Crisis Plan for a Psychiatric Emergency

A Crisis Plan For People Who Experience Psychiatric Symptoms

I feel very strongly that anyone who has ever experienced psychiatric symptoms needs to develop for themselves, while they are well, a crisis plan such as the one that follows. This plan allows those of us who experience psychiatric symptoms to maintain some degree of control over our lives , even when it feels like everything is out of control.

Developing such a plan takes time-don't expect to do it in one sitting. Work on it with family members or friends, your counselor, case manager or psychiatrist-whoever feels comfortable to you.

The hardest part for me was uncovering those symptoms that indicate I need others to take over for me. It brought up memories of very hard times in the past. I did it very slowly with lots of support.

Once you have completed the plan, keep a copy for yourself, and give copies to all your supporters.

Update it whenever you need to.

CRISIS PLAN

When I am feeling well, I am (describe yourself when you are feeling well):

The following symptoms indicate that I am no longer able to make decisions for myself, that I am no longer able to be responsible for myself or to make appropriate decisions.

When I clearly have some of the above symptoms, I want the following people to make decisions for me, see that I get appropriate treatment and to give me care and support:

I do not want the following people involved in any way in my care or treatment. List names and (optionally) why you do not want them involved:

Preferred medications and why:

Acceptable medications and why:

Unacceptable medications and why:

Acceptable treatments and why:

Unacceptable treatments and why:

Preferred treatment facilities and why:

Unacceptable treatment facilities and why:

What I want from my supporters when I am experiencing these symptoms:

What I don't want from my supporters when I experiencing these symptoms:

Things I need others to do for me and who I want to do it:

How I want disagreements between my supporters settled:

Things I can do for myself:

I (give, do not give) permission for my supporters to talk with each other about my symptoms and to make plans on how to assist me.

Indicators that supporters no longer need to use this plan:

I developed this document myself with the help and support of:

Signed: ___________________________ Date: _______________

Attorney: _________________________ Date: _______________

Witness: __________________________ Date: _______________

Witness: __________________________ Date: _______________

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