Action Planning for Prevention and Recovery
A Self-Help Guide
Crisis Planning
Identifying and responding
to symptoms early reduces the chances that you will find yourself in crisis.
It is important to confront the possibility of crisis, because in spite
of your best planning and assertive action in your own behalf, you could
find yourself in a situation where others will need to take over responsibility
for your care. This is a difficult situation—one that no one likes
to face. In a crisis, you may feel as if you are totally out of control.
Writing a clear crisis plan when you are well, to instruct others about
how to care for you when you are not well, helps you maintain responsibility
for your own care. It will keep your family members and friends from
wasting time trying to figure out what to do for you. It relieves the
guilt that may be felt by family members and other caregivers who may
have wondered whether they were taking the right action. It also insures
that your needs will be met and that you will get better as quickly as
possible.
You need to develop your crisis plan when you are feeling well. However,
you cannot do it quickly. Decisions like this take time, thought, and
often collaboration with health care providers, family members and other
supporters. Over the next few pages, information and ideas that others
have included in their crisis plans will be shared. It can help you develop
your own crisis plan.
The crisis plan differs from the other action plans in that it will
be used by others. The other four sections of this planning process
are implemented by you alone and need not be shared with anyone else;
therefore you can write them using shorthand language that only you need
to understand. However, when writing a crisis plan, you need to make
it clear, easy to understand, and legible. While you may have developed
other plans rather quickly, this plan is likely to take more time. Don’t
rush the process. Work at it for a while, then leave it for several
days and keep coming back to it until you have developed a plan you feel
has the best chance of working for you. Once you have completed your crisis
plan, give copies of it to the people you name in this plan as your supporters.
On the fifth tab write “Crisis Plan” and insert at least nine
sheets of paper. This crisis plan sample has nine parts to it, each addressing
a particular concern.
Part 1 Feeling well
Write what you are like when you are feeling well. You can copy it from
Section 1, Daily Maintenance Plan. This can help educate people
who might be trying to help you. It might help someone who knows you well
to understand you a little better, for someone who doesn’t know you
well—or at all—it is very important.
Part 2 Symptoms
Describe symptoms that would indicate to others that they need to take
over responsibility for your care and make decisions on your behalf. This
is hard for everyone. No one likes to think that someone else will
have to take over responsibility for his or her care. Yet, through a careful,
well-developed description of symptoms that you know would indicate to
you that you can’t make smart decisions anymore, you can stay in
control even when things seem to be out of control. Allow yourself
plenty of time to complete this section. Ask your friends, family members,
and other supporters for input, but always remember that the final determination
is up to you. Be very clear and specific in describing each symptom. Don’t
just summarize; use as many words as it takes. Your list of symptoms might
include—
- being unable to recognize or correctly identify family members and friends
- uncontrollable pacing; inability to stay still
- neglecting personal hygiene (for how many days?)
- not cooking or doing any housework (for how many days?)
- not understanding what people are saying
- thinking I am someone I am not
- thinking I have the ability to do something I don’t
- displaying abusive, destructive, or violent behavior, toward self, others, or property
- abusing alcohol and/or drugs
- not getting out of bed (for how long?)
- refusing to eat or drink
Part 3 Supporters
In this next section of the crisis plan, list these people who you want
to take over for you when the symptoms you listed in the previous section
arise. Before listing people in this part of your plan though, talk with
them about what you’d like from them and make sure they understand
and agree to be in the plan. They can be family members, friends, or health
care providers. They should be committed to following the plans you have
written. When you first develop this plan, your list may be mostly health
care providers. But as you work on developing your support system, try
to add more family members and friends because they will be more available.
It’s best to have at least five people on your list of supporters.
If you have only one or two, when they go on vacation or are sick, they
might not be available when you really need them. If you don’t have
that many supporters now, you may need to work on developing new and/or
closer relationships with people. Ask yourself how best you can build
these kinds of relationships. Seek new friends by doing things such as
volunteering and going to support groups and community activities. (See
Making and Keeping Friends a Mental Health self-help booklet in this series)
In the past, health care providers or family members may have made decisions
that were not according to your wishes. You may not want them involved
in your care again. If so, write on your plan, “I do not want the
following people involved in any way in my care or treatment.” Then
list those people and why you don’t want them involved. They may
be people who have treated you badly in the past, have made poor decisions,
or who get too upset when you are having a hard time.
Many people like to include a section that describes how they want possible
disputes between their supporters settled. For instance, you may want
to say that if a disagreement occurs about a course of action, a majority
of your supporters can decide or a particular person will make the determination.
You also might request that a consumer or advocacy organization become
involved in the decisionmaking.
