Mental Health Crisis Planning and Management

Summary

Phone numbers to have handy:

• 911 in case of emergency
• Local police
• Mental health expert
• Friends or neighbors

Know what steps to take if your loved one with mental illness is in danger of hurting himself or hurting others:

• Make a list of places that can help you.
• Call 911 in case of an emergency.
• Keep the local police phone number and phone number of a mental health expert handy.
• Have on hand the phone numbers of friends or neighbors who might help you.
• Post these numbers by the phone or load them into your cell phone or smart phone.
• Talk to your loved one’s doctor or therapist before a crisis. Ask them what you should do if your loved one goes into crisis. 

Find out if your loved one has a crisis plan or a Wellness Recovery Action Plan (WRAP®). A person makes a WRAP® or a crisis plan when they are doing well. It gives directions to doctors, family, and others who may help the person in a crisis. If he has a crisis or WRAP® plan, ask him if you can have a copy. Encourage your loved one to use the other parts of his WRAP® when you see early warning signs that he may be headed toward a crisis.  It will have many instructions that will help you make the right decisions.

If you think your loved one’s mental health condition is getting worse, talk to her. Try to find out what is going on. Everyone has a bad day now and then. But there are early warning signs that signal a relapse. These can include changes in sleep or social activities. Or your loved one becomes very angry or paranoid. Try to get your loved one to see a doctor, therapist, or peer specialist. Your goal is to avoid a crisis.

It is a good idea to have info about your loved one handy. This is in case you need to call for help in a crisis. Make a list that has the following:

• Diagnosis
• Meds
• Situation or behavior that led to the crisis
• Other health problems (diabetes, etc.)
• Info about past crisis (did your loved one try to take her own life? Did he get violent? Did she run away from the hospital? Was he given meds that made him sicker?)

Have extra copies of the list to give to the police and to doctors. A little bit of planning will help your loved one get help she needs.

By Haline Grublak, Vice President of Member and Family Affairs, Beacon Health Options

©2010-2021 Carelon Behavioral Health

Summary

Gather information you will need for:

• Health emergencies
• Natural disasters
• Financial or legal matters

We all have rainy days, and some of us have hurricanes. You can prepare now for an emergency, large or small, by creating a kit. Write down all the needed information and store it in a safe place, so you’ll have it when you need it.

An emergency kit is a type of umbrella. Sometimes you don’t need to do much to prevent a small problem from turning into a big one. For example, if you lose your power in a storm but have a flashlight, you’ll be able to find your keys, your meds, and other important things. Without that light, your power emergency could quickly get out of hand.  

Crisis plan: Expect the unexpected

Here are a few things to find now—before you need them—so you can prepare your own crisis plan:

1. Medical information. Make a list of your doctors and service providers. Write down the drugstores you use, your meds, and renewal numbers. Also make note of any allergies, disabilities, or diet restrictions. Write a few words about your most serious health problems. 
2. Important phone numbers. Keep numbers handy for your medical and mental health doctor. Also write down the local police, fire department, and utility companies (in case of a natural disaster). 
3. Contacts. Write down names, addresses, and phone numbers of close relatives, neighbors, or other people who might be able to help you if you are having a hard time. Ask one or two if they would take you to a doctor or hospital, if you needed urgent care. 
4. A health care agent. Ask someone you trust to take over your health care and make decisions for you, if you can’t make them yourself. You can ask a family member, a neighbor, or anyone you trust to make good decisions. Ask a social worker or any medical office for a health care agent form.  
5. Crisis information. Think about this: what do you consider a crisis?  What would you want people to know about you, if you are “in crisis?”
6. Your preferred care. Decide what care you want or don’t want, in case you are seriously injured or ill and can’t speak for yourself. You’ll put this information in special forms called advanced directives. Check with your state or county health department, or look on this website for a sample.
7. Loved ones. If you have children or pets at home, find someone to care for them if you are suddenly sick or injured. Include their contact information in your kit. Be sure to write out instructions that person can follow to care for your loved ones.

