Why make a crisis plan?
Many people with BPD experience crises. Often it can feel like life is lurching from one crisis to the next.
Unfortunately, when we are in crisis, those around us may not know how to respond in helpful ways. We might not know either, because in a crisis the rational part of our brain can be overwhelmed by the emotional part of our brain. This makes it hard for us to think or communicate clearly about what we need at that moment.
What is a crisis plan?
A crisis plan is something we create when we are not in crisis (i.e. when we have better access to our full range of thinking). A crisis plan reflects our own context, personality and needs. A crisis plan can be a useful tool for working through, or even averting, future crises. Research has shown that having a crisis plan is one of the most effective general therapeutic strategies for people with BPD.
What does a crisis plan look like?
There are many names used to describe crisis plans, including:
- Collaborative crisis plan
- Wellness Recovery Action Plan (WRAP)
- Advance Statement
- Advance Directive
- Mad Map.
A crisis plan can be created with support from a health care worker, with friends or family, or by yourself.
Including other significant people in the planning process can be useful. Having someone to bounce ideas off or to think about it from different angles can help. In addition, other people are more likely to agree to the plan, if they’ve been engaged in the process.
Include supportive people in your crisis plan (e.g. friends, family, community group members, spiritual leaders, etc.), who have supported you in the past. These people should be able to listen to you in the way you need (e.g. giving useful advice if that’s what you want, or NOT giving advice if that’s you would prefer).
You may be reluctant to involve anyone else, particularly if you don’t want to inconvenience others. However, building up a support network can be invaluable part of your plan. A crisis plan is often useful for communicating to support people what you find helpful or not helpful, and at which times. One way to make sure others know what is helpful is to agree on a ‘code’ (see graphic example). This will avoid the need to go into lengthy explanations. And remember, many people are glad to be able to help.
You should also discuss your crisis plan with any professionals involved in your care (e.g. GP, counsellor, case manager, etc.). They may have some other useful suggestions to help you cope during a crisis. It’s also helpful for you to know what kind of support they are able to offer.
What does the law say?
You may wish to formalise certain aspects of your crisis plan using an Advance Statement. An Advance Statement sets out a person’s treatment preferences in case they become unwell and need compulsory mental health treatment.
They are legally recognised in Victoria (under the Mental Health Act 2014) when someone is treated as an involuntary patient (’under the Act’). Many services have a standardised Advance Statement template, although you are legally allowed to create your own. Any type of Advance Statement must be signed, dated and witnessed. Under the Act, the treating psychiatrist is obliged to ‘have regard’ to what is said in your Advance Statement. They don’t have to follow what you have written if they believe it’s not in your best interests, but you have the right to request a written explanation if they have not followed your Statement.
Outside of this formal context, a crisis plan has no legal status, but can still be incredibly useful, as it allows your wishes and crisis management strategies to be known.
What resources are available to make a crisis plan?
We recommend discussing crisis planning with a clinician, peer worker, or other support person you have a good rapport with.
Here are some tools and options that may assist you to create your own crisis plan:
- Wellness Recovery Action Plan (WRAP): There are seven different sections, each with a series of useful questions:
- creating your own wellness toolbox
- a daily maintenance plan
- early warning signs
- a plan for when things are breaking down
- crisis plan
- a post-crisis plan.
An advantage to the WRAP is that it puts crisis into the context of our lives. We can learn to discern when we might be headed towards a crisis, and act accordingly.
- The Icarus Project: The Icarus Project has brought together a number of resources on crisis planning, living with suicidal feelings, and self-harm.
- Alternatively you may wish to create something simple for yourself. For example, some people find it useful to illustrate their crisis plan. Others may write one page that describes everything that might be useful for people who are supporting them in crisis.
What to include in your crisis plan
It’s important to keep your reader in mind. If your crisis plan is highly creative, or longer than one page, it may be difficult to understand. You may wish to include the following content in your plan:
- Practical information: Is there information that people might need to know? For example, do you have dependent children, animals, or other responsibilities that need to be attended to? Is there someone who can be called upon to attend to these? You might write ’Please call Mary (phone number). She is on the school list to pick up my children/knows where the spare key is to feed my cat.’
Some people also include the telephone number of their psychiatrist, best friend or relative (whoever is useful).
- What works and what doesn’t: Are there interventions that have been useful (or harmful) that you would like people to be aware of? Are there medications that you take? Is there anything you have found very unhelpful in the past? Are there alternatives you are happy with? (e.g. a de-escalation approach).
- Other useful information: Is there anything else that you’ve found useful? Be specific about things that are useful. For example, you may find listening to your favourite music on your iPod really soothing. Is there a particular person who is really good at being with you when you’re in crisis? Is it possible to create an environment that meets your needs but isn’t hospital? For example, there may be someone or a team of people who can come and be with you. Would you find it useful to have someone cook for you, or help you with some complicated administrative task like communicating with Centrelink or your workplace?
- Some people find their brain works differently when they are in crisis, so you might want to say: 'Please speak slowly and clearly to me, and remember that I can get confused easily. This doesn’t mean dumb things down, just slow them down!' or 'Please try to listen to the feelings I am expressing, even if you don’t agree with all the details. Arguing about details is not useful when I’m in crisis.'
Remember that a crisis plan is highly individual and is designed to be useful for you, and for those who support you.