise how limited that mindset was. In my practice, I’ve made it a priority to proactively expand my thinking as a clinician and as a prescriber. Through those experiences, I’ve evolved into someone who understands that the process of prescribing needs to be as personalised as the treatment itself.

These days, I am attuned to hearing my patients’ needs and desires and making sure I’ve got the right tools to support them. In my prescribing toolbox, I aim to have a breadth of medications and strategies that reflect what they’re actually going through and not just what’s written in the chart. The key is to keep listening. When patients come back and something has shifted, I repeat my understanding back to them. That opens the door for them to clarify, adjust or express what they really need. Then, we move forward together. That kind of give-and-take builds trust. It helps patients feel like they’re not just following instructions, but are part of the process.

Prescribing with purpose is about paying attention. When we take the time to understand who our patients are, what they carry, what they can manage and what they hope for, we’re able to build plans that fit the whole individual.

About the author

Kevin N. Williams MS, MPAS, PA-C is the CEO and lead clinician at OnPoint Behavioral Health. He is a physician associate who specialises in psychiatry and has a mission to provide care that is experienced, holistic, and compassionate. He holds two Master’s degrees in Interdisciplinary Medical Sciences and Physician Assistant Studies from the University of South Florida and South University, respectively. He has gained experience treating children, adolescents, and adults for the past nine years in the areas of in-patient, out-patient, and long-term care. Williams has eight years of experience teaching as an Adjunct Professor at several institutions around the country. He also has over 10 years in executive leadership experience and maintains a passion of educating others to lead with effective influence. Williams has participated in mission work abroad and has enjoyed volunteering in several organisations in the Tampa Bay community. He enjoys spending time with his family, along with his hobbies of aviation and travelling abroad.