Parents of bipolar children often change their home environment to make their child's life--and the whole family's life--easier. It's one of those things that moms and dads do without really thinking about it. Just as you look at your home in a new light when an infant begins crawling and exploring, the emergence of bipolar symptoms in a child warrants some revisions. You might think of it as making your home a therapeutic environment.

Families can take many cues from hospitals--not from the typical sterile hospital room, but from the better sort of psychiatric ward for adolescents. Warm, soft colors are chosen for their soothing nature. Lighting is bright where it is needed for reading and studying, soft where the mood should be restful. Furniture is comfortable and too heavy to throw in anger. Knick-knacks and valuables are safely stowed out of reach. Accident and suicide hazards are eliminated. There is a designated place to go when rage and anxiety take over--not a "rubber room" for punishment, but a time-out area for cocooning and regrouping. There are activities available that the child can master and enjoy, such as puzzles, board games, art supplies, and developmentally appropriate toys.

Your home has many advantages over even the best hospital ward, of course. At the top of the list is the presence of people who not only care, but who truly love your child deeply. No professional can substitute for you in this department.

Today, most US families feel they need two incomes to achieve a middle-class standard of living. Your child's health is going to challenge that standard, if it hasn't done so already. You may find that having a parent, grandparent, or other permanent adult at home with your child is the most important therapy there is. Depending on your family's financial situation, this can mean doing without some of the trappings of middle-class success, or even without a great deal more. If one parent--and it doesn't have to be Mom--can move to a part-time schedule to provide firm guidance and limits after your child's school hours, it may make more of a difference than anything else you do. Numerous studies have shown that children and teens who are unsupervised between school and their parents' return from work are more likely to abuse drugs and alcohol, have sex at an earlier age, and engage in other self-destructive behavior. And these studies were looking at all adolescent latch-key kids, not just those with the additional risk factor of a bipolar disorder.

Families of bipolar children have made all sorts of creative arrangements to balance their child's needs with the family's financial needs. These include staggering work schedules (one parent works nights, one works days; one parent works part-time and weekends only while the other works full-time), two parents working part-time so that one is always home, exploring options for working at home and/or self-employment, and making permanent childcare arrangements with grandparents or other family members.

Because I homeschool, I have the flexibility to work with Cass's moods. On good days, we may cover all kinds of materials. When she is "off " the school day may consist of my reading to her snuggled on the couch.
--Stephanie, mother of Cassidy

Single parents have the most difficult time with this, of course, and public assistance has unfortunately become less of an option. Some single parents whose extended families or former partners have not been willing or able to help have banded together to share childcare chores, sometimes even sharing a home with another single mom or dad. Others have found ways to ensure reliable, safe after-school care through school-based programs or community resources.

It's not going to be easy, but bipolar kids need the extra supervision, and the feeling that their parents are going to be there for them no matter what. They need to know that they are more important to you than a swank wardrobe, new cars, or a larger house. Your love and your time are really the only thing that can give your child the inner feeling of security that eludes so many people with bipolar disorders.

Drop-in centers

Some older teens, especially those who are finished with high school but not yet ready for adulthood, can access drop-in centers for the mentally ill. These can combine access to therapists, peer support groups, and socialization help. Well-run drop-in centers have esteem-building activities, opportunities to learn new job skills, and an atmosphere of camaraderie. They may also be able to place regulars in supportive housing and work.

Liberty Place Clubhouse Downtown in Pennsylvania's Allegheny County, for example, provides hang-out space for people with mental illness. They meet their peers in a structured, supervised environment, and can gradually reintegrate into society. The staff (most of whom are also clients) provides transitional employment leads, housing help, and personal advice.

Don't call it therapy

Everyday life with a bipolar disorder is stressful, and yet it's in everyday life that children have the experiences that form their adult personalities. Parents can help build affirmative, life-enhancing, joyful and, yes, therapeutic experiences into the rhythms of our children's daily experiences. When we do so, we become their protectors, guides, and friends as they journey toward adulthood.

Here are just a few activities that build important skills and self-esteem. Whatever you do, don't call these activities therapy (even though they are):

• Keeping a personal journal or diary
• Taking personal time to play or listen to music, read, or work out for stress reduction
• Playing card games and board games
• Enjoying swimming or sports
• Playing on the playground, at the park, or in your yard
• Playing less-competitive group games like London Bridge and freeze tag
• Using costumes and props for imaginative play
• Starting and maintaining collections of rocks, stamps, cards, or toys
• Turning off the television and video games in favor of relating to one another
• Gaining mastery of lifelong activities like cooking, mechanical work, or the arts
• Caring for a pet or a garden
• Helping others in need, whether it's by participating in a charity marathon, volunteering in a homeless center, or choosing an important cause to which you will donate money

Finally, while therapy, medical appointments, and taking pills are going to be part of your child's life for a long time, maybe even forever, they shouldn't be the totality of it. Therapies are intended to enhance life, not turn it into an endless grind of appointments and to-do lists. Make time for relaxation, play, hugs, Saturday morning cartoons, and just watching the clouds go by. Treasure the times when your child is well, and store up energy then to deal with the inevitability of future problem episodes. Find therapeutic professionals whose work can buttress what you can accomplish at home, and then take it one day at a time.