Natural disaster kit: Before the storm

Here are some items you’ll want to keep on hand, in case of a big storm or other natural disaster:

1. Keep a few gallons of water, toilet paper, and a flashlight (with batteries) handy. You can store tap water in clean gallon jugs. 
2. Leave a small blanket and some basic first-aid supplies (bandages, cleansers, and pain relievers) in your car or home. This is helpful no matter what the season.
3. Buy a battery-operated radio in case the power goes out. 
4. Put a can opener in a water-resistant container with a few canned meals, fruit juices, and other canned food.
5. Include a small amount of cash in your kit, just in case.

Financial emergency kit: Money matters

Here are some things you can put in a financial emergency kit:

1. Start saving for an emergency now. A little bit each week can add up fast, and will be here for you when you need it.   
2. Keep a record of account numbers. Make a list of any credit cards, debit cards, bank accounts, and pension or disability accounts. Put that list in a safe place.
3. Keep all important receipts in a folder, shoebox, or large envelope. Be sure to label it so you can find what you need.
4. Keep a copy of your health insurance coverage information in your kit. Include your account number.
5. Make copies of documents you wouldn’t want to lose. This includes your Medicare or Medicaid card, driver’s license, and Social Security card. Also your marriage or divorce information, birth certificates, child support papers, or other legal papers. Keep these copies in your financial emergency kit.
6. Keep the name and contact number of someone who might be able to help you if you have a money emergency.

With some luck, you’ll never need any of these kits, but if you do, you’ll be glad you have them.

By Paula Hartman Cohen

©2010-2021 Carelon Behavioral Health

Source: Maine Department of Health and Human Services, www.maine.gov/dhhs/mh/rights-legal/crisis-plan/home.html; National Safety Council

Summary

• Know what resources are available.
• Understand that your family member or loved one might be afraid. 
• Share your concerns with other family members and try to get their cooperation.

The most costly care is not always the best. Private doctors are not always better than community mental health centers. Community mental health centers may be the first recovery step for people with serious mental illnesses. There, your loved one can get services like housing, job hunting, peer support, and more.

If this is the first time you’ve tried to get help for your loved one, you may be at a loss as to what to do or say. Here are some ideas to get started:

• Most important, know that your loved one’s mental illness is neither your fault nor her fault. If you get a therapist who tries to blame you or your loved one, find another doctor or therapist.
• Know what resources are on hand. Talk to your local community mental health center. All of them should offer therapy. Most have many other programs that help people with mental illnesses. Find out about all the services they have. Find out who to call for programs that interest you and your loved one.
• Understand that your loved one might be afraid. Be patient and supportive. Accept the fact that he may be more willing to talk with a trusted friend, doctor, clergy, or another family member.
• Always be honest. Your relative needs to know she can trust you. Talk about going into the hospital with her if this is a possibility. Do not hide books about mental illness. Do not make empty threats or promises you can’t keep.
• What your loved one is seeing, hearing, and feeling is real to her. It will not help to argue with her. Instead, tell her that you love her, and you know what she is seeing and feeling is real to her.
• Share your concerns with other family members. Try to get them to work together with you. Be aware that they may deny, or be embarrassed by the idea of having a family member with a mental illness.
• Be ready in a crisis. Call 911 or call the police if you feel your loved one is losing control and may be in danger of hurting himself or others. If he is in crisis but there seems to be no immediate risk, call the crisis team at your mental health center.
• If the situation isn’t urgent, take time to talk with your loved one. Let her know you care and are worried. Don’t diagnose your family member. Just explain that you want her to see a doctor to find out if she needs help. Ask her how she feels and how she feels about talking to a doctor. Be honest. Don’t use words that will set her off, like crazy, dangerous, or losing it. Respect her right to choose. She may not admit she needs help at first. By talking it over with her, you have opened the door. She may be ready to talk and get help later.
• You may need to get an involuntary commitment. This is a last resort. An involuntary commitment is when the court makes your loved one go into the hospital. This only happens when a person is a danger to themselves or others, or is so sick they can’t take care of themselves. It’s always better if your loved one decides to go into the hospital on their own. This is called voluntary treatment.

