Crisis Plan

You may benefit from developing a crisis plan if your symptoms sometimes overwhelm your ability to lead your life. Mary Ellen Copeland has written about the value of developing a crisis plan. Her recommendations are contained in her work entitled Wellness Recovery Action Plan (WRAP).1 One purpose of a WRAP is to help you address any worsening of your symptoms as soon as possible in an effort to avoid any further decompensation. The other purpose is to outline your wishes for care should you be unable to advocate on your own behalf.

She recommends writing down your plan in a loose-leaf notebook, so it can be improved as you learn more about what is helpful for your illness. She divides the plan into five parts.

The first part is a daily maintenance list of things you do for yourself every day to keep yourself feeling good. These include eating sensibly, exercising, relaxation techniques, contact with a partner and friends, work, and engaging in fun activities. Extra activities might include getting a massage, meeting with a mental health professional, spending time with pets, doing laundry and housework, planning vacations, and planning other activities.

The second part involves making a list of "triggers," external events or circumstances that may produce symptoms. Although the reaction to these events may be normal, your symptoms may get worse if you don't respond to them. Triggers include anniversary dates of losses or trauma, conflict with family, friends, or people at work; physical illness; being criticized; stress; or even a lack of sleep. Write a specific plan you will follow if one of your triggers occurs. For example, if the trigger is conflict with your family, your plan may be to perform some deep breathing exercises, call a friend to talk about the situation, and talk about it with your therapist.

The third part is a list of early warning signs that signal the need for further action to prevent your symptoms from getting worse. Some early warning signs include increased anxiety, irritability, craving drugs or alcohol, lack of motivation, isolating yourself, feeling unconnected to your body, and not keeping appointments. Make a plan you will follow should these early warning signs occur. These plans may include doing things on the daily maintenance list, seeking an early appointment with a mental health professional, and spending additional time with family and friends.

The fourth part is a description of symptoms that occur when things are breaking down or getting worse. Such things may be irrational responses to events, withdrawal from your usual activities, excessive sleeping, thoughts of self-harm, and risk-taking behaviors. Again, make a plan you will follow if these symptoms occur.

The last part describes a plan to follow if you need others to make decisions for you. It describes your symptoms, people who can help you during a crisis, medications, other treatments that may help you or that you want to avoid, treatment facilities where you prefer to be treated, and things that other people can do for you.

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