Having attempted suicide, I'm well aware of my own vulnerability and of the dangers my unchecked thoughts and moods create. Given this, I believe that it's essential that I have a Crisis Plan - what I call My Self-Care Plan - in place to help supplement my safety should the crisis arise. This is that Plan.
In presenting it to you I include notes explaining why I've structured My Self-Care Plan as I have. As you'll read in those notes, I view my Plan as something that helps me not only in a time of crisis, but as I conduct my everyday life.
My Self-Care Plan
Shortly after I attempted suicide, I read about crisis plans. I immediately sensed that this was a tool that I'd benefit from; however, I didn't know how to create one so I asked my case manager to help me.
He agreed and made a few suggestions on what I might want to include: the warning signs of mood change, the signs that immediate action is needed, who to approach for help, how to distract myself, etcetera. He encouraged me to continue researching crisis plans and to make notes of ideas I'd like to use. He advised that the key to these plans was my consideration of actions I'd take if a warning sign existed. These actions were the steps I'd follow to right myself and negate the crisis.
At that time we were meeting weekly so he suggested that I take the next week to think on these things and continue my research. In turn, he'd create a template which we'd review together. When we next met, we'd incorporate my thoughts into the template.
Over the next week I sat and thought and came up with ideas for what was to become my first crisis plan. I did my best to list my warning signs, both of changing mood and imminent danger, and ways I could help myself safely respond to these warnings. Admittedly, the warning signs I listed were rudimentary as I was still learning about myself and what took me to take such drastic action.
A week later, my case manager and I met and modified his template by adding into it my ideas. While doing this he brought to my attention warning signs that I'd overlooked but he had observed, and actions that I'd thought were unimportant but that he thought were critical to my safety. That initial document was a true joint effort.
Over time the plan has grown. The structure has been refined and it has evolved into what I now call My Self-Care Plan. It's a living document subject to constant revision as I discover new tools or get better at using older ones. This has given me an unexpected benefit: because I revisit my Plan frequently to add indicators, or to add tools or refine older ones, it's never forgotten. Turning to my Plan is a habit, one that's benefited me many times.
Please note that the highlights below are directly copied from my Plan.
The Heading
MY SELF-CARE PLAN
My Self-Care Plan was originally called Crisis Plan. The first change I made to the original plan was to add the word "My" to the heading. For me, this change is significant. It makes it clear that this is my plan, created by me for me. It reaffirms why I have a Plan - to help myself when I'm in need of help.
The next change I made was to convert the heading from My Crisis Plan to My Safety Plan and then again to My Self-Care Plan. Here's why.
I disliked the name My Crisis Plan. It suggested that I turn to the Plan only when I'm in crisis, and I felt that this might be too late. My fear was that the overwhelming thoughts and emotions experienced during a crisis might mean I'd forget all about the crisis plan itself. Often, these overwhelming thoughts and emotions deny me the ability to think or do anything outside of them. For me, this wasn't good enough.
Similarly, the name My Safety Plan suggested that the Plan was limited to a single, albeit important, purpose. It suggests that the Plan is only to be used when safety is in jeopardy. Again, though, the overwhelming thoughts and emotions I described above might make me forget all about the safety plan. Again, not good enough.
What I wanted was to create a scheme where I could catch the thoughts and emotions before a crisis was reached or before my safety was threatened. For me, it's better to take action when the thoughts and emotions first start to appear, at the earliest signs of mood change, and not wait until it's almost too late!
Over the years, by engaging in talk therapies, and through tracking my moods and sleep, I've learned to spot some subtle indicators of possible depression or hypomania. For example, being unable to write is a typical signal for the onset of depression while reduced sleep is a typical signal for oncoming hypomania. Thus it's important that my Plan is wide enough in purpose to capture indicators as early as possible to mitigate against the onset of a crisis or threat.
Entitling my plan as My Self-Care Plan recognizes this wider purpose.
Additionally, it's important that my Plan isn't stagnant. I'm always looking to discover improved indicators of changing mood and a deeper understanding of my temperament and triggers. I also keep learning about Bipolar II Disorder and the tools that can better help me cope with it. This means that my Plan needs to be adaptable, able to incorporate these new lessons.
Since My Self-Care Plan is about me, my self-care, it will evolve as my self-care evolves.
