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 de veloping 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.
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.
Sourced in November 2013 from:
Center for Mental Health Services
Substance Abuse and Mental Health Services
5600 Fishers Lane, Room 15-99
Rockville, MD 20857