A crisis support plan can be beneficial for everyone, not just those who live with diagnosed mental illness.

At any given time we all have the potential to encounter thoughts, feelings, emotions, or experiences that we feel unable to live with safely. 

There is no one way in which a mental health crisis is experienced. To be in crisis is not necessarily to be suicidal. 

A crisis can be when you feel at your highest: uncontrollably euphoric and uninhibited, fueled by feelings of grandiosity that may make you more likely to engage in damaging situations and behaviour that you could come to regret. Maybe your sense of reality is different to that which others experience or you feel emotions with an unbearable and overwhelming intensity. You may feel a sense of clarity in crisis, soothed by your intention to act upon suicidal thoughts. These thoughts and experiences can be dangerous and, in the worst instance, result in irreversible outcomes. 

"Had I been educated on crisis support plans and the options available when I was at school, it could have saved myself and my parents so much heartache and trauma".

For me, living with Bipolar Disorder means that the possibility of a crisis is ever present so it’s important to be prepared for it. I can experience a crisis as being scary and confusing. Because it's hard to think straight when I am in the midst of crisis, planning in advance when I am stable gives me the reassurance that I am prepared to get myself - sometimes with the support of others - back to a place in which my mood, feelings, thoughts, and experiences are more manageable. Creating a crisis support plan helps to keep me safe and lets my support system know how to help, allowing me to feel more in control of what will happen if I am unable to voice my preferences at the time.

I have three different types of crisis support plan: a personal crisis support plan, a crisis support plan with my non-professional support system, and one with healthcare professionals. 

Personal crisis support plan 

My first crisis support plan is the one I have with myself. I used to have this written down and kept it with me; doing this can remind you of what you need to do in a clear and digestible way if you are unable to think clearly, and it can be a reassurance if you are anxious about experiencing a crisis. Now that I am accustomed to using this part of my crisis support plan I no longer need it written down. 

The first part of this crisis support plan is to evaluate my mood, experiences, and feelings to figure out if I can deal with them on my own or whether I need to reach out for more support.

If I decide that I can get through it own my own, then it’s all about distraction. I have a few go-to methods of distraction, one being spending time with my dogs: taking them on a walk, playing with them, or cuddling them. Doing some arts and crafts whilst watching one of my favourite films is another thing I like to do to distract myself.

I listen to calming or cheerful music depending on whether my mood is potentially dangerously high or low; calming music can help bring my mood (which directly impacts my experiences and behaviour) to a more manageable level, and the cheerful music can do the same if feeling low. When you’re in crisis anything and everything can feel like too much - even just the thought of picking out a song to listen to can be overwhelming. Having a playlist ready on your phone can be a great idea so you can just hit play without the pressure to make decisions. 

Crisis support plan with my support system

The second crisis support plan is the one that I have with my support system.

If I decide that I need to reach out for help I have a list of people I can call or text. Having the contact details of trusted people in an easily accessible list on your phone or written down can be beneficial. You may agree on different levels and types of support with different people. This should be in accordance with what you feel comfortable sharing with them, the level of responsibility over your care you feel appropriate to give them, the level of trust between you - and of course whether they feel comfortable being in this position.

For me, this crisis support plan is mainly with my husband. Schoolchildren/teenagers may find it useful to co-create this plan with a family member or another trusted adult. In advance of a crisis I have discussed with my support system what I would like them to do if they feel that I am unable to make informed choices for myself. Giving permission for someone to take over your care and to know when this would be needed is an extremely deep level of trust.

You should only make this decision if you are comfortable with it and are in a frame of mind in which your judgement is not clouded by the thoughts and feelings characteristic of a crisis. I feel reassured that my husband understands the difference between me and my illness; he knows when I am in control and when I am not and he knows what treatment I would consent to - or not consent to - if it was needed. He has a list of numbers ready to call on my behalf and will take the lead to reduce pressure on me to co-ordinate support for myself. 

It can be great to discuss with your support system how they can help you on an everyday basis, not just when you are crisis. Being clear with others about how they can help lets them feel more equipped to help which ultimately means you receive better support.

For me, this involves my husband knowing what I need from him and when: he understands when to gently encourage me to talk and when not to push things, to remind me to take my medication and ensuring that it doesn’t run out, and many other things that may seem small but make all the difference. Whatever works for you is what is important. We are all individuals and will have different preferences, needs, wants, desires - and difficulties. Articulating what these are and establishing boundaries are a key part of helping others to help you. 

Support from mental health professionals

There are times when my previous two crisis support plans are just not enough and I need professional intervention. 

Knowing who you or someone in your support system can speak to in order to get you access to professional support is so important.

Many crisis teams will offer you support even if you are not already in receipt of mental health services. Many people find this option preferable to going into A&E or calling 999 as you can stay at home. For more information if you need urgent help, having resources like the following at hand may be helpful: "I need urgent help, I'm feeling suicidal", "I have experienced or witnessed something traumatic".

My support system and I have discussed what I would want and not want in the event of a crisis where I could not speak for myself in reference to medication and treatment. I also have access to an out of hours crisis team who I can call anytime; they will talk to me, find out what is going on, evaluate me, and meet me in person if they feel it’s necessary to see what steps they can take to help me next. This may involve going into hospital or having home visits for a few days to ensure that I am being evaluated continually. I also have medication that I don’t take every day but that can be given in the event of crisis to help to stabilise me.

There are many reasons why a child/teenager would not want to involve mental health services, even when in crisis. A service like Childline which offers confidential support through online chats and phone calls may be incorporated into a crisis support plan. 

What could have been

Had I been educated on crisis support plans and the options available when I was at school, it could have saved myself and my parents so much heartache and trauma.

We spent many years of terrifying visits to the hospital when my crisis had become dangerous but had we been better equipped, we would have been able to prevent the crisis from escalating. If I had had a robust crisis support plan in place maybe my life would not have been in danger so many times as a teenager. My family and I still have to live with the memories of feeling powerless and unsupported. 

Education on these matters is vital. 

There isn’t a "right" way to plan for a crisis. Ultimately, having a crisis support plan is all about planning and tailoring it to suit you; you can do what you feel comfortable with and what you feel is going to be helpful for your situation.