Mental Health Care Plan

Planning for Your Loved One’s Mental Health Crisis

Developed by NAMI-San AntonioWritten by Mary E. Jensen, LCSW Executive Director –NAMI San Antonio

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Mental Health Care PlanPlanning for Your Loved One’s Mental Health CrisisIntroduction

This booklet is intended for families and friends of individuals living with mental illness. For the critical times, it is our hope the reader is able to recognize a crisis including:

Learning the components of a crisis plan, Understanding provider resources, Advocating for loved ones in crisis, and Utilizing considering tools provided

A mental health crisis is just as important to address as any other health care crisis. It is difficult to predict just when a crisis will happen. While there are triggers and signs, a crisis can occur without warning. It can occur even when a person has followed their treatment or crisis prevention plan and used techniques they learned from mental health professionals.

We all do the best we can with the information and resources we have. Some days we can handle more than other days; this is normal and to be expected, especially for those living with mental illness. You or your loved one may need help when you have exhausted all your tools or means of coping with the crisis.

We hope that this booklet will help guide you in creating a crisis plan for you or your loved one BEFORE a crisis during which it may become more difficult to think and plan.

Your NAMI-San AntonioProvides free education

classes and support

groups to help

strengthen families

through education

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Table of Contents

Recognize........................................................................................4

Prevent............................................................................................4

Plan.................................................................................................6

Reflect.............................................................................................7

Advocacy.........................................................................................8

Sample Plan...................................................................................10

Resources......................................................................................11

RECOGNIZE-What is a mental health crisis?

Definitions

Crisis: any situation in which a person’s thoughts, feelings, or behavior put them at risk of hurting themselves or others: and/or when they are unable to resolve a situation with skills and available resources.

Mental Health Crisis: a behavioral, emotional, or psychiatric situation, which could result in, reduced levels of functioning in primary activities of daily living (bathing, eating, working, etc.) an emergency situation in the need for placement in a more restrictive setting, including but not limited, to inpatient hospitalization.

Many things lead to a crisis:

StressPhysical illnessWork/school problemsFamily changesCommunity/personal violence/traumaSubstance use

“These issues are difficult for everyone, but they can be especially hard for someone living with mental illness” – A NAMI Family to Family participant

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PREVENT-

Symptoms can sometimes appear unexpectedly. It is possible for people living with mental illness to experience a crisis even when they are following their treatment plan. The best way to prevent a crisis is to develop a treatment plan with a treatment team and support network everyone is comfortable with following. Before a crisis occurs, ask:

Have all available resources been utilized? i

Documenting changes in behaviors by keeping a journal or making notes on a calendar may help you recognize when a possible crisis is building

What Situations have led to a

crisis in the past?

What Stress reduction strategies

have worked before?

How can conflict be avoided?

What steps can be taken to keep

everyone safe and calm?

Who can be called for support in a

crisis?

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LEAPDr. Xavier Amador, in his book, I Am Not Sick, I Don’t Need Help, outlines a communication skill that can be used to engage your loved one and help them to calm down. LEAP stands for Listen, Empathize, Agree, and form a Partnership. It is a family-friendly version for a form of therapy called Motivational Enhancement Therapy.

The first step when taking a leap is to “Listen”. There are some key elements to the art of listening. It is one of the first things we do as human beings. Listening is how we learn and mimic what others do.

Listen

Emphasize

Agree

Partner

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Listen Listen and Learn:drop your agenda Use questions, not statements State what you heard – all of it (reflecting) Let the person correct you Don’t avoid listening to scary topics or thoughts

(Even delusions) Know your “hot-button” fears Don’t rush it Don’t have an emotional reaction to what you hear Don’t try to problem-solve while listening initially Avoid going right to empathy

Empathy Express empathy for feelings This doesn’t mean you have to agree with beliefs Normalize: “I think I would feel that way too

(If I had those beliefs).” Listening + empathizing = “What do you think?”