By Haline Grublak, Vice President of Member and Family Affairs, Beacon Health Options

©2010-2019 Carelon Behavioral Health

Reviewed by Trenda Hedges, C.R.S.S., C.P.R.S., Wellness & Recovery Program Manager, Beacon Health Options

Summary

A crisis plan covers:

• Who I am
• What I need
• How I want people to help me in a crisis

Life is full of surprises. You can have a good day on Monday and a terrible day on Tuesday. This can be even more likely if you’re having problems with your mental health.

It’s a good idea to plan for a crisis by putting important info in one place so you can pull it out and read it. Or you can hand it to someone else.

Here is a basic outline for a crisis plan that can help someone help you if you find yourself struggling with your mental health. Change it any way you like to make it work for you, but try to keep some of the same info in your plan.

You might want to leave one copy at home, and carry another copy with you when you go out. Take it with you if you’re meeting with a crisis team or hospital staff.

Name:

Address:                                                                                       

Phone #:

Birth date: 

Gender:   

Who to Contact in an Emergency:
Name
Address
Phone
Relationship to you

Health needs:

Chronic health conditions, if any:

Nearest cross streets to your home:

Your health care and service providers:

Pets:

Children:

Describe what a crisis is to you.

In the past, what has helped you when you were in a crisis?

How do you act or what do you look like when you are having a hard time?

Are there things you do that might frighten other people?

How do you want them to react? 

Is there anything else you want people to know about you, so they can help you when you’re having a hard time?

By Paula Hartman Cohen

©2010-2021 Carelon Behavioral Health

Source: Maine Department of Health and Human Services, www.maine.gov/dhhs/mh/rights-legal/crisis-plan/home.html

Summary

• Decide what you want and don’t want in emergency treatment.
• Describe what works for you and what doesn’t.
• Pick someone to speak for you.

You might face a time when you need medical help for a mental health crisis. Serious situations may happen, even to people who work hard on their recovery and have a regular program of meds, therapy, and support.

Depending on the crisis, you might not be able to properly speak with those trying to help you. If that happens, a psychiatric advance directive (PAD) will let people know what treatments you prefer and what you don’t want. If you write a PAD while you’re well, you will know you have made your wishes clear, no matter what happens.

Important things to remember

• A PAD is a legal document and can have a big impact on your care.
• A PAD gives you some control over treatment decisions.
• As you work on it, you will want to discuss some decisions with your family and treatment providers.
• You can always change it, if you want to.

If you do find yourself in a mental health crisis, your PAD may prevent your situation from getting worse.

Make decisions in advance

Here are 12 things to ask yourself before you write your own PAD. Your answers can be dropped into a form provided by a state mental health agency, or into one you write yourself. (Look at a few sample forms by clicking on the links below.)

1. What medications do you take? Do you have any allergies? What medications would you prefer in a crisis? Is there anything you would not want to take?
2. Where would you like your care to take place?
3. Do you want your physician, therapist, and/or case worker contacted? 
4. What warning signs come before a crisis, for you?
5. When you have a crisis, what are the symptoms? Be as specific as possible, so you can help someone spot your crisis in its early stages. 
6. What helps you when you’re in a crisis?
7. Have you ever been in a hospital for mental health treatment? How did you react?
8. How can hospital staff help you stay calm and comfortable?
9. Will you let people visit you if you’re in a hospital? 
10. Would you agree to electro-convulsive therapy (ECT) if doctors decide it is necessary?
11. Is there anything else you would want hospital staff to know about you or your needs? Do you have a crisis plan they could read for basic health and contact information? 
12. Can you confirm that you wrote this plan? Some states require the signature of a witness and/or notary public. Find out what your state mental health agency requires before you complete your PAD.

You might want to ask someone you trust to make important decisions for you. Or, you might want to direct the hospital to call your doctor and follow his instructions.

Look at the PAD as your voice in a serious situation in which you cannot speak. Your instructions will make it easier for people to plan your care, even if you are in a busy ER.

