Planning for a mental health crisis can feel uncomfortable. Nobody particularly wants to imagine reaching a point where they are struggling to cope, but that is also why it can be useful to think about it when things are relatively steady.
When we are distressed, overwhelmed or unwell, it can become much harder to explain what is happening, decide what we need or tell other people how they can help. A crisis plan does some of that thinking in advance, helping you recognise when things are becoming more difficult, identify the people you trust and make it clearer what support is useful to you.
It doesn’t have to be complicated. It simply needs to make sense to you.
What is a mental health crisis plan?
There is no single way a mental health crisis looks. For one person, it might involve overwhelming anxiety. For another, severe depression, thoughts of self-harm or suicide, psychosis, or reaching a point where ordinary day-to-day tasks become extremely difficult. The signs can also build gradually rather than appearing suddenly.
A mental health crisis plan is a written record of the things that may help if your mental health deteriorates. It can include your early warning signs, people to contact, things that usually help, things that don’t, and practical information that trusted people may need.
The important thing is that the plan is personal. What helps one person may be completely wrong for somebody else, so a useful crisis plan needs to reflect your own experiences, circumstances and preferences rather than somebody else’s idea of what support ought to look like.
Why make a crisis plan before you need one?
A crisis is not usually the easiest time to make decisions. Planning when you are feeling relatively well gives you the chance to think more clearly about what you have noticed in the past, what has helped and what you would want other people to know.
It doesn’t mean assuming that a crisis will happen. It simply means putting some useful information in place in case you need it.
Notice your early warning signs
Changes in mental health do not always come without warning. You may notice differences in your sleep, appetite, energy, concentration or mood. Perhaps you become more anxious, withdraw from other people or lose interest in things you normally enjoy.
Your signs may be completely different. The useful question is: what tends to change for me when I am beginning to struggle?
Recognising those changes does not mean that every difficult day is the beginning of a crisis. It does, however, give you and the people around you an opportunity to notice when something is changing and respond earlier.
Know what helps, and what doesn’t
It is easy to concentrate only on what people should do, but what not to do can be just as important.
Perhaps you need quiet rather than lots of questions. You may find certain phrases frustrating or dismissive. Being surrounded by people might help, or it might make things harder. There may be particular routines, places or activities that help you feel more settled.
Thinking about these things beforehand means somebody supporting you has a better starting point and does not have to guess.
Make asking for help simpler
One of the hardest things during a period of severe distress can be explaining what you need. You might know that something is wrong without being able to find the words to describe it, or you may simply not have the energy to explain everything from the beginning.
A plan gives you something concrete to share. It can help the people around you understand what is happening, what you have found useful before and what you would like them to do.
What should a mental health crisis plan include?
There is no compulsory format for a crisis plan. It could be a document on your phone, a page in a notebook, a printed sheet or something you have developed with a professional who already supports you.
What matters is that you can find it and understand it when you need it. The following six areas provide a useful starting point.
Your warning signs and helpful responses
Start by writing down some of the changes you tend to notice when your mental health is becoming more difficult. Alongside each one, add anything that has helped before.
For example:
Warning sign: I’m sleeping very little and becoming increasingly anxious.
What may help: Tell someone I trust, reduce unnecessary commitments and contact my usual source of professional support.
Try to keep this practical. You do not need to produce a perfect description of how you feel. The purpose is to identify things you or somebody supporting you can actually recognise and respond to.
The people you can contact
Think about who you would genuinely feel able to contact if you were struggling. This could include a friend, family member, your GP, someone from an existing mental health team or support service, or another trusted person.
Different people may be able to offer different kinds of help. One person might be good to talk to, while somebody else may be the person who could come round, help you make a phone call or take care of something practical.
Try not simply to write down names without discussing it with the people involved. If someone is part of your crisis plan, it helps if they know that beforehand and understand what you might be asking of them.
What you would like other people to know
When you are struggling, what would you want somebody supporting you to understand?
You might want to record:
- how you tend to communicate when you are distressed
- what usually helps you feel calmer
- what can make things worse
- who you would like contacted
- what you would like someone to do first
- when you would want professional or urgent help to be sought
This isn’t about trying to control every possible situation. Circumstances can change, and there may be times when somebody needs to act differently to keep you or somebody else safe.
What the plan can do is give the people around you a much better understanding of you and what is normally helpful.
Practical tasks you may need help with
Mental health difficulties affect more than thoughts and feelings. When things become particularly difficult, ordinary tasks can suddenly feel much harder.