Common feelings and experiences to empathize with:

Give your Opinion:

Only if AskedDelay 3 times before answeringFollow the 3 “A’s”:

o Apologizeo Acknowledge

fallibilityo Agree (to

disagree)

How to delay your Opinion:

“I promise to answer your question. If it’s alright with you, I would like to first hear more about . Okay?”

“I will tell you what I think. I would like to keep listening to you first because I am learning a lot. Can I tell you later what I think?”

I will tell you. I want you to know that I think your opinion is more important than mine and would like to learn more before I tell you what I think. Okay?”

Discomfort Fear

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Agree Stick to perceived problems and symptoms only. Review advantages and disadvantages of treatment or adherence from the

person’s perspective. Agree to disagree when needed. It’s Okay to set boundaries. You can try to correct misinformation gently. Reflect back and highlight the advantages. Use this as the basis for a plan.

Partner Move forward with agreed-upon goals

Use phrases that support feelings of control and safety:

o “Would that be all right?”

o “Do I have that right?”

o “So, let me see if I got this straight. Are you saying that….”

o “Would you mind if I ….”

o “I can see why you’d feel that way….”

o “I am sure that is upsetting to hear and I know you don’t agree. It’s just how I feel. Can we agree to disagree on this one?”

Practicing these strategies before a crisis occurs will make them easier to use when needed.

Frustration Desire

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PLAN – Create a Crisis Plan

People can still experience a crisis when they have utilized the best resources available. It is important to have a written plan in place in case of a crisis. A good plan will:

Identify people willing to helpList the phone numbers of the mental health providers and the mental health crisis teamInclude a list of current medications and their dosagesList treatments that have been used in the past (e.g., talk therapies such as CBT, DBT, medications, peer support, crisis lines, etc.)Identify key words or calming techniques that have worked in the pastIdentify ones’ preferred treatment facilitiesInclude a copy of their advanced psychiatric directive (if available)

Other important steps include:

Contact your local police department; provide them with a copy of the crisis plan.Create a safe environment by removing any and all weapons and sharp objects.Lock up all medications, both over-the-counter and prescription medications.Talk with others in the household about how to stay safe during a crisis; andPost the phone number of the mental health crisis team and/or crisis line.

It is important to involve your loved one in the creation of the crisis plan. The plan should be distributed to family, friends, and professionals with permission from your loved one. It should be updated whenever there is a change in the

person’s diagnosis, medication, treatment or health care providers.

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Crisis Kit

A crisis kit should include the crisis plan, medical information, snacks, music, books, a change of clothes and basic hygiene supplies. This kit should be kept in an easily accessible place.

REFLECT- What Has Happened

Following a crisis, it is important to reflect on what can be done to potentially prevent or minimize future crises. Some important questions to ask include:

What situations or triggers led to the crisis?What worked to reduce tension or avoid a conflict?What steps did we or could we have taken to keep everyone safe and calm?

Write down the results of this reflection and include it in future crisis plans. Review with your treatment team. The more you understand the underlying causes and triggers of a crisis and what strategies helped, the more prepared you will be in case of future crises.

Invite your loved one to develop a list of things you can do to help them feel more comfortable and recover as quickly as possible. Including your loved one in this process helps the family and other care givers feel good about the support they offer. No one likes to think that someone else will have to take over responsibility for their care. A mental health crisis is a difficult situation – one that no one likes to face alone.

If possible, have the person living with a mental illness provide cues to help others recognize when the crisis has passed. Some examples might be eating at least two meals a day, sleeping regular

hours or taking care of personal hygiene needs.

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ADVOCACY-Advocating for a person living with mental illness in the midst of a crisis can be extremely frustrating and difficult. It is not easy to navigate the health care and/or mental health system or obtain appropriate services for your loved one. You may require help learning how to advocate appropriately and effectively. Learning to be a strong advocate and developing these skills takes time.

Health care privacy laws and the interpretation of them by providers may make advocacy especially difficult. Providers are generally not permitted to give information to family members without the written consent of the patient unless there are concerns about safety or abuse. Individuals may choose not to give their family access to their full medical records. You may want to ask your loved one to sign a release giving you access to communicate with their treatment team.

