Mental Health & Wellbeing

Advance Crisis Planning

I wanted to write a little bit about advance crisis planning: what it is, who it’s useful for, how to do your own.

I’d like to clarify some terms that appear in this post or might be useful otherwise:

  • Capacity: having capacity means an individual is able to make decisions for themselves and about themselves. Lacking capacity means that an individual is unable to make decisions for themselves at that particular time due to a disturbance in the brain’s function. 
  • Mental Capacity Act (2005): a piece of legislation that protects individuals who lack capacity, and involves them in the planning of their own care as much as possible.  
  • Independent Mental Health Advocate: an advocate is someone who is nominated to listen and to support an individual to make their views and their decisions known. An advocate can support with exercising rights, raising concerns or complaints, requesting reviews, supporting at meetings, etc. relating to an individual’s treatment and care.
  • Representative: someone an individual elects to speak on their behalf to support and communicate for them if necessary to do so. A representative is usually a family member. 

Advance crisis planning is anything that sets out to prevent and manage a crisis individually: a plan centred around you, what works for you, your preferences, decisions to refuse treatment, etc. It’s something that usually involves family members or close friends, and mental health professionals. 

When I came out of hospital in August last year, I started down the long road to recovery. I wasn’t given much by way of information on how to manage immediate crises in my discharge meeting, but was sent on my way. Knowing myself and my safety risks, I argued with the psychiatrist leading the meeting to have medication that I can take or be given in an emergency to keep me safe. I won the argument (surprise, surprise), but I’m pleased to say that it still sits in my medicine cupboard, untouched.

One of the biggest anxieties I had about leaving hospital was not having a plan in place to both prevent and manage a crisis. I was discharged to the Acute Day Service (ADU), an outpatient program at the hospital with classes and groups that promote positive mental health and wellbeing, and also to the Crisis Team, who do regular home visits to people in crisis and in their immediate recovery from crisis. I was then assigned to a care coordinator and then the ADU discharged me back to my Community Mental Health Team (CMHT). All in all, my transition from inpatient hospital treatment, to outpatient, to community care was smooth.

But as I recovered, I became more aware of the need to plan to minimise the risk of ending up in crisis and to then make sure I communicated my thoughts and feelings about treatment, in case I ever lost capacity or was in a situation that meant I couldn’t easily communicate decisions and preferences.

I did some research, spoke to my care coordinator and found information that enabled me to plan and write a crisis plan which included Advanced Statements and Advanced Decisions.

Crisis Planning

Writing a crisis plan is relatively straightforward, but it’s important to take time over it. It isn’t something set in stone, so it can be adjusted at any time in order to keep it up-to-date with your current circumstances and preferences. You can include anything you think would be helpful in your crisis plan. You might want to write it alone, with a family member or with a mental health professional – if you write it alone, you might find it helpful to ask someone close to you to read it over.

It’s important to make sure your crisis plan is communicated once you’ve written it, which would usually mean sharing it with at least one family member who agrees to take responsibility for sharing it with healthcare professionals if it’s ever needed. It can then also be shared with people who you (and they) feel would benefit from having it.

A crisis plan can include:

  • Basic personal information:
    • name
    • date of birth
    • emergency contact details
    • contact details for anyone else you would like to be contacted in a crisis
  • Medical information:
    • diagnoses
    • medications
    • GP contact details
    • mental health team contact details
  • Warning signs of a crisis: a list of things to look out for that might be signs that you’re becoming unwell
  • Information about what to do in a crisis:
    • any ‘as required’ medications that can be taken (including dose, when to take, etc.)
    • who to call and in what circumstances (e.g. call GP or Community Mental Health Team with general concerns, call mental health lines if out of hours, call 999 if immediate danger, etc.)
    • Crisis Team details, if under a Crisis Team
    • numbers for out of hours helplines
  • Attach information relating to:
    • Advance Statements
    • Advance Decisions

Advance Statements

  • These are pre-communicated wishes relating to care when you are unwell and not able to communicate these easily.
  • Advance Statements are not legally binding – they are just a communication ahead of time regarding your own preferences relating to your care and treatment, which can include where you would like to be treated if you need to go into hospital.

Advance Decisions

  • Also known as an Advance Decisions to Refuse Treatment (ADRT).
  • These are decisions made to refuse specific medical and care treatment in advance, in case you aren’t able to communicate these yourself if you become unwell and lack capacity.
  • Advance Decisions must be written down, signed by you and signed by a witness.
  • Advance Decisions are legally binding as long as they are valid, relevant and comply with the Mental Capacity Act (2005).

Advance crisis planning doesn’t need to be complicated. It can include any or all of these things, or any number of things that I haven’t written about here. It can be a simple written statement and you can take your time over writing it.

I’d really encourage you to think about writing an advance crisis plan and to make sure it’s something you do when you’re well. Support is so important. It’s helpful (to both us and to them) for the people around us to know what to look out for and how to act in a crisis. Laying it out clearly means your preferences are communicated and can be taken into account when it’s most important.

I hope the information in this post is helpful to you or can be passed on.

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