PMP Risk Management as Applied to Behavioral Health

This is a blogpost detailing the use of PMP risk management techniques to help manage mental health disease symptoms:

During the last 20 years or so, I have been applying risk management techniques learned as a Project Management Professional to help manage risks associated with my mental health and mental illness characteristics.  What I learned as a technical skill as a project manager to manage risks can be applied to illness management as a person with bipolar illness.  Typically in risk management, the project manager identifies with the team all the risks associated with the particular project in hand.  After recounting the risks, the team goes through the process of assigning probability of occurrence and level of impact associated with each risk to the project.  After the severity and likelihood of the risk is captured, the team then works to develop mitigation strategies for each risk and to indicate whether mitigation strategies are sufficient to address each risk recorded. 

How can this be helpful to a person with mental illness?  The idea of risk management is characterizing the probability and impact of the risk and then creating risk mitigation strategies.  This same scenario can be applied to managing risks associated with bipolar illness.  This risk management may take place with the patient’s care team including the prescribing doctor and the therapist.  For example, say I have extreme anxiety about leaving my home and have an Obsessive Compulsive Disorder-type set of checking routines I do to mitigate this anxiety.  The risk would be the anxiety condition and the mitigation would be the checking routine.  This is a largely effective strategy for managing this form of anxiety unless the OCD ritual becomes ever-present and ever-pervasive.  In this instance with the OCD mitigation it might be said that the risk mitigation strategy is becoming non-mitigating.  It may be time to revisit that risk or anxiety and re-evaluate what an effective new mitigation strategy might look like.  This might include self-talk about the probability of the risk occurring based on the prior number of years the risk has been managed and self-talk about the impact if ever the risk or anxiety has manifested itself in an actual real event during the course of tracking the risk.

All in all, assigning probability and impact to behavioral health management risks helps set priorities for what is a big risk to manage versus what is a smaller risk to manage.  Key is the development of effective risk-management mitigation strategies to use to address the risks.  Also key is the reassessment of risk mitigation strategies when the risk mitigation is no longer effective.  At that time, new measures of risk mitigation need to be developed and put into place.

All in all, risk management learned through the Project Management Professional lens can prove helpful in the management of unwanted behaviors associated with bipolar illness.  Different risks can be catalogued and associated with different mitigation strategies.  When these mitigation strategies no longer are viable, new mitigation techniques are developed and applied.   

What tools – either from your professional life or not – do you use to help mitigate your illness symptoms?

My Sojourn through Bipolar Illness – Managing Anxiety Then and Now

My daughter was born 16 years ago when I was 40 years old.  She is the light and the delight of my world, yet her birth marks a turning point in my illness particularly as regards my experiences of anxiety.  As a parent, my experience of anxiety has quadrupled or more over the years of being a parent. 

In years prior to the birth of my daughter, everyday life felt relatively normal between breaks with breaks or mini-breaks coming every six months or so each year.  After the birth of my daughter this scenario was replaced by a low to medium to sometimes high level of generalized anxiety all of the time.  This generalized anxiety now persists as my benchmark or my norm with little or few break-down episodes.

While I no longer have episodes that land me in the hospital or at my sister Jane’s house twice a year, I do maintain and live with a generalized sense of anxiety all the time.  In many ways my illness has migrated from severe to partially severe breaks every six months to living with anxiety on a regular basis.  The anxiety may also be the by-product of mixed moods – or experiencing mania and depression simultaneously.

The good news is I have become better at policing my environment and know those things that trigger my anxiety:   fears of safety, not being sure the house is locked or secure, not knowing the location of important things like documents in the safe or prescription medication, big parties where there is an emphasis on alcohol and drinking…. In many ways it feels like my bipolar illness has migrated toward including a combination of Obsessive Compulsive Disorder and Generalized Anxiety. 

But, I am not the doctor and as far as I know I am still diagnosed as having bipolar illness… 

As a parent as discussed, I tend to be hyper-focused on safety concerns for my daughter as well as for my family.  I tend to be extra vigilant about little things like crossing the street or being in a venue where alcohol is served or being aware of predators on the internet or elsewhere.

I also appear to have some short-term memory problems that I associate with a high dosage of meds over the years and/or over-active brain synapses.   These short-term memory issues continue to present challenges to me particularly in the workplace.  At times, I am challenged with finding a place for everyday things like a wallet or keys or cell phone.  It is also difficult for me to keep track of things of my daughter’s like phones, laptops, keys, etc. Each of these things has to have a specific place or I will become anxious in the not knowing.  The not knowing again is tied with the short-term memory challenges. 

These short-term memory issues have turned me into “a checker.”  Before leaving the house, I check routinely that the stove and oven are off and that other appliances are unplugged.  I have developed a checking routine for various appliances and doorways before leaving the house.  This level of “checking” feels important for me because of the memory issues but drives my husband and my daughter crazy.  

In general, I would say that the general anxiety that I experience currently presents my largest challenge in the management of my life including my role as mother to my sixteen-year-old daughter.  The anxiety is something that I face every day.  Being overly sedated so as not to feel the anxiety is one approach.  I am hopeful, however, that the medication I have been taking for the last 10 years will allow me to address that generalized sense of anxiety.  Perhaps also, this anxiety simply is tied with being a parent and all the worrying about things that that role entails.    Perhaps also this anxiety is due to unresolved issues of potential child abuse when I was six.

Prior to my daughter’s birth, I managed my condition with a combination of lithium and tegretol for ten plus years.  This was my regime when I had the mini breaks every six months or so that were treated with Mellaril and Haldol.  Now, I no longer have those mini break-through episodes, but I do have a sense of generalized anxiety a lot of the time.  The generalized anxiety appears for now to be the trade-off for no longer having the mini-breaks.   Managing through this generalized anxiety is my current mental health challenge.     I am hopeful as I get through to the other side of child abuse as a six-year-old, these anxiety symptoms will abate markedly.