Synopsis
Create and use an individual crisis plan that translates warning signs, coping, social support, service responses, means safety, treatment preferences and review arrangements into practical actions shared with the right people.
- A crisis plan is a jointly written, accessible set of actions for the person, supporters and services; it is not a contract promising never to self-harm.
- Record personal warning signs, triggers, internal coping strategies, safe places, social contacts, professional and emergency contacts, and collaborative restriction of lethal means.
- Include what helps, what worsens distress, communication needs, treatment preferences, dependants, physical-health issues and any advance statement or decision.
- Specify named roles, response times and out-of-hours routes so vague advice such as seek help does not fail when cognition is narrowed by crisis.
- Risk tools and low, medium or high categories must not decide treatment or discharge; use current needs, safety and a collaborative formulation.
- Follow the plan as far as possible, but reassess every presentation because intent, injury, context and capacity may differ from previous crises.
- Frequent crises or ineffective treatment should trigger a multidisciplinary review with the person, a care coordinator and one coherent future approach.
- After a crisis, review antecedents, helpful and harmful responses, medicine started, follow-up and any changes needed while memory is still useful.
Key red flags
Current intent, preparation, access to lethal means or inability to use agreed coping steps means escalation must not wait for the next routine contact.
A new method, greater medical lethality, different trigger or loss of usual support makes an old plan potentially obsolete.
Confusion, seizure, fever, severe intoxication, withdrawal or head injury requires medical assessment rather than reliance on psychiatric crisis instructions.
Unsafe housing, domestic abuse, risk to children or carers unable to maintain safety requires safeguarding and practical action beyond individual coping.
Investigation priorities
Map antecedents, warning signs, thoughts, emotions, actions, support and consequences from recent episodes.
Management branches
The person is sufficiently settled to reflect on previous crises and rehearse future responses.
- Define crisis in the person's terms and list early signs, later danger signs, triggers, reasons for living and strategies that have actually helped.
- Arrange internal coping, social distraction, direct support, professional contacts and emergency action in a clear order with accessible details.
- Agree means safety, information sharing, dependants, physical needs, preferred responses and where the signed current plan will be stored.