Medically reviewed by Melissa Shepard, MD
*Trigger warning – suicidal thoughts, self-harm*
Driving up 85 North, I often pass billboards with this message: “Don’t Wait, Make a Plan” usually accompanied by a gigantic image of a basement being flooded, or a mother hugging her child.
These roadside billboards aim to prepare us for crises like floods, hurricanes, tornadoes, and other natural disasters out of our control. I have lived through my fair share of crises, but one thing I was not prepared for was my mental health crisis.
As I sat on my hardwood floor in my home office, on the phone with a crisis line volunteer, I started laughing through snot and tears at the absurdity of the situation. I felt so completely shocked by the terror, sadness, and chaos consuming my mind and body. I was, to say the least, unprepared.
Unfortunately, mental health crises can be hard to predict. Unlike the windstorms that arise over the ocean, no rating system helps us rate our mental health struggle from Tropical Depression to Category 5. Even if you have experienced one before, your next mental health crisis could look very different. But there are some clues that might tell you it’s time to enact your crisis plan:
Sleep: you sleep way more or way less than usual and often feel fatigued/weak.
Routines: you find it increasingly difficult to do activities and tasks that are usually easy for you, such as going to work, cooking dinner, maintaining personal hygiene, or even getting out of bed.
Withdrawal: you stay in more, ignore texts/calls from loved ones, cancel/turn down social activities.
Substance use: you start using alcohol/drugs more frequently or in higher quantities than usual, often alone.
Hopelessness: you think, “it’s hopeless, I’m never going to be enough” or “I can’t get anything right, I might as well not try.” You feel like you can’t find meaning in your life. You start to think about death or suicide.
If none of these apply, that doesn’t mean you are not in crisis. Ultimately if you feel overwhelmed and think you are in crisis, trust your gut.
So, now that you know what to look for start to think about your crisis plan. It is important to note that this plan should be made and practiced before you’re in crisis. As ready.gov says, “The best time to prepare for any disaster is before it happens.” Think about it like you think about the tornado drills you did in elementary school: your teacher instructed you to duck under your desk with no sign of a tornado on the horizon, rather than as it was touching down on the playground.
Images from Shutterstock
As you read the following steps, consider jotting them down in an accessible place. Even if you can’t reach for them in your crisis, writing them down will help solidify the plan.
Pick a “safe person” in your life who you trust with your mental illness: it may be a parent, friend, colleague, teacher or boss… anyone counts as long as they will be there for you when you ask. Let them know they’re your crisis contact: call them, text them, write them a letter, it doesn’t matter! Here’s how you can broach the subject if you don’t know where to start:
“Hey, so you know how I’ve been struggling lately? Well, I decided I should probably come up with a crisis plan, just in case I can’t be alone. Would it be alright if I called to talk to you if I ever reach that point?”
“I read that it’s good to have a contact for when I have thoughts of self-harm like I did the other day/week. Would you be willing to talk to me and help me get care if that happens again?”
“Hey, in case I start having suicidal thoughts, could we come up with a safe word that would mean I need help immediately?”
Your safe person might be enough support for you but if you feel like you need more professional help or if you can’t designate a safe person there are numerous resources in the United States for people in crisis:
Emergency Medical Services: 911
24/7 National Suicide Prevention Lifeline: 1-800-273-TALK (8255) or Live Online Chat
SAMHSA Treatment Referral Helpline, 1-877-SAMHSA7 (1-877-726-4727)
Veterans Crisis Line – Call: 1-800-273-8255, text: 838255, chat online
National Graduate Student Crisis Line: 1-800-472-3457
Teenline (open nightly from 6-9pm PST, 9pm-12am EST) Call: 800-852-8336, text TEEN to 839863
TrevorLifeline: 1-866-488-7386, TrevorText: text START to 678-678
Remember, you can use this step at any point.