Part 4 Health care providers and medications
Name your physician, pharmacist, and other health care providers, along
with their phone numbers. Then list the following—
- the medications you are currently using, the dosage, and why you are using them
- the medications you would prefer to take if medications or additional medications became necessary—like those that have worked well for you in the
past—and why you would choose those
- the medications that would be acceptable to you if medications became necessary and why you would choose those
- the medications that must be avoided—like those you are allergic to, that conflict with another medication, or cause undesirable side effects—and
give the reasons they should be avoided.
Also list any vitamins, herbs, alternative medications (such as homeopathic remedies), and supplements you are taking. Note which should be increased or decreased if you are
in crisis, and which you have discovered are not good for you.
Part 5 Treatments
There may be particular treatments that you like in a crisis situation
and others that you would want to avoid. The reason may be as simple
as “this treatment has or has not worked in the past,” or you
may have some concerns about the safety of this treatment. Maybe you just
don’t like the way a particular treatment makes you feel. Treatments
here can mean medical procedures or the many possibilities of alternative
therapy, (such as injections of B vitamins, massages, or cranial sacral
therapy). In this part of your crisis plan, list the following—
- treatments you are currently undergoing and why
- treatments you would prefer if treatments or additional treatments became necessary and why you would choose those
- treatments that would be acceptable to you if treatments were deemed necessary by your support team
- treatments that must be avoided and why
Part 6 Planning for your care
Describe a plan for your care in a crisis that would allow you to stay
where you like. Think about your family and friends. Would they be able
to take turns providing you with care? Could transportation be arranged
to health care appointments? Is there a program in your community that
could provide you with care part of the time, with family members and
friends taking care of you the rest of the time? Many people who would
prefer to stay at home rather than be hospitalized are setting up these
kinds of plans. You may need to ask your family members, friends, and
health care providers what options are available. If you are having a
hard time coming up with a plan, at least write down what you imagine
the ideal scenario would be.
Part 7 Treatment facilities
Describe the treatment facilities you would like to use if family members
and friends cannot provide you with care, or if your condition requires
hospital care. Your options may be limited by the facilities available
in your area and by your insurance coverage. If you are not sure which
facilities you would like to use, write down a description of what the
ideal facility would be like. Then, talk to family members and friends
about the available choices and call the facilities to request information
that may help you in making a decision. Also include a list of treatment
facilities you would like to avoid—such as places where you received
poor care in the past.
Part 8 What you need from others
Describe what your supporters can do for you that will help you feel better.
This part of the plan is very important and deserves careful attention.
Describe everything you can think of that you want your supporters to
do (or not do) for you. You may want to get more ideas from your supporters
and health care professionals.
Things others could do for you that would help you feel more comfortable
might include—
- listen to me without giving me advice, judging me, or criticizing me
- hold me (how? how firmly?)
- let me pace
- encourage me to move, help me move
- lead me through a relaxation or stress reduction technique
- peer counsel with me
- provide me with materials so I can draw or paint
- give me the space to express my feelings
- don’t talk to me (or do talk to me)
- encourage me and reassure me
- feed me nutritious food
- make sure I take my vitamins and other medications
- play me comic videos
- play me good music (list the kind)
- just let me rest
Include a list of specific tasks you would like others to do for you, who you would like to do which task, and any specific instructions they might need. These
tasks might include—
- buying groceries
- watering the plants
- feeding the pets
- taking care of the children
- paying the bills
- taking out the garbage or trash
- doing the laundry
You may also want to include a list of things that you do not want others to do for you—things they might otherwise do because they think it would be helpful, but that
might even be harmful or worsen the situation. These might include—
- forcing you to do anything, such as walking
- scolding you
- becoming impatient with you
- taking away your cigarettes or coffee
- talking continuously
Some people also include instructions in this section on how they want to be treated by
their caregivers. These instructions might include statements such as
“kindly, but firmly, tell me what you are going to do,” “don’t
ask me to make any choices at this point,” or “make sure to
take my medications out of my top dresser drawer right away.”
Part 9 Recognizing recovery
In the last part of this plan, give your supporters information on how
to recognize when you have recovered enough to take care of yourself and
they no longer need to use this plan. Some examples are—
- when I am eating at least two meals a day
- when I am awake for six hours a day
- when I am taking care of my personal hygiene needs daily
- when I can carry on a good conversation
- when I can easily walk around the house
You have now completed your crisis plan. Update it when you learn new information or change your mind about things. Date your crisis plan each time you change it
and give revised copies to your supporters.
You can help ensure that your crisis plan will be followed by signing
it in the presence of two witnesses. It will further increase potential
for use if you appoint and name a durable power of attorney–a person
who could legally make decisions for you if you were not able to make
them for yourself. Since power of attorney documents vary from state to
state, you cannot be absolutely sure the plan will be followed. However,
it is your best assurance that your wishes will be honored.
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