When I was first released from the hospital, I came home with a crisis plan. It included things like triggers, what to do when I was struggling, who to contact, etc. The problem was, it wasn’t a very good crisis plan. I didn’t see the value in it so I didn’t put the time in, and at the time I wasn’t diagnosed with bipolar, so it wasn’t customized to my condition.
As someone with bipolar, I need several different crisis plans depending on the mood state I’m in. Something that might help when I’m depressed might hinder me when I’m hypomanic.
At the bottom of this post is a free template that I created based on my own personal crisis plan. Use it if you find it helpful, make your own if you don’t, find another one online, I don’t really care. Either way PLEASE make a crisis plan and share it with your care team.
There are two broad parts to a crisis plan for someone with bipolar: what to do in a crisis and information for medical professionals to treat you in a crisis.
As bipolar people, we’re not always in a clear state of mind. When we’re not in a clear state of mind, it can be difficult to communicate effectively important medical information like previously tried medications, medication allergies, previous hospitalizations, etc. (plus things like that can just be hard to remember!) so the second part of the crisis plan includes this information.
What is considered a crisis with bipolar?
I consider a crisis to be when I can no longer safely manage my own life. This might be due to depression, mania, hypomania, etc. but in essence it looks like me no longer being able to handle my own mood states and needing intervention from others.
I keep a “non-crisis” plan as well, which goes over coping strategies and what to do when I’m experiencing more mild symptoms. This crisis plan, however, is more when my coping skills are no longer working and I’m “losing it” (saying that, or that I’m losing control is actually one of my warning signs for a crisis).
What to Include in Part 1 of your Crisis Plan
Depression Crisis Signs
I consider a depressive crisis to be when I’ve been non-functional (defined as missing work or, if it’s a weekend, not getting out of bed/couch) for multiple days or have active suicidal ideation. What you consider a depressive crisis is up to you and your care team.
Be specific with your signs – do you not shower, not eat, not clean up after yourself, etc. Being specific will help other people who know you know when you’re at or are approaching a crisis.
What to do in Depression Crisis
Again, what you do in a depression crisis will be different from person to person. Please note that if you’re experiencing suicidal ideation, you should reach out to a healthcare provider ASAP. If you have a plan already, go to the ER. If you find yourself self-harming or near self harming contact a healthcare provider ASAP, call a crisis line, or go to the ER.
Some examples of what can be done during a depressive crisis include reaching out to your care team, going to urgent care/ER, calling a crisis line such as 988, or seeking in-patient treatment.
Mania/Hypomania Crisis Signs
In your crisis plan, also include signs that you’re in a crisis due to mania or hypomania. Some of these signs might be spending more than x amount of money in a day, not eating for x amount of time, not sleeping for x amount of time, experiencing psychosis, or whatever else applies to your personal situation.
What to do in Mania/Hypomania Crisis
If you are experiencing psychosis or thoughts of harming yourself or others, go to the ER.
If you’re not sure if you need to go to the ER, reach out to your care team and call a crisis line such as 988.
What exactly you do, who you contact, etc. is up to you, your care team and your loved ones to decide. Some examples of what can be done during a hypomanic/manic crisis include reaching out to your care team, going to urgent care/ER, calling a crisis line such as 988, or seeking in-patient treatment.
Mixed Episode Crisis Signs
If you experience mixed episodes, include signs that you’re in a mixed episode crisis in your crisis plan. For me personally, that includes all the signs of a hypomanic/manic episode and all the crisis signs of a depressive episode.
What to do in Mixed Episode Crisis
If you are experiencing psychosis or thoughts of harming yourself or others, go to the ER.
If you’re not sure if you need to go to the ER, reach out to your care team and call a crisis line such as 988.
For me personally, I just duplicated what to do in a depressive crisis and what to do in a hypomanic/manic crisis in this section.
What to Include in Part 2 of your Crisis Plan
Diagnosis
Include your most current diagnosis. You may also want to include previous diagnosis.
Medications
This might be one of the most important sections for ensuring a good continuation of care. A medication section will allow health care professionals to know what drugs they can and can’t give you and what you’re currently taking.
Ensure that you include as needed medications as well as medications you take every day in all the following sections.
Include the following in your medication section:
- Medication History (what meds have you taken and at what dosages. What were your side effects? Did they work? Will you take them again?)
- Current Medications (Including dosages)
- Medication Allergies
Update this section as your medications change.
Contacts
I can’t remember many people’s phone numbers most of the time, much less when I’m having an episode. This section of your crisis plan will allow you and medical professionals to contact loved ones if needed and your care team. For example, I do not know my therapist’s phone number or email by heart. However if I were to be hospitalized, the hospital would need to contact them. By including my therapist’s contact information in my crisis plan, the hospital would be able to quickly and easily reach out to them.
Do not include anyone in your crisis plan’s contact information who you would not want contacted in an emergency. For example, if you are uncomfortable with your father being involved in your medical care, don’t include his number (this is an example, I’m comfortable with my father being involved in my medical care).
It’s possible that a hospital’s policies will mean that you will need to sign/fill out additional paperwork before these people can be contacted, but having their numbers readily available will make that process easier.
Previous Hospitalizations
Health care professionals may want to get information from places you’ve previously been hospitalized at. Include the locations you’ve been hospitalized at and the dates as well as why you were hospitalized and any relevant details.
Ex. Hospitalized at (Insert Name) due to a mixed manic episode.
Mental Health History
I recommend any person with bipolar keep an episode log which includes the type of episode, symptoms, and dates. I included a QR code to my episode log in my crisis plan. This allows for someone looking at a print version of the crisis plan to be able to still access the information. I use QR Code Monkey which is totally free and creates codes that don’t expire.
If Hospitalization is Necessary….
Include information on where you’d like to go, what you’d like to happen if hospitalization is necessary. For example, I include which hospital I’d like to go to and, if no beds are available there, that I’d like it to be as close to my city as possible. If there are hospitals you do not want to go to, include them there as well.
Please note, if you’re being hospitalized involuntarily, it’s possible that you will have to go to a hospital you noted you did not want to go to.
Where to store/save your crisis plan
- Your phone
- With your care team
- With loved ones
- As a paper copy in your home