NAMI suggests family members write down concerns and give them to your loved ones’ treatment team. Focus on the signs and symptoms you are concerned about so that the treating providers have this information to allow for the best assessment possible. Your loved one may not be able to provide as a reliable history while in a crisis as they would when more stable.

Stay CalmWhen meeting with professionals, remember that you attract “more bees with honey than vinegar”. Try to keep the conversation focused, objective and stay in the present. As hard as it can be, try not to get overly

Organization

Over the course of your loved one’s illness, they will receive and need to keep track of a great deal of information. It is important to keep all this information together in one central place where it is easily accessible.

Things you need to keep:

Current diagnostic assessment and current diagnoses

Copy of current crisis plan Notes from phone calls and

appointments Hospitalization history List of medications and

dosages Copies of their advanced

psychiatric directive, and Names and phone numbers of

mental health professionals and mental health agencies working with your loved one.

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emotional. The more you can stay calm, the more control you can have in the situation and the easier it will be for you to stay involved in decisions about your loved one.

Get SupportTo be an effective advocate, you need to take care of yourself. You will need to make sure that you eat, sleep and take a break from the crisis when your loved one is safe. Consider joining a support group. NAMI support groups help you deal with the stresses of advocating for your loved one. At a support group you meet with others who have similar experiences, and you gain knowledge and skills to help in future crises. You also get a chance to support others by sharing your experience. For a list of current support groups in the San Antonio community please visit www.nami-sat.org and click on the support group link to find a location near you.

Communicate EffectivelyEffective communication helps ensure that your loved one receives the appropriate services. Good communication is a two-way street. Be aware of how your words and actions influence how others perceive you.

Your message will be clearer and more powerful by providing information about your loved one that is current and in the here-and-now. Avoid the temptation to tell the whole story. When information is kept to what is needed now and based on facts, not feelings or emotions, you are more empowered. Remember to keep an open mind and listen to what the other person says.

Legal Considerations in an Emergency:

While NAMI-SAT does not provide legal advice, there are certain legal processes that can be helpful when a crisis arises.

If you or your loved one is experiencing a mental health crisis that is causing an immediate risk of danger to self or others, you can call 911 and request a Crisis Intervention Trained (CIT) officer. If one is not available, the police will respond anyway (many officers are trained in crisis intervention). Law enforcement can

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issue a warrantless emergency detention and transport you or your loved one to a facility for evaluation where further treatment can be discussed.

There are other ways for you or your loved one to plan ahead in the event of a mental health crisis. There are several advanced directives that allow your loved one to authorize consent to mental health treatment when he or she is incapacitated; these include Declaration of Mental Health Treatment and Designation of Guardian in Event of Later Incapacity. Your treatment provider can give you information and resources regarding these advanced directives.

CONCLUSION

Advocating and caring for someone experiencing a mental health crisis can be extremely stressful. Have a plan in place, know the best techniques to de-escalate the situation and know where to turn when you need help. Following the steps outlined in this guide can help you support a loved one when they experience a crisis and ensure the safety of everyone involved.

If you have comments or suggestions for future printings of this publication please contact the NAMI San Antonio office at:

NAMI-SAT510 Belknap PlaceSan Antonio, TX 78212(210) 734-3349

www.nami-sat.org

NAMI-San Antonio Community

NAMI4SAT

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SAMPLE CRISIS PLAN

Individual /Family Information: ________________________ Date of Plan: ____

Person’s Name: D.O.B. Diagnosis(s) Diagnosis(s)

Medication: Dosages Medication: Dosage:

Medication: Dosages: Medication: Dosage:

Description of immediate needs: ___________________________________________________

Safety Concerns: ________________________________________________________________

Treatment Choices:

Interventions preferred: ____________________________________________________Interventions that have been used with good results: ____________________________Interventions that should be avoided if at all possible: ____________________________

Professional involvement:

Psychiatrist Name / Phone: Therapist Name /Phone:

