The recent publication of the Bipolar Commission’s report, ‘Bipolar Minds Matter’, by Bipolar UK (BDUK) makes it timely to revisit the place of UK primary care in bipolar disorder (BD).1 Bipolar disorder is a severe mood disorder that affects more than 1 million people in the UK; this is nearly one-third more than dementia and twice the number for schizophrenia.

This chronic disease is subclassified into distinct categories; for example, patients with BD1 have more severe manic episodes, whereas in BD2 the episodes of elation are less severe and shorter, often not coming to medical attention. Whatever the type of disease, the outcomes can be poor.2 Without effective pharmacological and psychological interventions patients will suffer relapses. The aims of treatment are to prevent relapse and improve function. Most people with BD have a co-existing psychiatric illness, such as drug and alcohol misuse, eating disorders, anxiety disorders, or attention deficit hyperactivity disorder.2

The Bipolar Commission surveyed 2334 patients living with diagnosed BD and interviewed over 100 patients, relatives, clinicians, and academics. It reports stark facts.1,3

Mortality is increased from natural (cardiovascular and respiratory disease) and unnatural causes (suicide, accidents, and homicide), with most attributable to physical health causes. People with BD die on average 10–15 years earlier than their peers without BD. They have a 20 times greater risk of suicide than the general population; up to 20% of (mostly untreated) people with BD end their life by suicide.1

In the BDUK survey, it took an average …