Thrive with bipolar at university

Christina St Clair, who graduated from medical school in London in June 2024, shares her insights for anyone who's living with bipolar at university.

You are the best authority on your life and your condition, but if you’re living with bipolar at university, I recommend trying out a few of the suggestions below, seeing what works and leaving the rest.

Above all else, take your time and be kind to yourself. Nothing is ever as urgent or as important as you think.

First symptoms

I first started experiencing symptoms in my teens, but I lived with undiagnosed bipolar until the age of 26. My diagnosis came at the end of my 4th year of medical school after I failed an exam.

The illness had been affecting my studies for years but this was the first time it showed up ‘on paper’. Up until this point, I had mostly lived in a perpetual state of exhaustion, confusion and chaotic coping mechanisms.

It became necessary to take a year away from university for treatment of hypomania, severe treatment-resistant depression and recurrent mixed affective states. Fortunately, I was able to return, resit the year and get the support I had desperately needed.

Academic adjustments

When I returned to university, I got a lot of help from:

The head of my course
My personal tutor
The student disability service

They helped me to set up what are known as ‘academic adjustments’ and they communicated with me frequently.

I told them that sometimes my symptoms mean I can’t get up in the morning and I need to arrive late. Or that sometimes I need a few days off during term-time to rest and recalibrate to prevent a severe episode. Depressive symptoms can make it harder to meet deadlines and elevated symptoms can make it difficult to concentrate and retain information.

Talk to your university learning support team to see what adjustments they can make for you. You may never need to use them but it’s good to put them into place when you’re well rather than waiting until you become overwhelmed.

Examples of possible supportive measures

Extra time in examinations (for work or for rest)
Taking exams in a separate, smaller room
Automatic extensions to written submissions
Extended library loan times
Getting notes or lectures in advance
1-1 learning support assistant

Pastoral support

Try to meet with your personal tutor/educational supervisor/head of year at the beginning of every term. You can share as much or as little as you like but making a faculty member aware of your personal situation, exploring any potential challenges, and explaining some of your signs and symptoms will help to guide them about the best ways to support you.

This person should know you personally and will hopefully check on you as the term wears on. This helps to keep channels of communication open between you and the university in case anything major happens, and it also helps you to feel seen and supported even when you are well.

Honest and collaborative communication will be the best way to get meaningful support through the ups and downs of studying and living with bipolar.

Talking to people about bipolar

You are under no obligation to tell anyone about your condition, but in my experience it’s better if you don’t keep it to yourself. It’s a great burden to carry and it can be very isolating.

There is nothing wrong with you and silence just adds fuel to the fire of shame. Test the waters by talking to people you feel comfortable around. You never know, they might just surprise you.

If you are studying certain courses where you might come into contact with vulnerable populations, such as patients or children, or dangerous materials or machinery, it is important that someone in your faculty is aware of your condition.

Examples of courses where you may need to share your diagnosis

Medicine
Nursing
Psychology
Education
Chemistry
Engineering

There is no reason why you can’t participate in your course in exactly the same way as everybody else, but your faculty should know what symptoms and signs to look out for in case you become unwell.

Manage your money

It can be very daunting to manage your own money, especially for the first time. And it’s well known that mental illness can affect financial security. For anyone living with bipolar, increased spending and excessive charitable giving are well-known symptoms of (hypo)mania.

Universities (or the university student unions) often have special money advisors who can help you navigate your finances.
Even if you don’t stick to it, it’s good to to make a budget as a benchmark. Set out what money you have coming in (student loan, bursaries/grants, income from work) and your necessary expenditure (rent, bills, food, medication, transport). Make a rough plan of how much you have to spend and how you can split it up, so you don’t run out of money before the end of term.
The student loan normally comes into your account as a lump sum at the beginning of each term meaning you get 3-4 months’ worth of money in one go. I recommend paying your rent and bills immediately and then putting most of it aside in a separate savings account.
You can then set up a standing order for a certain amount per month/per week to go from your savings into your current account for your everyday spending.
More and more banks are recognising the specific needs of their customers and will allow you to set up personalised limits on your spending. For people with bipolar, it can be a good idea to ask the bank to require extra authentication for any expensive purchases and to only allow one overdraft.
You may be able to block any gambling transactions (in betting shops or online). These are simple but effective measures to help safeguard yourself against any mood-related erratic spending. Additionally, PayPlan offer free advice about debt to anyone with bipolar.

Manage your mood

Tracking your mood and bipolar symptoms can be hard work, and sometimes it makes you feel like your whole life revolves around the condition. I’ve always struggled to keep a mood or symptom diary. There were always so many factors and I never felt like I was doing any of them right (sleep, exercise, eating, caffeine, meditation… the list goes on).