That might include shopping, preparing food, looking after pets, collecting medication, dealing with an essential household task or getting to an appointment. Think about the responsibilities that would matter most if you were struggling and who could realistically help with them.
Again, agreement matters. A crisis plan should make support clearer, not unexpectedly place responsibility on somebody who did not know they had been given it.
Signs that things are improving
Progress after a difficult period is not always dramatic. It may begin with getting some sleep, eating properly, answering a message, going outside or starting to take an interest in something again.
Knowing your own signs of improvement can help you recognise that things are shifting, even if you are not yet feeling completely well. It can also help the people supporting you understand that small changes may be significant.
This does not need to become another checklist you are expected to complete. It is simply a way of noticing what improvement tends to look like for you.
Space to notice patterns
Some people find it useful to make brief notes about what was happening before, during and after a particularly difficult period. Over time, these can reveal patterns that are difficult to see while you are in the middle of things.
Were particular pressures building? Had your sleep changed? Were you withdrawing more? Was there something that seemed to help?
You don’t need to keep a detailed journal unless you find that useful. A few observations can be enough to give you a clearer picture of what tends to happen and what you might want to include when you next review your plan.
Involving people you trust
A crisis plan becomes much more useful when the people named in it know that it exists. If you can, choose people you trust and talk to them while you are able to have the conversation relatively calmly.
Explain why you are creating the plan, what your early warning signs can look like and what you may need from them. It is also worth discussing what can make things harder and when you would want them to seek professional or urgent help.
Try to be as specific as you reasonably can. “Help me if I’m struggling” leaves somebody with a great deal to work out. “If I’ve stopped answering messages for a couple of days, please phone me rather than assuming I want to be left alone” gives much clearer guidance.
Peer support can be valuable too. Someone with their own relevant experience may understand aspects of what you are going through in a different way, and shared experience can make some conversations easier.
That does not automatically make somebody the right person to support you during a crisis, though. Trust, boundaries and what each person can realistically offer still matter. Nobody in your personal support network has to become responsible for managing your mental health.
Putting your crisis plan into practice
Writing the plan is only the first part. It also needs to be something that you and the people around you could realistically use.
Share it with the right people
Make sure the people who may need the plan know that it exists and where to find it. You may want particular people to have their own copy, especially if they are likely to be closely involved in supporting you.
Talking about the plan can also uncover assumptions. Something that seems perfectly clear when you write it may mean something different to the person reading it.
Keep it somewhere accessible
A carefully prepared crisis plan is not much help if nobody can find it.
Think about where you would realistically look for it when things were difficult. That could be your phone, a particular folder or a printed copy kept somewhere obvious. If trusted people may need access to it, make sure they know where it is too.
Talk it through
You do not need to rehearse a pretend crisis, but it can be useful to talk through the plan with somebody you trust.
Does it make sense to them? Do they understand what you are asking them to do? Are they comfortable with the role you have discussed? Is there anything important you have assumed they already know?
These conversations can make the plan much more practical and can also give the other person an opportunity to be clear about their own boundaries.
Review it
Your needs can change. People move, relationships change, support services change and things that once helped may stop being useful.
Come back to your plan occasionally and check that it still reflects your life now. It can be particularly useful to review it after a difficult period, when you may have learnt that something you expected to help didn’t, while something surprisingly simple did.
When a crisis plan isn’t enough
A personal crisis plan can help you and the people around you respond more clearly, but it is not a substitute for professional or emergency support when that is needed.
If you already receive mental health support, include the contact details for your usual service in your plan. In Scotland, if you need urgent mental health support, phone NHS 24 on 111 and choose the mental health option. If someone’s life is at immediate risk, phone 999 or go to A&E.
Part of good crisis planning is recognising the point at which you or the people around you need additional help rather than trying to manage everything alone.
Keep the plan useful
There is no prize for creating the most detailed crisis plan. A good plan is one that you and the people around you can understand and use.
A useful place to start is with a handful of questions:
- What tells me that things are becoming more difficult?
- What tends to help?
- What tends not to help?
- Who do I trust?
- What practical support might I need?
- When should we seek further help?
You can add to the plan as you learn more about what works for you.
Mental health can be difficult to predict and no plan can cover every eventuality. But making some important decisions while you are able to think clearly can make a difficult situation less confusing, both for you and for the people trying to support you.
Sometimes, simply having had the conversation beforehand can make asking for help a little easier when you need it.