The Tagline
HOW TO PROMOTE MY SELF-CARE AND WHAT TO DO WHEN I AM FEELING DISTRESSED, DEPRESSED, ANXIOUS, (HYPO)MANIC OR OVERWHELMED
The tagline is quite a mouthful. It has to be because it serves two purposes.
The first purpose is to reinforce the idea that the Plan promotes self-care. Since it promotes my self-care, I find that it's looked at by me with greater frequency.
The second purpose is to remind me that the tools within it are there because they work. They mitigate the possibility of harm, harm that is typically caused by strong thoughts and emotions manifesting themselves through harmful behaviours. Each of these thoughts and feelings can be debilitating, especially if they're the ones in control.
The language of the tagline reminds me that those thoughts and emotions don't have to be in control. Instead, I can make a real effort to take control back. I can reassert my control over that very thing that seems most out of my control - how I respond to thoughts and feelings affecting my mental illness and health.
By following the actions in My Self-Care Plan I can act sooner thereby promoting better mental health and improving my self-care.
The Plan
My Self-Care Plan is a graduated system of interventions. It begins with basic reminders and grows in intensity with each intervention. Where necessary, there are alternative skills or activities within an intervention to give me options while I seek to manage my mental illness and overall health. Each intervention is highlighted below.
Reasons to Live
This section is a recent addition to My Self-Care Plan. It's a simple list, ever-changing, ever-growing, of reasons to live. It reminds me that despite thoughts or feelings to the contrary, I have a great deal to live for.
The first reason to live on this list? My son. I can't underestimate how important his faith in me has been to my ongoing recovery. The second? A recognition that despite my darkest thoughts and feelings, I am worthy.
First Level Actions: The Seemingly Simplest Steps
- RELAX!
- BREATHE
These initial interventions - relax and breathe - sound so easy but they're often the first things I forget about and they can be incredibly difficult to do. I forget them because they're so obvious and I, like many others, overlook the obvious.
We know that many affects of mental illness are visible. They can cause the body to tense up, cause your breathing to become shallow, and increase the heart rate. Through taking deliberate action to relax and breathe, I allow my body to open itself, breathe deeper, and slow my heart rate.
This breathing is controlled and focused. One method that I often turn to is box breathing: a simple in 2-3-4, hold 2-3-4, out 2-3-4, hold 2-3-4, repeat. To focus on this pattern, I have to pull my mind away from the cause of distress.
An alternative breathing technique I employ is 4-7-8 breathing. This involves breathing in for a count of four, holding for a count of seven, and exhaling for a count of eight. It takes practice to get to this level, so you might want to consider shorter hold and exhale counts. I find that I have to really concentrate on the holding of the breath, the exhaling, and the counting. This degree of concentration often pushes out of my mind the thoughts and emotions causing me the discomfort.
The aim of these simple interventions is to create a pause, both physical and mental. That pause begins the process of separating me from my distress allowing me to view the distress with a new perspective, one that is less responsive and is moving to proactivity.
Second Level Actions: Passive and Active Coping
DISTRACT: APPLY your coping skills or activities:
Practice passive coping:
- Listen to music
- Watch TV
- Bathe
- Sleep
- Listen to an audiobook
- Listen to a guided meditation
Practice active coping:
- Colour
- Paint
- Read
- Write
- Eat
- Go for a walk
- Go out for a coffee
- Monitor sleep: complete sleep diary entries
- Monitor spending: update budget
- Track moods: complete mood diary entries
- More intensive mindfulness practices (mindful walking, body scan meditation, etc)
Third Level Actions: More Intensive Active Coping
If Second Level Distraction fails to arrest the thoughts and emotions I turn to more intensive active coping tools.
The first of these is my CALMtainer. It's a large basket that contains a variety of objects designed to engage as many of my senses as possible. For example I have a fidget cube that loudly clicks, has uneven surfaces, and a variety of moving parts. In it you will also find scented candles, adult colouring books and markers, and the Buddhist prayer mala I made for myself. It includes the Form 42 given to me when I was Form 1'd. It's a reminder of where I once was and how far I have grown since then. It's also a reminder that I can be there again if I'm not diligent or vigilant with my ongoing mental health and wellbeing. Finally, it includes objects that bring warm memories: a photograph of my son and another of my granda (my grandfather).
I know someone who used golf balls, golf tees, trophies, etc, in his CALMtainer because the golf course was his happy place. Someone else I know has threads and patches of fabric in hers because she loves to quilt. The only limit to what to include in your CALMtainer is your imagination.
