Q: My 39 years old husband has been diagnosed with bipolar disorder last year. We got married 13 years back and he is unemployed since then. There have been multiple incidents of depression and aggressive behaviour. He has taken treatment for depression twice but he does not agree that he has any problems. He was prescribed a medicine Depakote which he took for a couple of months. Since then he has had episodes of violent behaviour and depression. How can his behaviour be managed?

A:You raise several interrelated issues including diagnostic clarity, effect of medications, level of insight, help seeking, violent behaviour, impact on life and employment. It can be very frustrating and challenging to get someone takes help. Help seeking behaviour can be affected by several variables including the level of understanding of what the problem is as well perceived stigma and family support. Especially in the Indian context it can be difficult to get someone to seek help in a vacuum without support of family / friends.

I wonder whether there is a possibility of influence / support from either his or your relatives / friends to assist in establishing contact with a psychiatrist. It might be useful to even go back to the same doctor who had prescribed Depakote. Things delayed can sometimes lead to chronicity and become more difficult to change with time. It is not very clear whether your husband has been using any drugs / alcohol, has there been any previous history of mental health difficulties, what are the family supports, whether there are any financial difficulties, and what does he do in the well period.

In India, we have several private psychiatrists and clinics which if affordable can provide the level of confidentiality and quality of treatment. It seems that the treatment may have to include significant psychological work to deal with issues of insight, poor compliance, issues of violence, employment options.