Your behavior is very erratic. You experience drastic mood swings that can cause intense episodes of anger, depression, and anxiety. You also have a very unstable self-esteem, identity and relationships with others. As a result, you have a difficulty trusting others and having relationships. You have considered getting help, but know that treatment is expensive and you don't want to cause your mom more stress.

1. What is the name of the mental health condition?

2. What are the pros and cons to getting help? (give 2 pros and 2 cons)

3. What are the barriers to getting help? (list 2)

In the specific case of bipolar disorder, it has a complex phenotype with high external validity that requires a broad knowledge of psychopathology, neuropsychology, psychopharmacology, and psychotherapy. These, and other reasons, have prompted some authors to advocate that bipolar disorder is ‘the heartland’ of psychiatry. Reference Goodwin and Geddes2 In this issue of the Journal, Kessing et al Reference Kessing, Hansen, Hvenegaard, Christensen, Dam, and Gluud3 report that treatment in a specialized mood disorder clinic early in the course of bipolar disorder substantially reduces readmissions to hospital and increases satisfaction with care compared with standard community care. Strengths of the study include the randomized design and the practical relevance of the question addressed. This study supports the specialized management of patients with bipolar disorder.

What would be the cons of giving too much support to specialized care as opposed to traditional community care? One risk may be fragmentation of care, especially if the setting for specialized care is a tertiary hospital that may be far away from patients' homes. Too much specialization may also result in gaps in overall care if not properly organized, and may not guarantee the focus on functional recovery. Reference Rosa, Reinares, Amann, Popovic, Franco, and Comes4 Another concern may be cost. However, bipolar disorder units may provide better continuity of care if the same patient is seen by the same team regardless of the setting, and they may also carry advantages in terms of education and research. Reference Vieta5–Reference Henry, Etain, Mathieu, Raust, Vibert and Scott7 Hence, the European Union seventh framework program has sponsored a network of expert centers called ENBREC (European Network of Bipolar Research Expert Centres), aimed at developing common tools for the assessment and management of bipolar disorder across Europe. Specialized centers may well be better suited for research and training on the specific condition of their expertise compared with community centers. Moreover, sophisticated interventions that have been designed by experts from referral centers, such as group psychoeducation or functional remediation, may be cost-effective and may be implemented in all sorts of settings if therapists are adequately trained. Reference Scott, Colom, Popova, Benabarre, Cruz and Valenti8–Reference Martínez-Arán, Torrent, Solé, Bonnín, Rosa and Sánchez-Moreno9 Hence, the key to getting the best from both specialized and community care may be to enable their rational integration into existing psychiatric services, Reference Lyndon10 and choosing the right setting for the right patient at the right moment – perhaps not easy, but feasible and highly desirable.