News and Business
Mania, often seen in bipolar disorder, is an elevated, irritable, or expansive mood that affects thoughts, behaviour, and relationships.
An ER24 branch manager shares how emergency medical services are trained to respond when a person is having an intense manic episode.
During a manic episode, a person may experience increased energy, little need for sleep, rapid or racing thoughts, inflated self-esteem, difficulty concentrating, and impulsive or risky behaviour. These symptoms can significantly disrupt daily functioning and may require urgent clinical attention.
There is also a recognised link between mania and psychosis. In some cases, people experiencing a manic episode may develop psychotic symptoms such as hallucinations or delusions, further impairing judgment and insight. “Our response is guided by whether the patient is a danger to themselves or to others,” says Daneel Scheepers, Branch Manager at ER24 Rustenburg.
ER24 paramedics are often among the first responders called to assist, managing these crises with care, clinical expertise, and empathy.
Recognising mania
Rather than focusing on a single symptom, ER24 paramedics are trained to identify clusters of behavioural emergencies.
“When we speak about a cluster, we look at several factors together, including the type of behaviour displayed, how long it’s been happening, how severe it is, what may be causing it, and the environment the patient is in,” Scheepers explains. “It’s the combination of these factors that helps us understand what we’re dealing with.”
Paramedics use structured triage processes to assess both the patient and the situation. “We observe behaviour, assess orientation and awareness, gather information from family members, and rule out medical or substance-related causes,” says Scheepers. “This thorough assessment helps differentiate mania from other mental health crises and guides safe decision-making on scene.”
Early warning signs of mania aren’t always obvious. Families often miss rapid changes in mood or social behaviour such as increased irritability, restlessness, or uncharacteristic impulsiveness, especially when these changes develop gradually.
Real-life scenario
“In one case, a middle-aged woman was reported by her family to be confused and unusually irritable – behaviour that was out of character for her,” says Scheepers.
“When our team arrived, we focused on remaining calm, asking simple, non-threatening questions, and giving her space to speak without challenging her perceptions. By making her feel safe and comfortable, we were able to build trust. She cooperated with medical staff and was safely transported to an appropriate facility for further care.”
Managing mania: De-escalation and safety measures
De-escalation is always ER24’s first approach when responding to a person experiencing mania.
“Our approach is rooted in understanding that people react differently in different situations,” Scheepers explains. “We try to meet patients where they are, with understanding and compassion, while always maintaining safety.”
This may include reducing environmental stimulation, speaking slowly and calmly, avoiding confrontation, and giving the patient time to process instructions. These techniques are designed to reduce distress and prevent further escalation.
Physical restraint or sedatives are only a last resort when a patient poses a danger to themselves or others.
“If de-escalation is unsuccessful, we consult with a qualified doctor who guides the treatment plan and ensures the patient is safely transported to a medical facility, whether that involves physical restraints, or sedatives (chemical restraint).”
Throughout the process, ER24 professionals focus on treating the patient with respect, keeping them safe, and complying with the law.
Training, compassion, and community support
ER24 strongly emphasises compassion when training paramedics to respond to behavioural emergencies. “Behavioural emergencies are medical conditions, and our patients should be treated with the same compassion as any other patient,” says Scheepers.
Training is mostly hands-on, with realistic scenarios that help paramedics practise how to communicate in the real world, including how to:
- calm distressed patients
- avoid argumentative language
- acknowledge emotions without reinforcing delusions
- help patients feel safe.
These techniques were applied in the real-life scenario described above, where calm communication helped stabilise the situation.
How to support someone during a manic episode
Family members and caregivers also play a vital role. “Information from family members about a patient’s medical history, baseline behaviour, and treatment is extremely important,” Scheepers explains. “It helps us make safer and more informed decisions on scene.”
Communities can further support individuals experiencing mania by keeping the environment calm and avoiding confrontation.
“Overly confronting or arguing with someone having a manic episode is a big mistake,” Scheepers emphasises. “Always try to maintain calm and supportive communication.”
Responding to mania requires professional expertise, empathy, and collaboration between emergency services, families, and communities. ER24 paramedics are trained to ensure patients are treated safely, respectfully, and with dignity during moments of crisis.