Thank you for asking this important question. Dealing with episodes like mania and depression can be very challenging and quite upsetting. It does sound like your friend’s sister would benefit from professional help—as well as your friend herself. There are a couple of possibilities worth considering. There are free or low-cost public services available in most communities throughout the United States. If your friend and her sister live near a major metropolitan area, there should be several programs and services available. A good place to start is an online search with keywords such as “community mental health services in (location),” or “programs or services for people with bipolar disorder (or depression).” Another possibility is to contact therapists in your community—you can search for local therapists at www.GoodTherapy.org, for example. Send e-mails asking local therapists if they ever provide free or low-cost services, and ask them what local programs or services they know of. Your friend may want to contact the nearest local Mental Health Association. These are the local affiliates of the national Mental Health Association and are nonprofit advocacy and resource centers. They should have listings of free or low-cost services available in your area.
Your friend may need some support or guidance herself. She may want to consider seeing a therapist who is familiar with her sister’s disorder. There are a few very helpful guidelines to keep in mind when you live with someone who has bipolar disorder (and other kinds of severe emotional disorders such as major depression). It’s important to understand that the symptoms—mood, behavior, and disturbing things that are said—are indeed part of a real biological, psychological, and emotional disorder, or illness. Those who live with people who struggle with these disorders often are affected in ways that are totally normal and even expected. These “caregivers” often become angry or depressed themselves, and they often experience feelings of guilt, helplessness, and frustration. Your friend needs to know that these feelings are predictable and understandable and that she did not cause the problem or disorder—nor can she cure it. She can be emotionally supportive, make sure her sister is safe (if there are any suicidal statements she must take her sister to the hospital or contact the proper authorities), and suggest help from local programs or therapists. She should also practice self-care, everything from setting boundaries (saying no to her sister when necessary) to taking care of her own needs. These are important guidelines for all of us who care for people with significant psychological problems.