Table 3. Provider and Healthcare System Level Barriers to Disease Self-Management Among Poorly Adherent Patients with Bipolar Disorder (n =21).

Themes and Categories	Illustrative Quotations from Respondents
Patient/ Provider Relationships	“That's fine and well, but it would be nice if I understood what is all go in on, so I can at least appreciate the visit, half hour though it may be…I: …then I can at least understand or know which direction I'm go in, or at least I'll have a work in knowledge of why you're asking the questions you are asking me, or whatever. When I see my therapist again, I'm gonna ask him to explain to me what the hell bipolar is—nobody ever told me.” Respondent #2052 “The same questions every time. It's just a standard group of questions. Do I hear voices? Can I read other people's minds? Sometime I want to tell what's goin on. Like, if my brother, sister dies, my past. I'll get upset about that and I want to vent. I wanna get that out. It's like, I go in just to get a prescription for meds.” Respondent #2093
Access to Care	“It's been over a year. They state you have to have a referral. Well, if that's the case I'm still waiting almost two years for that same referral for someone to call me. Hey look, what does it take? Me to hurt myself or someone else or to really have a bad, you know, reaction for myself, in order to get some help.” I need to speak to somebody. I got a lot of issues.” #2089 “…but every six months they give you a new one (therapist) anyway. So you don't really have a chance to have a close relationship. So, personally I try not to discuss anything with them that I feel is very personal to me.” Respondent #2006