I call this tool CALMtainer because it instills calm in me.
The second of these tools is my Portable CALMtainer - my smartphone. Unlike my CALMtainer, my smartphone accompanies me wherever I go. Consequently I've done what I can to transform it into a tool to better my ongoing mental health - a Portable CALMtainer if you will.
In it apps are used that allow me to track my moods, sleep, and budget. The app I use for mood and sleep tracking is also used as a daily diary, gratitude journal, and keeper of my lists of successes. There's an app I can use to guide my breathing. In addition, there are audiobooks, meditations, photos, and sounds, all of which have been added to help me shift my thoughts and emotions, and all of which are with me should the need arise.
In future posts I'll revisit both my CALMtainer and my Portable CALMtainer and give more information about each.
The third tool is my mental health notes that can be found in three primary binders plus a few notebooks and notepads. The first binder contains all of the handouts given to me when I participated in an Out-Patient Day Treatment program in 2016, the second gathering the handouts from an Out-Patient Day Treatment program in 2019, and the third containing the handouts from talk therapy I received in 2020. These handouts include Cognitive Behavioural Therapy (CBT) and Dialectical Behaviour Therapy (DBT) forms and exercises, mindfulness exercises, general information, and so much more. There's always something in them that can help me.
More intense active coping:
- Use CALMtainer (Wellness Toolbox)
- If not at home, use Portable CALMtainer (smartphone)
- Review Mental Health notes (Out-Patient Day Treatment notes) (esp. Distress Tolerance modules and notes)
Fourth Level Actions
If the thoughts and emotions are stubborn and are becoming increasingly overwhelming, I reach out. I start with a friend and then escalate to whom I reach out in stages. Each stage is a reflection both of my thoughts and emotions and the type of service I can expect to receive. They are tried in turn, or I may jump directly to that service that I believe would be most immediately beneficial.
Please note that the services I use are local to me in Ontario, Canada.
REACH OUT! Call:
- a trusted friend
- Durham Mental Health Service Crisis Access Linkage Line (C.A.L.L.): 1-800-742-1890 (in crisis and need immediate support)
- Ontario Shores Crisis Line:: Call 1-800-263-2679
- 988.ca: Call or Text 9-8-8
- Kids Help Phone: Call 1-800-668-6868, Text 686868, or visit https://kidshelpphone.ca/
- 211 Ontario Helpline: Call 211
- Mental Health Service Information Ontario: Call 1-866-531-2600
FOR YOUR OWN SAFETY REMOVE FROM VIEW ANY ITEMS THAT MAY CAUSE SELF-HARM.
If these services are unable to ease my distress I turn to the next step.
The Final Step
IF I AM UNABLE TO COPE AND FEEL I AM AT HIGH RISK OF SELF-HARM
- GET TO THE HOSPITAL
- CALL 9-1-1
Personal Information
On the back of My Self-Care Plan, I keep basic personal information including: the name and number of my emergency contact AND my next of kin; the name and number of my psychiatrist; the name and number of my doctor or nurse practitioner; the name and number of my case manager; and my OHIP number.
The idea is to have all of this information accessible to me so that I don't have to rely on my memory or go looking for the information when I need it.
Final Thoughts
While this might seem complex, My Self-Care Plan fits on a single sheet of paper. I did this deliberately to counter the weight of being overwhelmed. When I'm overwhelmed, the last thing I need is a complex and convoluted plan.
My Self-Care Plan isn't perfect. That's why it undergoes constant updating. Moreover, while the structure of my plan works me it may not work for you. My hope, though, is that this will give you some ideas on how to create the Plan that best suits your needs.
Here are some ideas for other things you might want to add to your Plan:
- you may find it helpful to identify your mood, behaviours that you associate with the mood, and triggers that may worsen it
- if you have children or pets, you may want to add a section providing for their care
- if you have a history of risk or self-harm you may want to include it together with a note on what's helped to alleviate this risk
Thank you for taking the time to read this lengthy post. I encourage you to create your own self-care plan using a title that is meaningful to you. I hope that you've found my thoughts to be beneficial to you.
If you are in Canada and you are having trouble in designing your own personal plan, the apps Hope by CAMH, Be Safe by mindyourmind, and my tools from suicide.ca, are excellent resources to get you started. They all include include additional Canadian resources for you to use, and they are all available on the Play Store and the App Store.
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