Doctors do not have to follow your plan if they think your choices are inappropriate. Still a PAD is a good thing to have, even if it doesn’t guarantee that you will get the treatment you ask for. It will help doctors decide what to do and what not to do when planning your emergency care.

Resource

Mental Health America
www.mentalhealthamerica.net

Myths and Facts about Advance Directives by the American Bar Association, www.americanbar.org/content/dam/aba/migrated/Commissions/myths_fact_hc_ad.authcheckdam.pdf.

Advance Directives for Mental Health Treatment, North Carolina Division of Mental Health, http://pad.duhs.duke.edu/PAD%20Worksheet.doc.

By Paula Hartman Cohen

©2010-2019 Carelon Behavioral Health

Source: Loretta Kearsley, R.N., B.A., M.Ed., Psychiatric Nurse, Charlemont, MA; National Resource Center on Psychiatric Advance Directives, www.nrc-pad.org/

Reviewed by Trenda Hedges, C.R.S.S., C.P.R.S., Wellness & Recovery Program Manager, Beacon Health Options

Summary

• Plan ahead for when symptoms of the illness occur.
• Set reasonable rules and limits and stick to them.
• Do not go along with delusional thinking.

Your family member should have a home that is safe and stable. A setting like this will help your loved one with his recovery. Your support and understanding is critical. Even when your loved one has support and a safe place to live, there may be times when your loved one is not doing well. He may act in a way that causes worry for you and other family members. These ideas may help you and your family:

• Plan for when your loved one gets bad symptoms. Talk to her doctor or therapist about how to plan. If possible, learn what can set off the symptoms. Agree on a course of action ahead of time.
• Learn to spot signs of relapse, such as changes in mood, sleeping, and eating habits. Your family member should also learn these signs. He may be able to tell you what has worked to rid him of stress and get control of symptoms. Seeing his doctor or therapist may help avoid a relapse. This is especially true if your loved one needs his meds evaluated.
• Learn what situations may cause trouble. Do not invite an insensitive friend to your home when your relative is there.
• Do not agree to stop the meds if your family member feels cured, or because the meds have side effects. Talk to the doctor who prescribed the meds. She may not know that your relative is having side effects. Be sure she understands the problems your loved one is having because of the meds. If your doctor refuses to listen or to act, a change in doctors may be in order.
• Set fair rules and limits and stick to them. It may help to ask the therapist for ideas. 
• Don’t tell your family member to “pull yourself together.” If he could, he would. Not being able to do this is part of the illness. Know that he is dealing with more than you are.
• Don’t expect that all bad habits be fixed at once. Focus on good things your relative is doing. Don’t focus on what is going wrong.
• At times people with mental illnesses have memory loss or can’t concentrate. Be patient with your relative. If your relative seems like she’s not listening, it may be because of the illness. Repeat the info in a kind and clear way.
• Do not go along with delusional thinking. The person with mental illness needs to be able to depend on someone who is in touch with reality.
• Your family member may see or hear things that aren’t there. Be honest. Accept his view of the world as his own. If asked, say that you are not having the hallucination. Learning how to respond in a respectful ways to these and to other symptoms is an important part of family support.  

By Haline Grublak, Vice President of Member and Family Affairs, Beacon Health Options

©2010-2019 Carelon Behavioral Health

Reviewed by Trenda Hedges, C.R.S.S., C.P.R.S., Wellness & Recovery Program Manager, Beacon Health Options

Summary

Signs of relapse:

• Difficulty in carrying out everyday activities
• Behaviors that are similar to previous relapses
• Extreme changes in emotions that are not caused by outside events

People with mental illnesses are stressed by the same kind of life events as everyone else. But the way they react to it can be different. Stress can bring on a relapse of their illness. Not eating right, lack of sleep, or worries about day-to-day problems can cause stress.

While you can’t make a person’s life stress free, you can lessen the effects of stress. Make sure your family member has lots of ways to live a healthy lifestyle. Help her eat healthy, balanced meals, exercise regularly, and get enough sleep. Encourage a regular routine and help her stay away from drugs and alcohol. Know what the early signs of a relapse look like. Acting early can help speed recovery.