Work/School Contact/ Phone:

Case Mgr. Name / Phone:

Crisis Team Phone: Medical Doctor Name / Phone:

Hospital Name / Phone:

Other:

Supports to use in crisis resolution:

Name / Phone: Name /Phone: Name/Phone: Name / Phone:

Name / Phone: Name /Phone: Name/Phone: Name / Phone:

Community Resources:

Advocacy Group: Support Group: MH Agency: Other:

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CRISIS PLANNING RESOURCESUNABLE TO GO TO A PSYCHIATRIC EMERGENCY ROOM or CHCS CRISIS CARE CLINIC

San Antonio Police Crisis Intervention Team (210) 207-7273

(Trained mental health police officers respond anywhere in the City)

Bexar County Sherriff’s Office Mental Health Unit Dispatch (210) 335-6000

Monday – Friday ask for a Mental Health Deputy

Saturday-Sunday inform dispatch you have an emergency so patrol will respond

(Respond to all areas within Bexar County including municipalities and unincorporated areas)

UNFUNDED or NON-RESOURCED PSYCHIATRIC CAREThe Center for HealthCare Services (CHCS)

(24-hour access to mental health crisis services)

Adult Crisis Care ClinicAdults’ phone line (210) 225-5481 601 N. Frio (Screening/assessments 24/7) 1-800-316-9241

Children’s Crisis Care ClinicChildren‘s phone line (210) 223-7233227 West Drexel (Screening/assessments 24/7)

Mobile Crisis Outreach Team (MCOT) (210) 223-7233(Licensed professional meets adults at the scene of the crisis)

Children’s Mobile Outreach Team (CMOT) (210) 223-7233(Licensed professional meets parents/children at the scene of the crisis)

PSYCHIATRIC EMERGENCY ROOMS

Clarity Child Guidance Center (210) 616-0300Child/Adolescent Psychiatric Emergency Service (24/7)8535 Tom Slick Drive, 78229

Nix Behavioral Health Center (210) 579-3800Psychiatric Emergency Service - Adults (24/7) 1975 Babcock Rd, 78229

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ACUTE CARE HOSPITALS WITH BEHAVIORAL HEALTH PSYCHIATRIC UNITS

Hospital Name Emergency Room

Evaluations

Children Adolescents Adults Seniors

Methodist Specialty & Transplant Hospital8026 Floyd Curl Drive, 78229(210) 575-0500

Yes Yes Yes

Nix Health4330 Vance Jackson, 78230(210) 579-3800

Yes Yes Yes Yes Yes

Christus Santa Rosa2827 Babcock Rd, 78229(210) 705-6620

Yes Yes Yes

Southwest General Hospital7400 Barlite, 78224(210) 921-2000

Yes Yes Yes

Baptist Medical Center111 Dallas Street, 78205(210) 297-2000

Yes Yes Yes

NE Baptist Hospital8811 Village Dr., 78210(210) 297-2000

Yes

University Health System4502 Medical Drive, 78229(210) 358-4000

Yes Yes

Free Standing Psychiatric Hospitals (without emergency rooms)

Hospital Name AdmissionsDepartments

Children Adolescents Adults Seniors

Clarity Child Guidance Center8535 Tom Slick Dr, 78229(210)616-0300

Yes Yes Yes

Laurel Ridge Treatment Center17720 Corporate Woods Dr. 78259(210) 491-9400

Yes Yes Yes

SA Behavioral Hospital8550 Huebner Rd, 78240(210) 541-5300

Yes Yes

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Additional Resources

National Suicide Prevention Lifeline 1-800-273-8255 Bazelon Center for Mental Health law - www.bazelon.org National Institute of Mental Health- www.nimh.org Substance Abuse Mental Health Services Administration - www.samsha.org www.dshs.state.tx.us/mhsa/suicide/suicide-prevention.aspx www.TexasSuicidePrevention.org Mental Health & You (MHU) mobile application can be downloaded from the Apple

store for free. Twitter: @StopTXSuicides