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Planning for a Mental Health Crisis

When living with bipolar or another mental health disorder, sometimes a mental health crisis arises. A mental health crisis is no one’s fault. It is a sign that your or your love one's treatment may need to change or medicine dosage might need to be adjusted. A mental health crisis can be traumatic for everyone involved. Planning ahead helps to reduce trauma.1-5

Action plan

If you are living with a mental health condition or caring for a loved one with a mental health condition, it is important to create an action plan during a period of stability. You or your loved one should have input into what is the most helpful during a crisis. Share this plan with those you feel comfortable with or with the people your loved one chooses.1-4

People who are most responsive during a crisis should have a copy of the action plan. Place multiple copies throughout the home. Options might include:1-4

  • Kitchen drawer
  • Nightstand
  • On a cell phone
  • Refrigerator or corkboard
  • Car glove box

What to include

Each person’s action plan will be unique. The goal is to de-escalate the crisis and avoid hospitalization. With a good crisis plan, 911 becomes a last resort. Things to include in a crisis plan include:1-5

  • Doctor/psychiatrist/therapist names and contact information
  • All health diagnoses and prescribed drugs
  • Insurance information and preferred healthcare setting
  • Known drug allergies or interactions
  • Contact details for local crisis centers or mobile crisis centers
  • Trusted family and friends’ names and contact information
  • Behavior warning signs
  • Known triggers
  • National Suicide Prevention Lifeline contact information
  • History of suicide attempts or psychotic episodes
  • History of substance or alcohol abuse
  • What has helped de-escalate in the past

Behavior warning signs

Loved ones need to know the warning signs of a mental health crisis. People living with mental health conditions often do not recognize the early warning signs. Catching a possible spiral early can prevent a full crisis. Some general warning signs include:1,2,5

  • Sleeplessness or other changes in sleep patterns
  • Verbal threats
  • Hostility
  • Paranoia
  • Increased or slowed down talking or movement
  • Increased drug or alcohol use

How to act around a triggered loved one

Avoiding escalation is essential when a loved one is spiraling. A mental health crisis requires staying calm. Whatever your loved one says or does, try not to react. This applies if they are not endangering themselves or others. Ways to approach a loved one in a mental health crisis include:1,2

  • Mirror their posture. If they sit, you sit. If they stand, you stand – but do not hover.
  • Give them personal space.
  • Leave exits accessible so they do not feel trapped.
  • Speak calmly, slowly, and soothingly.
  • Avoid anger, threats, or criticizing your loved one.
  • Be agreeable to requests, as long as they are not dangerous.
  • Limit or avoid touching or continual eye contact. This can feel threatening.
  • Lock up anything dangerous, such as guns, knives, or drugs.
  • Take away the car keys.
  • Call trusted friends and family members for support.

Research crisis intervention teams (CITs) in your area

In some cases, you may not be able to de-escalate your loved one. Even with a good plan in place, some people with mental health conditions remain triggered.

One alternative to calling 911 during a mental health crisis is reaching out to a crisis intervention team (CIT). Many communities have CITs available. Take time to research CITs in your area before a mental health crisis occurs. CITs include several resources who are all trained in mental health crises. Members of most CITs include:3,5

  • Mental health professionals
  • Law enforcement
  • People who live with mental health disorders
  • Mental health advocates
  • Caregivers

Create a psychiatric advanced directive (PAD)

A psychiatric advanced directive (PAD) is a legal document outlining treatment preferences. A person with a mental health disorder completes this when they are stable.1,3-5

In an emergency, a PAD helps your loved get the treatment they need. When they cannot consent to treatment, the PAD states their wishes. A PAD also permits doctors to share medical details with you and other specific loved ones. Each state has slightly different rules for PAD. Talk to your doctor or a lawyer to help you create a suitable PAD.1,3-5

While a mental health crisis can be challenging for you and your loved one, having a plan in place can help improve outcomes.

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