Relapse and rehospitalization are, unfortunately, common in serious mental illnesses such as bipolar disorder and schizophrenia, especially among patients who don’t recognize they are ill (a condition known as anosognosia).
When a loved one is in an active psychiatric crisis, it can be hard to think clearly and quickly. Always having emergency contacts, personal data, prescription information and legal paperwork collected in a single source, at your fingertips, will make it faster and easier for you to respond effectively if a crisis develops. If your loved one is in a crisis, your goal in an emergency is to stabilize the situation and get the person to professional help as quickly as possible.
Crisis Plan
Make a list of items you may need for an emergency; what are the crisis essentials? Things like:
The person’s name, age, physical description
The person’s current location/living situation
Whether the person has access to a weapon
Mental health history, diagnosis(es)
Psychiatrist, therapists, primary care physician
Medications, current/discontinued
Suicide attempts, current threats
Prior violence, current threats
Drug use
Contributing factors (i.e. current stressors)
What has helped in the past
Clothing, material items, etc. that may help de-escalate
Any delusions, hallucinations, loss of touch with reality, other common symptoms
You can include all these things in a Crisis Plan. Here are a few that may be helpful. Choose one that works best for you:
Mental Health Recovery Crisis Plan (WRAP)
Crisis Plan by the State of Maine
Mental Health America Crisis Plan
Whether you keep your kit in a paper or digital file – or maybe both – be sure to review and update the information regularly (e.g., after a change in providers, diagnosis, prescriptions, address). Give a copy to anyone who might have to act if you are unavailable (e.g., other adult children, your siblings). Keep the information near you at all times (e.g., scanned onto your mobile devices, stored on a flash drive in the glove compartment of your car, organized in a file in your desk at the office).
It can also be helpful to enlist a stable and reliable third party in advance who is willing to back you up in an emergency by joining you on the scene, staying home with your children or providing other support you need in order to focus on getting help for your loved one.
Other Ways to Prepare
Knowing the laws in your state;
Knowing the procedures at the local emergency room or other facility where your loved one is likely to be taken by police or paramedics in an emergency and providing them with any forms or information that can be kept on file (e.g., an advance directive, a signed release for medical information);
Identifying diversion options where your loved one lives (e.g., a hospital “safe room” where individuals in crisis can voluntarily shelter, a sub-acute group home that takes voluntary admissions, the local police department’s mobile crisis team); and
Networking with other families through the local affiliate of the National Alliance on Mental Illness (NAMI).
View NAMI SW WA Family Support Groups.
If you are worried about a loved one, but there appears to be no immediate danger, alerting the person’s psychiatrist, caseworker, ACT team or other mental health professional can lead to help before crisis occurs and emergency intervention becomes necessary.
Learn more about Navigating a Mental Health Crisis.
Mental Health Advanced Directive
A mental health advance directive is a legal written document that describes what you want to happen if your mental health problems become so severe that you need help from others. This might be when your judgment is impaired and/or you are unable to communicate effectively.
It can inform others about what treatment you want or don’t want, and it can identify a person to whom you have given the authority to make decisions on your behalf.
For more information, please read the advance directives information for consumers pamphlet.
Where can I get a form?
Download and complete a mental health advance directive form. Your mental health provider may also have copies of the form.
Who should get my completed form?
If you name an agent to represent you, you must give them a copy. You may also want to give copies to your current mental health care providers, your lawyer, or trusted family members.
Read more about the WA laws surrounding Advanced Directives. RCW 71.32.
Other Options
Guardianship and Power of Attorney may be other ways to help prepare for a crisis. Learn more on our Guardianship page.
Durable Power of Attorney
More than just mental health
A power of attorney is a document through which a person (the individual) gives someone else (attorney, family member, etc.) legal authority to act for the person (the individual). A durable power of attorney includes language indicating that the power will continue even if the principal becomes disabled or incapacitated in the future. If the document lacks this kind of language, the power of attorney is not “durable,” and it terminates if the principal becomes incapacitated.
The language used in the power of attorney document determines the extent of the agent’s powers. The document may give powers over financial affairs, health care, or both. Financial powers may be narrow or broad.
A durable power of attorney may be written to take effect immediately or to take effect only when the person becomes incapacitated. The latter type of power of attorney is called a springing durable power of attorney. These powers of attorney should include language describing how incapacity will be determined.
Durable powers of attorney have many advantages. They are relatively simple and inexpensive to arrange compared to trusts or guardianships. The agent under the power of attorney is a fiduciary, meaning legally required to manage the principal’s assets in the interest of the principal.
Powers of attorney can be abused. A potential disadvantage of powers of attorney compared with guardianships is the lack of a protective oversight system. (Guardians, by contrast, must report periodically to the court). Professional guardians are certified and regulated by a board through the state’s court system. Problems with powers of attorney, such as failure to provide an accounting can be addressed in legal proceedings under state law. When a power of attorney is abused or mismanaged, however, losses may be difficult or impossible to recover.
For more information go to the website www.washingtonlawhelp.org, select Aging/Elder Law and then Guardianships and Powers of Attorney.
Where can I get a form?
Download and complete a durable power of attorney form. Your mental health provider or attorney may also have copies or their own form.