However, sometimes it can be helpful to have a rough sense of how you’ve been doing over time whilst you get to know your illness, your patterns and your triggers. Bipolar UK has an excellent Mood Tracker app (downloadable from App Store or Google Play).

Mixed states are really hard to identify so I find an awareness of instability as well as of depression and elevation can help me to recognise when I’m not well much sooner.

Take your medication

Take your medication with you when you go out. Take your medication on the bus. Take your medication in a lecture. Take your medication wherever and whenever you remember but just take it.

When I was first diagnosed, someone suggested that I use empty contact lens cases to store my meds and I’ve never looked back (no pun intended).

I put my morning medication in the left-hand side, evening medication in the right. That way, it’s easy to see if I’ve taken my tablets for the day and I can slip it into my pocket when I’m out and about. It also makes it easy to pack enough supply if I’m travelling anywhere overnight.

You’ll find what works for you. But just take it. And don’t feel you need to explain it to anyone.

Dual diagnosis

Getting a diagnosis of bipolar is hard enough but many academically high-achieving people with bipolar can often have other underlying conditions that don’t become apparent until a bit later on in life. University can be the first time that these things really begin to impact someone’s day-to-day coping.

Examples include… Attention-Deficit Hyperactivity Disorder (ADHD), Autistic Spectrum (ASD) or Learning Difficulties (dyslexia, dyspraxia). If you find yourself struggling and think there might be something else going on besides bipolar, reach out to the university learning support team or your GP / mental health team.

Keep a treatment log

It’s useful to keep a record of your medical and psychiatric history, especially since many people move away from home for university and encounter new health systems.

I think it’s helpful to record:

Past medications: what you took, when you took it, whether it worked and any side effects
Past therapeutic input: psychological therapies and any group work
Hospital stays: any hospital stays, the reason for admission and the dates

Set up an Advance Choice Document

Advance Choice Documents [https://www.advancechoice.org] are becoming increasingly recognised in the UK. These are forms you can fill in when you are well (with the help of family, friends or clinicians) which act to provide information and guidance about your illness and your wishes regarding treatment should you become unwell again.

University ‘life’

As well as spending your mornings in lectures and your afternoons in the library, there are a million and one new and exciting activities, hobbies, clubs, societies, and sports that you can try at university.

Try to avoid the temptation to sign up for absolutely everything before you’ve got a sense of your workload, your new routines and how best to manage your mental health. Try out a few things that interest you and know that the rest can wait until next term or next year.

Additionally, make sure you think carefully before you take on extra responsibilities (e.g. class rep, club president, sports captain) to prevent yourself from becoming overwhelmed.

You may be perfectly capable of managing the extra workload but you just need to think ahead about how to factor it into your life so that it can be a source of joy and not a source of stress.

All-nighters

There is no reason why you should need to stay up all night to finish a piece of work in time for a morning deadline. Your degree is designed to be fully achievable during the daylight hours. You may spend a few evenings in the library or a few weekends flipping through your reading list but you do not need to be staying up all night working.

Other people can do this if they like but, as someone living with bipolar, regularly getting a full night’s sleep is one of the best ways to prevent relapse. Get to bed and give yourself the best chance to succeed. Most things can wait until morning!

Keeping in touch with home

One of the challenges about going to university is that, for many of us, we don’t have people around us who know us well. This can be a beautiful fresh start especially if recent years have involved illness. However, it does mean that other people are less likely to see the signs and symptoms when we’re becoming unwell.

It’s important to keep in touch with parents, childhood friends, siblings or grandparents. Whoever it is, I’d say try to phone home at least every month. That way, someone who knows you can pick up on any changes that may not be obvious to those around you.

Your loved ones will be the ones who notice that you’re video-calling at 4pm with all your curtains closed, or that you sent loads of texts and missed calls in the middle of the night. The people who know you well will know that certain behaviours are associated with certain mood states and they can act as a safety net. Keeping in contact will reassure you and those who care about you.

Keeping yourself safe

Adulthood (and university) is often the first time people encounter exciting new freedoms and experiences. We all know that drink and drugs can have a harmful impact on our mental health, but if you do come across alcohol, substance use, late nights, whirlwind romantic relationships and any other mood-altering or mind-altering experiences, please remember that these things affect people with bipolar differently to everyone else.

These lifestyle factors have the potential to be really destabilising to mood and often end up being used as unhealthy coping mechanisms to disguise underlying symptoms.

The best thing you can do to keep yourself safe is to be careful and be honest (with yourself and with those around you).

Being a student is a wonderful opportunity – good luck!