The importance of crisis planning

Modern life can throw unexpected curveballs our way. The COVID-19 pandemic that lasted several years, along with political unrest, has left many feeling anxious or depressed.

One of the best ways to deal with stressful events is by having a mental health crisis plan ready beforehand, according to Cape Cod Hospital social worker Brooke Hall, MSW, LCSW. She has been facilitating group therapy sessions about the importance of crisis planning in both the outpatient and inpatient psychiatric programs at the hospital.

Hall says it is her favorite group therapy topic because she has seen how much it helps her patients.

“Any population of patient can do this and it’s just really crucial,” she said. “It’s really important to do it when you are not in a crisis situation to kind of pre-plan for a crisis. Having a group to do it in is beneficial because you can get ideas from people and make it realistic for yourself. It can be really helpful because when we’re in a crisis a lot of us tend to have impaired thinking, which can lead to illogical thinking and sometimes panic.”

To facilitate the group, Hall hands out a template with different sections to fill out. After she gives patients some time to fill out the template, they come together as a group and bounce ideas off of each other. One of the most important parts of the crisis plan is to identify the community resources that are available to those in crisis.

“There’s not a lot of advertisements,” she said. “Unless you are working in mental health and doing it every day, you really don’t know about the resources.”

Community Resources

Resources Hall gives her patients include:

• The 988 Suicide and Crisis Hotline number. People who are having suicidal thoughts or are having any type of mental health crisis can call or text 988 and get help 24 hours a day. Anyone who is suffering from mental health struggles, emotional distress, and alcohol or drug problems can find a caring counselor to talk with them.
• Bay Cove Behavioral Health and Wellness Center in Hyannis offers mental health crisis intervention 24 hours a day, seven days a week. A counselor will meet in person or over the phone to assess your crisis and refer you to services that can help with your individual situation.
• The Massachusetts Department of Mental Health offers resources to help people apply for services like housing, case management, job applications and other helpful community organizations.
• Hyannis Recovery Connection Center offers peer support with both psychoeducational groups and non-psychoeducational groups like art and music groups to help people improve their social supports.
• Cape Cod Healthcare’s Adult Partial Hospital Program offers a short-term outpatient group treatment program to individuals with psychiatric conditions who would benefit from additional support and structure during the day. This program offers group therapy and case management to manage the specific needs and requests of the patients. It can also serve as a transition following psychiatric inpatient hospitalization for those who no longer require 24-hour supervision.

“The Partial Hospitalization Program is a great resource to have in your crisis plan,” Hall said. “You can meet with a case manager one-on-one and once you are already an established patient there, you could always come back and self-refer and there’s never a limit on how many times you can come so it’s a great resource to have.”

A lot of patients who come in are experiencing worsening anxiety and depression. Both of those diagnoses are a good fit for the Partial Hospital Program because Hall does suicide safety planning, which is part of the crisis planning. She asks patients questions like, “You’re safe to go home right now, but what about later? If you are not safe, what are you going to do? What steps are you going to take?”

It's really important for patients to identify who their support people are. It can be family members, friends, resources in the community, churches and senior centers. Alcoholics Anonymous and Narcotics Anonymous can also be a support, even if you don’t have any substance abuse issues, Hall said.

Once you have identified your support, then think about what kind of help you are looking for from them. Some people want someone to give them advice but also let them come to their own solution. Others want their support person to guide them through and help with decision making. Knowing what you want or need ahead of time leads to better communication with your supports, Hall said.

Identify Triggers

Another component of crisis planning is helping patients identify their triggers and things that make them feel uncomfortable. Hall asks them to write down their early warning signs like headaches, stomach aches, sweaty palms and becoming restless or fidgety.

“If you are about to go into a crisis in the future, knowing and picking up on those warning signs can help you make a plan before you experience a crisis,” Hall said. “It’s important to identify some coping skills or distractions that you can do before you’re in crisis or while you’re in crisis. Preplanning some things you can do, like self-care or turning on a favorite movie, is really helpful.”

If the plan is written out in steps, it’s easy to look at it and follow through. It’s not really practical for people to carry around a piece of paper everywhere they go, so Hall recommends writing down your steps in the Notes app on your phone. There are also apps specifically for crisis planning like Safety Plan, Suicide Safety Plan and WRAP.

“Those are great resources,” she said. “Making it accessible is really, really vital, because a lot of times we’re not really experiencing a crisis at home.”

You don’t need to be experiencing a mental health crisis to benefit from crisis planning. Hall thinks it’s a good idea for everyone to do it. It doesn’t have to be fancy, and you can even do it in your own home.

“Even if you don’t experience crisis a lot, that’s okay because mental health is never linear, so having this plan is important no matter what,” she said. “Having something planned even if you never need it is okay. It doesn’t hurt anything.”