Warning signs of a relapse:

• Changes in eating or sleeping patterns, personality changes
• Problems with doing everyday activities
• Changes in how your family member talks with others
• Acting in a way that is like other relapses your family member has had
• Extreme changes in feelings that are not caused by outside events

If you suspect your family member is having a relapse, you should:

• Tell his doctor or therapist right away. Ask for an evaluation of his meds.
• Try to lessen stress that may be coming from outside sources.
• Encourage her to stay involved in any therapy or peer programs.
• Try to keep the home environment as calm, secure, and stable as possible.
• Try to talk to your relative about your concerns. Talk with him about things he can do to keep the relapse from getting even worse.

Be prepared:

• Have a crisis plan ready for yourself.
• Keep emergency phone numbers (doctor, therapist, police, hospital, etc.) in a convenient place.  Load these numbers in your cell or smart phone.
• Know your limits and how you will react if those limits are broken. Make sure your relative knows your limits and what will happen if your limits are broken. 

By Haline Grublak, Vice President of Member and Family Affairs, Beacon Health Options

©2010-2019 Carelon Behavioral Health

People with serious health problems are at risk of having a crisis. This is the same for people with serious mental illnesses. A crisis can come about for many different reasons. Sometimes it can happen for no clear reason at all. Events like these can also set off a crisis: 

• Stopping or refusing to take meds
• Meds no longer work or the dose needs to be changed
• Overusing drugs or alcohol
• Losing a loved one, losing a job, holidays, or physical illness

People seldom lose control all of the sudden. There are often warning signs that the family will spot long before the crisis. There may be certain kinds of behaviors that predict a crisis. 

During these early stages, you can do things to avoid a full-blown crisis. Try to get your family member to visit her doctor or therapist. You may need to make the appointment yourself and drive her there.

If you haven’t been able to avoid the crisis, be calm and act rationally. Accept the fact that the person has a mental illness. You are not the cause of it. These guidelines can help:

• Don’t threaten your loved one. This may cause him to become more excited or afraid. People who are afraid may act out.
• Don’t shout. If she’s not listening, it isn’t because she is ignoring you on purpose. Other voices or intense feelings may be interfering.
• Don’t criticize. Criticizing will not make the voices go away or calm a person who is scared. It will only make the situation worse.
• Don’t argue. The person is not having the same reality that you are. 
• Don’t dare a person to act on what he is threatening to do. 
• Don’t stand over the person. If she is sitting down, sit down too.
• Avoid direct constant eye contact or touching the person.
• Follow requests the person makes if they are not risky or unreasonable. This lets the person feel somewhat in control.
• Don’t block the doorway, but don’t let the person get away.
• Be positive. Even if your loved one is out of touch with reality, he will respond to your love, care and concern.  

By Haline Grublak, Vice President of Member and Family Affairs, Beacon Health Options

©2022 Carelon Behavioral Health

Summary

• Talk to family members.
• If a patient ID card is available, carry one.
• Carry the NAMI helpline number.

It’s sad but true: People with serious mental illness have a high chance of being arrested. You don’t have to commit a serious crime. The offense can be something like sleeping at a train station. Or a family member might call the police when your symptoms get out of control.

Daniel Yohanna, M.D., a psychiatrist with the University of Chicago Medical Center, says about one in five people behind bars are severely mentally ill. They should not be there, but they can’t get the right treatment. Instead, they get into trouble with the law.

So what do you do if you’re arrested?

First of all, remember that you have rights. It doesn’t matter if you have a mental illness. Like everyone else, you have the same right to remain silent and the right to legal help.

Second, you should ask for the crisis intervention team (CIT). Or tell the police that you need a CIT officer. Yohanna says many police departments train officers in ways to deal with mentally ill people under arrest. So don’t panic. Ask for help instead.

It helps to be prepared, of course. Here are some steps you can take to be ready if you get in trouble:

Talk to family members. The people who are close to you should know how to help you in case of arrest. Talk with them about what they can do if you are arrested. Make sure you are able to call them at any time. Also, give them phone numbers of your doctor, lawyer, or a local mental health center. They could call these if you are unable to.

