Crisis Planning

Identifying and responding to symptoms early reduces the chances that you will find yourself in crisis. 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 also ensures 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. The crisis plan differs from the other action plans in that it will be used by others. Once you have completed your crisis plan, give copies of it to the people you name in this plan as your supporters.

Feeling well

Write what you are like when you are feeling well. You can copy it from your 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.

Symptoms

Describe symptoms that would indicate to others that they need to take over responsibility for your care and make decisions on your behalf. Ask your friends, family members, and other supporters for input. Be very clear and specific in describing each symptom. Here are some examples:

• being unable to recognize or correctly identify family members and friends
• uncontrollable pacing; inability to stay still
• neglecting personal hygiene(for how many days?)
• thinking I am someone I am not
• 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

Supporters

List people who you want to take over for you when crisis symptoms arise. Before listing, talk to 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. It’s best to have at least five people on your list of supporters. 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.

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 decision-making.

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 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.

Treatments

There may be certain treatments that you like in a crisis situation and others that you would want to avoid. Treatments here can mean medical procedures or the many possibilities of alternative therapy, (such as injections of B vitamins, massages, or cranial sacral therapy). 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

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?

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.

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 more information. Also include a list of treatment facilities you would like to avoid.

What you need from others

Describe what your supporters can do for you that will help you feel better. 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. Here are some exmaples:

• listen to me without giving me advice, judging me or criticizing me
• let me pace
• encourage me to move, help me move
• lead me through a relaxation or stress reduction technique
• give me the space to express my feelings
• don’t talk to me (or do talk to me)
• encourage me and reassure me
• make sure I take my vitamins and other medications
• play me funny 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. Here are some examples:

• 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.

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. Here are some examples:

• 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 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.

Instructions