Why are suicide rates so high in bipolar disorder, and what can we do about it?

Heston Blumenthal, the celebrity chef known for his experimental cuisine, recently shared his experience of being sectioned under the UK’s Mental Health Act, saying it was “the best thing” that could have happened to him. His openness about living with bipolar disorder highlights the little-discussed fact that people with this condition face one of the highest suicide risks of any mental illness.

Bipolar disorder is a severe mental illness characterised by episodes of mania (high energy, impulsivity) and depression (hopelessness, fatigue). Suicidal thoughts and behaviour are a core feature of the disorder, with fluctuating risk that can persist over long periods.

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Although bipolar disorder affects around 2% of the population, studies suggest that up to 50% of people with the condition attempt suicide at least once, and 15-20% die by suicide – a rate much higher than in the general population. Unlike global suicide rates, suicide deaths in bipolar disorder have not declined.

Understanding why suicide is so common in people with this disorder is difficult. But one major factor is mood instability. Rapid shifts between emotional highs and lows, as well as mixed states where symptoms of mania (impulsivity) and depression (despair) occur together, can be particularly dangerous.

Social and economic factors also play a role. Research we conducted at Swansea University shows that the population suffering from bipolar disorder has become poorer over the last two decades. Financial strain, social isolation and poorer access to healthcare all lead to worse outcomes. Beyond suicide, people with the condition die up to 20 years earlier than the general population, often from preventable health problems such as heart disease.

While bipolar disorder cannot be cured, it can be managed. The most commonly used drug, lithium, has been found to reduce suicide risk significantly in some patients. However, people with the condition struggle to take it regularly.

The drug’s side-effects can affect the kidneys, thyroid, metabolism, cognition and cardiovascular health. Managing these side-effects requires regular blood tests and continuous monitoring, making long-term treatment difficult.

Many people stop taking their medication during manic phases, believing they are cured.

Other treatments, such as antipsychotics, mood stabilisers and electroconvulsive therapy (where electric currents are passed through the brain while the patient is under anaesthesia), can also be effective in some types and phases of bipolar – for example, in states of mixed mania and depression where there is a high risk of suicide – but they come with their own harms and limitations.

Some psychiatrists now question whether continuous lifelong treatment is necessary for all patients.

Even when people seek help, healthcare systems often fail to intervene effectively. Suicide risk is highest in the days following discharge from a psychiatric hospital. Many people who later die by suicide have recently visited emergency rooms after hurting themselves, but the help they received was either delayed or not enough to prevent further harm.

Existing tools to identify and measure suicide risk, such as checklists, questionnaires and structured interviews, are ineffective. Many people with bipolar disorder who die by suicide are assessed as “low risk” shortly beforehand, exposing a crucial gap between doctor and patient perceptions. This is in great part because these tools rely too heavily on past factors such as suicide attempts (which may not be disclosed), rather than dynamic, real-time distress or mood instability.

Despite the significant effect that bipolar disorder has on individuals, families and society, the development of new drugs has been frustratingly slow. Lithium, first used in the 1940s, remains the go-to treatment, while most other drugs were originally designed to treat schizophrenia. No truly new treatments have emerged in decades.

Not a single disorder

One difficulty is that bipolar is not a single disorder but a spectrum of conditions, rendering the one-size-fits-all approach inadequate — lithium is effective in only about one in three patients.

Drug development for bipolar disorder is particularly challenging. The complexity of bipolar disorder calls for equally complex trials that need to consider patient variability, ethical concerns and strict safety requirements. New treatments also face strict approval hurdles because lithium – despite its limitations – is highly effective for some patients. This results in slow treatment development, leaving patients with limited options.

Research is also slowed by concerns about whether it’s ethical to involve patients in trials. But it’s important to include people with the disorder who have experienced suicidal thoughts and behaviour, to better understand their mindset and decision-making.

However, new approaches offer hope. Several research projects, such as Datamind, are developing artificial intelligence platforms to help find new drugs quicker and to personalise treatments based on patients’ genetic and clinical profiles. AI could lead to faster, more effective therapies tailored to individual needs.

Blumenthal’s story highlights that being sectioned, while traumatic, can save lives and keep people safe. Yet the stigma around psychiatric hospitalisation prevents many from seeking care. There is a widespread belief that hospitalisation should be avoided at all costs – but for some, it can be the difference between life and death.

However, hospitalisation alone is not enough. The mental health system must do better to ensure that people with bipolar disorder receive long-term care, particularly during high-risk periods like hospital discharge. To prevent suicide, we need to rethink how risk is assessed, improve follow-up care, and reduce barriers to treatment.

While the statistics on bipolar are alarming, the message should be one of hope. The condition is treatable and suicide is preventable, but only if we commit to improving access to care, reducing stigma and advancing research.