Look around your space and try to identify things that could be contributing to your distress. Focus on the most crucial things first, like finding a place where you feel safe, connecting with (or removing yourself from) people, and distancing yourself from objects or substances that you could use to harm yourself. Then you can start addressing things like the temperature of the room, hunger or thirst, lighting, and sound.
Scanning your environment can also be a helpful grounding exercise (see #6 for more details).
Dehydration has been linked with increased depression, fatigue, tension and confusion. Water may not be an instant cure for your mental health crisis, but it will be crucial in facilitating your recovery. If you don’t like water you can try drinking seltzer water, sugar-free flavored waters, or water infused with fruits like lemons or berries. Pour yourself a cold glass of water and drink it as slowly or as quickly as you want. Keep refilling it every time you finish the glass. The act of drinking water can be calming as a grounding technique (see below for more) and can be a simple act of self-care.
Often when I reach a low point, I simply don’t know what to do with my body. Rather than sit idly and let your mind wander, think of an activity or that is generally calming or soothing. Mine are:
A hot shower with my favorite Spotify playlist on in the background
Watching my favorite episode of New Girl
Going for a walk around my block with my dog
Try to think of something engaging – but not difficult – that will help your mind and body reset. Make sure your safe person knows what your safe activities are when you first contact them so that they can help remind you during a mental health crisis.
Grounding techniques are meant to take you out of your mind and help you reconnect with your surroundings and feel safe. This step is especially important if you are experiencing physical sensations or symptoms that are out of the ordinary for you, such as chest tightness, uncontrollable crying, heavy or fast breathing, or irregular heartbeat. The 54321 Technique is one of the easiest ones to remember, but there are many to choose from (we’ll be publishing a list soon – stay tuned!) If you want more options, do a quick Google search for “Grounding techniques” and jot your favorite one down to give to your safe person.
Most of the time our mental health providers are unable to provide immediate relief in crisis situations, however, they will want to know what’s going on with you. Write an email, call, message, or text your mental health provider to let them know what happened and ask if you can set up a visit with them. You might even consider pre-writing a note on your phone in preparation. Here are some examples:
“Good afternoon – could I schedule some time with you this week? I had a really bad moment today that I think I need to process with you.”
“Hi – I’m not doing well. Do you have any time in your schedule tomorrow for a visit? If not, do you have time for a 10-minute phone call, and then a visit later in the week or next week?”
“Hello – I experienced a mental breakdown/crisis this afternoon and although I’m safe, I’m feeling really low. I’d love to get on your schedule ASAP.”
This is one of the hardest things for me in general (mental health crisis notwithstanding) but it can be incredibly helpful when your thoughts are all over the place. Once you have completed steps 1-7, sit down with a journal, notebook, computer, phone, or the back of a Target receipt and write. You can write anything, but here are a few places to start if you’re stumped:
Write down what you’re feeling, then below it, write down what’s making you feel this way. If you are having trouble identifying your specific feelings, try looking through a Feelings Wheel like this one.
Make a list of three things you’re grateful for and three things you would like to let go of.
Describe yourself physically, using objective language: “I have blue eyes,” “I am five foot seven,” etc. Once you have finished your physical description, start writing about your personality. Keep it simple, and make sure you only write things you like about yourself: “I am a good friend,” “I am a hard worker,” “I take care of my family.”
You may feel very fragile after coming down from a mental health crisis. Do your best to relax and give yourself some extra compassion for the next 12-24 hours. Empower the people in your life (spouse, parents, colleagues, friends) to help you. Remember, mental illness is exactly that: an illness. Treat this like being sick, and take care of yourself accordingly. Put your feet up, make a cup of tea, and binge-watch reality TV (no thoughts, empty head, just Love Island.)
Just like no hurricane looks the exact same hovering above the Atlantic, no mental health crisis looks the same. Your mental health crisis plan will be just as unique. You can use the steps above as a blueprint to start to formulate your plan, and don’t be afraid to change it up if something doesn’t work for you!
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