If a patient ID card is available, carry one. Find out from your doctor if you can have a card that will help the police understand your illness.

Carry the NAMI number. NAMI, the National Alliance on Mental Illness, has a national helpline at 800-950-6264 (800-950-NAMI). It also has local programs. Write down the helpline number and carry it. Go to the NAMI website to learn about programs in your area.

Learn how to keep your benefits. If you have to spend time in jail, you need to know how to keep your benefits from programs such as Medicaid and Supplemental Security Income (SSI). The Bazelon Center for Mental Health Law has a booklet on this topic.

By Tom Gray

©2010-2019 Carelon Behavioral Health

Source: Daniel Yohanna, M.D., Vice Chair, Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medical Center; National Alliance on Mental Illness (www.nami.org); Center for Mental Health Services National GAINS Center; Judge David L. Bazelon Center for Mental Health Law

Summary

• Do not blame yourself for what has happened.
• Do not be afraid to reach out to others for support.
• Where to turn for info and help begins with where your loved one is being held.

When a person goes to jail he is not the only one affected. Parents, siblings, friends, spouses, and kids are all changed in that moment. Life is no longer the same for the person or for his loved ones. Millions are forced to deal with this reality each year. Every situation is different. But, there are some common concerns and emotions.

A flood of feelings

One thing that is bound to occur is a wave of differing emotions. These feelings can range from shock, worry, and fear, to anger, shame, and regret. You will surely feel a sense of loss, grief, and separation. You may also feel abandoned and betrayed. At times, you may feel the situation is hopeless and out of control.

It is important not to blame yourself for what has happened. People make their own choices and sometimes these choices have bad results. Feeling guilty about it will not help you or your loved one.  Instead, try to stay positive and focus on ways you and your family can best move forward.

A wave of concerns

There are a number of issues that you will have to deal with. Some of these may include:

• Loss of income
• Legal fees
• Child care
• Upkeep of house
• Court dates
• Custody hearings
• Visitation rules
• Cost of visits and calls
• Social stigma
• Children’s questions

All of these new concerns can quickly get out of hand. Do not be afraid to speak with a mental health provider and the facility to find out more info. Reach out to others for support. This is a time for families to stick together and for friends to rally behind them. Sharing the burden will help to lighten the load.

Finding help

Where to turn for info and help begins with where your loved one is being held. If it is a local city or county jail, or juvenile facility, check with your county sheriff’s office. If it is a state prison, go to your state’s Department of Corrections (DOC) website. You can also access a USA DOC Directory. Locate federal prisons through the Federal Bureau of Prisons.

Contact your local welfare office about food stamps and other helpful programs. Check with your state’s Department of Children and Family Services about their Child Care Assistance Program. You may also be able to get financial help through programs such as Temporary Assistance for Needy Families (TANF). Find further help through the Directory of Programs Serving Children and Families of the Incarcerated.

Legal help can be accessed through the Legal Information Institute or the Prison Policy Initiative’s Legal Resource Database.

Many families also turn to local places of worship or to charities such as the Salvation Army.

Resources

USA Department of Corrections
www.prisonpenpals.com/corrections.html

Federal Bureau of Prisons
www.bop.gov/

Temporary Assistance for Needy Families
www.acf.hhs.gov/programs/ofa/help

Directory of Programs Serving Children and Families of the Incarcerated
http://nrccfi.camden.rutgers.edu/resources/directory/national-programs/

Legal Information Institute
www.law.cornell.edu/

Legal Resource Database
www.prisonpolicy.org/resources/legal/

Mothers of Inmates
www.mothersofinmates.org/

Daily Strength: Families of Prisoners Support Group
www.dailystrength.org/c/Families-of-Prisoners/support-group

By Kevin Rizzo

©2015-2019 Carelon Behavioral Health

Source: ASPE, U.S. Department of Health & Human Services, http://aspe.hhs.gov/basic-report/prisoners-and-families; BGCE at Wheaton College