A Childcare Field Coworker is Bipolar, Should I be Concerned about the Children's Safety?
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Q:  A Childcare Field Coworker is Bipolar, Should I be Concerned about the Children's Safety?

I work in the childcare field and have just learn that one of my coworkers was diagnosed with bipolar disorder a few years back. He is regularly left by himself with a group of up to 15 children. I know he is on medication. I also know that he has not informed our boss about his condition. I don't want to see this guy fired, he is a very good worker. But, I am still concerned about the safety of the children in his group. Should I be????

Thank you,

Dear Valerie --
Your reaction is understandable, and common.  It may have taken some courage to voice your concern, one which could easily be shared by many in your circumstances, but one which you can probably imagine could be interpreted as unfair and discriminatory, particularly in this forum.

Let us all just let go of a possible inclination toward such judgment, because you ask in a fair and I think possibly quite innocent way a question that may be on the minds of many, in one form or another.  Let’s focus on the question. 

Here’s the short answer [which then turned into a long one as you will see]: you should let go of your concern; you should not inform the boss about what you have learned; and you should maintain a relationship with him as though you had never learned about his bipolar disorder.

Meanwhile, you should of course maintain vigilance for any behaviors which anyone on the staff might manifest that would suggest the children under their care were less than completely safe.  For example, you could monitor for anyone who comes to work hung over from drinking too much the night before. You could monitor for lapses in attention, being distracted for example by emotional distress in a coworker who was going through a divorce. You could monitor for excess irritability in a coworker who might be perimenopausal or premenstrual and having a tough time dealing with the kids on that particular day. You could monitor for subtle changes in speech that might reflect a colleague’s diabetes was not well controlled and whose blood sugar was too high.

In other words, what matters are behaviors, not conditions.  Diabetes, divorce, hormonal changes, and even drinking to excess on one’s own personal time, are personal matters that do not warrant consideration in the workplace as long as they are not affecting performance.  Bipolar disorder is the same.  Indeed, bipolar disorder may well be more easily controlled in the majority of cases than is divorce, in terms of impact on work performance.

A friend of mine who has diabetes says that if he keeps his blood sugar very well controlled, right in the same physiological range as someone who does not have diabetes, then he does not effectively have diabetes at all.  The same can be said for bipolar disorder: if the illness is kept well controlled, so that a person is not having shifts in mood and energy at all (which is certainly our primary goal in treatment – achieved frequently, nearly 50% of the time overall in one study, for example), then that person does not effectively have bipolar disorder at all, in terms of his or her ability to function in the world. She or he has to stay vigilant, just like a person with diabetes, to maintain good symptom control. But if successful, the outcome is a life which is virtually unaffected – on the outside, at least – by the illness.  This is actually one of the main goals of treatment, to bring about such a state, including training people to be vigilant in their own monitoring.

So to conclude: in order not to be discriminating against people with medical problems (including strokes, multiple sclerosis, congestive heart failure – all of which could interfere with a person’s ability to function, if poorly controlled) , we should all presume that any one whom we happen to discover has “bipolar disorder” (of which there are many kinds) is someone who has worked hard to maintain good symptom control and is therefore unaffected by her or his illness – including in their relationship with you, as well as their work performance.  If evidence to the contrary emerges – the person exhibits erratic shift in mood and energy, for example – then you could debate whether to talk to the boss first or the person first.  That probably depends on how erratic the person is.  Obviously, talking to him or her first would be preferable, as long as you think that will be safe and practical.

Thank you for asking your question, and giving me the opportunity for this diatribe.  You’re not the only one who has found her or himself with such a question, and raising it openly I hope has been an opportunity for everyone to learn a bit.  Thank you for reading all the way through here.

Dr. Phelps

Published February, 2009


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