<h1>Suicide risk in bipolar disorder stems from mood instability and system failures; improve dynamic assessment and post discharge care.</h1> People with bipolar disorder face markedly elevated suicide risk driven by mood instability, mixed states and impulsivity, compounded by social and economic adversity and poorer healthcare access. Lithium reduces suicide risk for some patients but adherence and monitoring challenges, side-effects, and disorder heterogeneity limit its universal effectiveness; other therapies help in specific phases yet have harms. Clinical systems and static risk tools fail to detect dynamic distress, especially around hospital discharge, so better dynamic assessment, improved follow-up, reduced barriers to care, and targeted research including suicidal patients are needed.