World Bipolar Day: Recognising bipolar I disorder and addressing disparities
World Bipolar Day, which occurred 30th March 2026, raises awareness and encourages better understanding of bipolar disorder, including bipolar I disorder (BD-I). For clinicians, it is also a moment to assess how this condition is recognised and treated in real-world practice.
BD-I is a brain-based condition that affects mood and energy regulation to an extent that disrupts daily life, and is diagnosed by the presence of clinical mania in a person’s health history. During a manic episode, people living with BD-I experience increased energy and mood changes such as feeling uncharacteristically happy or irritable. During severe manic episodes, some people also experience psychosis, which can encompass disorganised thinking, false beliefs, or hallucinations. Periods of mania often alternate with depressive episodes indicated by intense sadness or despair.
The challenge of diagnostic clarity
An essential question clinicians face when evaluating mood disorders is diagnostic clarity. In my practice, patients more frequently arrive with complaints about their depressive symptoms than manic symptoms. This is not uncommon, and is a known contributor to misdiagnosis of BD-I.
Relying on a patient’s self-reported symptom history becomes difficult when they don’t – or don’t know to – disclose experiences their provider may then rely on. I find it useful to encourage patients to share every little detail, and to ask follow-on questions that lead me to the information I need.
Diagnostic challenges become more complex when we consider how different communities access care. In my experience, while the prevalence of BD-I is not less for Black patients, it is frequently recognised and addressed later, with implications for care and outcomes. It is not a difference in the condition itself, but rather a difference in how and when patients enter the mental health system, influenced by social and systemic forces.
Trust, history, and barriers to care
Part of that difference is driven by longstanding mistrust of the medical system within the Black community. The disconnect goes much deeper than asking if the clinician and the patient look like each other, though there are relevant cultural factors to consider. These are barriers to access rooted in fears about whether the broader system will understand or treat them correctly.
This dynamic is historically grounded. For generations, Black Americans experienced unequal treatment in the healthcare system. Racial stereotypes were persistently perpetuated in medical education alongside instances of unethical experimentation and exclusion from quality care. Knowing that so many people carry that context with them, it becomes easy to understand their cautious approach to the healthcare system.
Conversations with a clinician about mental health concerns may be particularly delayed. Research has shown that higher levels of medical mistrust among Black adults are associated with a lower willingness to seek care from mental health professionals. What I see in my practice reflects that trend. Stemming from a sense of self-protection, some patients may hesitate to seek help even when symptoms are present. In many cases, symptoms are managed privately within the family for as long as possible.
As I wrote in a previous pharmaphorum article, many in the Black community are familiar with the phrase, “what happens in the house stays in the house.” That mindset absolutely extends to include beliefs around healthcare, and mental health more specifically, which leads to a reluctance to take those concerns or experiences externally. As a result, clinicians may only become aware of the illness after it has escalated to an acute crisis.
In many cases, I first see these patients once symptoms have become so extreme they can no longer be contained within the family. When someone enters care at that point, the presentation will look very different than if I had the chance to meet them earlier in their illness. In some cases, there may already be psychotic features such as disorganised thinking or delusional beliefs. At that stage, the immediate focus for clinicians is stabilisation.
The importance of slowing down in diagnosis
While that immediate intervention is necessary, an equally important next step is careful follow-up care to ensure the underlying mood disorder is accurately assessed and ongoing treatment is discussed. As I often remind my peer clinicians, we have to pause in the busyness of practice and really listen to the patient. That means asking basic questions, such as when symptoms started, how they have changed, and what the patient has experienced.
Because many of my Black patients enter care when their symptoms have become so severe as to include psychosis, that is generally what clinicians first address. Psychosis is a symptom across multiple psychiatric conditions, and needs to be carefully managed to avoid presumptions about the associated diagnosis. For example, Black patients with psychosis are more likely to receive a diagnosis of schizophrenia than White patients.
When a schizophrenia diagnosis is initially made, treatment may focus narrowly on managing psychosis while undertreating the mood symptoms that become more observable after stabilisation. That is why it is so important for clinicians to understand the totality of a person’s clinical needs. When we slow down and take time, we are better able to recognise a pattern that points to BD-I, rather than schizophrenia, enabling providers, patients, and their care teams to make a thorough treatment plan, including appropriate medication.
Effective care for BD-I depends on how patients continue to engage in treatment. Living with BD-I requires ongoing follow-up and lifelong management. Selecting the right medication strategy, one that balances effectiveness with tolerability, is a big part of what I work toward with patients. I have observed that, even if a medication effectively controls a person’s symptoms, if the side effects interfere with their day-to-day life, they’ll choose to stop, which impacts their wellbeing both then and in the future.
The need for equity in care
World Bipolar Day is a time to raise awareness about bipolar disorder, and also a chance for clinicians to reflect on how we recognise and treat BD-I in practice. The ways people interact with and initiate mental health care are variable, nuanced, and culturally sensitive. Moreover, those differences can shape how quickly illness is identified and treated. To that end, amplifying efforts around World Bipolar Day should include addressing the disparities that still exist in diagnosis and care. When we take time to listen carefully and fully understand someone’s background, we are equipped to make the right diagnosis and develop treatment plans patients are motivated to engage with, and in turn lessen the next person’s concerns about asking for help.
About the author
Kevin N. Williams, MSc, 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.
