If you are experiencing a medical emergency, contact emergency services immediately: Emergency contacts and medical assistance
If you are in suicidal crisis right now, call SADAG: 0800 456 789 (24-hour, free).
Scenario 1 — Acute Manic Episode Requiring Hospitalisation
A severe manic episode — characterised by dramatically reduced sleep, grandiosity, racing thoughts, impulsive behaviour, or psychosis — may require psychiatric hospitalisation. Signs that hospitalisation is needed:
- Unable to sleep for 2 or more nights
- Engaging in behaviour that is dangerous to self or others (reckless driving, financial decisions, sexual behaviour)
- Psychotic features (hallucinations, delusions)
- Verbal or physical aggression
- Refusal to take medication
What to do: 1. Call your treating psychiatrist immediately. If unavailable, call the psychiatry emergency line of your nearest private hospital. 2. If there is immediate danger to the patient or others, call emergency services (10177 or 112). 3. Voluntary admission: If the patient can consent, contact your scheme's 24-hour mental health pre-authorisation line and arrange direct admission to a private psychiatric unit. 4. Involuntary admission (Mental Health Care Act): If the patient lacks capacity to consent, contact the nearest district surgeon or SAPS — an involuntary assessment under the MHA can be initiated. Note: involuntary MHA admission typically goes to public sector facilities unless a private specialist applies for a Form 7 process.
Scenario 2 — Suicidal Crisis
Bipolar disorder carries a lifetime suicide risk of 15–20% — among the highest of any medical condition. Suicidal crisis in bipolar disorder frequently occurs during the depressive phase, or in a mixed state (depressed mood with manic energy and impulsivity).
If you or someone with bipolar disorder is in suicidal crisis: 1. Call SADAG immediately: 0800 456 789 (24-hour, free, nationwide) 2. Do not leave the person alone. Remove access to means (medications, sharp objects, firearms). 3. If there is immediate danger, call emergency services: 112 (mobile) or 10177. 4. Go to the nearest emergency room — tell them "suicidal crisis with known bipolar disorder" — this is a psychiatric emergency requiring an urgent psychiatric assessment.
The emergency room is the right destination. Do not wait for a psychiatrist's appointment slot.
Pre-Authorisation for Psychiatric Admission
- Call your scheme's 24-hour mental health authorisation line (on the back of your medical aid card).
- Say: "I need to pre-authorise a voluntary psychiatric admission for [member name], membership number [X]. Treating psychiatrist is [name and practice number]."
- The scheme will assign an authorisation number. Record this and give it to the admitting facility.
- If the admission is an emergency, proceed first and call within 48 hours to ratify.
- Notify your gap insurer with the admission date and treating psychiatrist details.
What Your Medical Aid Pays For
| Item | Covered? |
|---|---|
| Psychiatric emergency room assessment | YES — PMB / CDL |
| Voluntary psychiatric admission | YES — scheme psychiatric benefit |
| Involuntary admission (MHA — public sector) | YES — PMB |
| Psychiatrist daily in-hospital visits | YES — scheme specialist rate |
| Allied health (OT, clinical psychologist in hospital) | YES — scheme allied health rate |
| Sedating medication for acute mania | YES — in-hospital medication |
| Psychiatrist shortfall (above scheme rate) | Gap cover pays |
| Facility co-payment | Gap cover may pay |
| Post-discharge chronic medication | YES — CDL chronic medication |
What Gap Cover Pays For in Bipolar Hospitalisation
Private psychiatric facilities and psychiatrists commonly bill above scheme rate. In a 2–4 week acute manic episode admission: - Psychiatrist daily visits: shortfall R600–R1,500 per visit × 14–28 days = R8,400–R42,000 - Clinical psychologist shortfall (if included in gap policy) - Facility co-payment (if scheme applies one)
Let's focus on what we can control. The financial management comes second to getting the patient safe and stable. Gap cover shortfall claims can be submitted after discharge. Focus on treatment first.
Gap cover OPL ~R220,000. Prolonged or repeated hospitalisations may approach this limit over a policy year. Know your OPL.
After the Crisis
- Psychiatric follow-up within 1–2 weeks of discharge. Relapse risk is highest in the first 30 days post-discharge.
- Medication review — was the regimen adequate? Should a medication change or addition be made?
- Psychoeducation and crisis plan update — update your written crisis plan. Did the plan work? What could be improved?
- Claims follow-up — ensure all in-hospital accounts are correctly settled. Gap cover claim should be submitted within 90 days.
- Family or carer support — SADAG has caregiver support resources. Family involvement in bipolar management improves outcomes.
Emergency Contacts
- SADAG Crisis Line (suicidal crisis): 0800 456 789 (24-hour, free)
- Emergency (private ambulance): 10177 | 082 911 (Netcare) | 084 124 (ER24)
- Emergency (public): 112 (mobile, all networks)
- Life Line SA: 0861 322 322
- Your scheme's 24-hour mental health line: On the back of your medical aid card
Check your bipolar disorder cover and gap cover options → AURA check
This page is general information about medical schemes. It is not medical advice: speak to a healthcare professional about your own treatment. Medical aid and gap cover advice is given by Eldon de Waal, a Supervised Representative of Approach Administration (FSP 23579).