Many people with serious mental health conditions will face a crisis at some point. These crises can be overwhelming, but creating a crisis plan ahead of time can make a huge difference. A crisis plan can help reduce the uncertainty and anxiety created by these situations. It can also build trust and partnership between caregivers and loved ones, making it more likely loved ones will seek help.

A crisis plan is best developed when the person is feeling stable and thinking clearly. Having these discussions ahead of a crisis increases the opportunity for everyone to have their voice heard and have a say in the plan. Here’s what to consider when making your crisis plan:

Privacy and Permission. Privacy is essential. If you’re a caregiver, talk with your loved one about how you can be involved in their care. For example, they might give you permission to speak with their doctor or therapist. These conversations should happen early; people are more likely to give permission when they’re feeling well. Be clear about boundaries and respectful of your loved one’s wishes. For instance, you might agree that you’ll only talk to your loved one’s healthcare provider in their presence unless they give permission otherwise.

Defining the Caregiver’s Role. Ask your loved one how you can help during a crisis. You might suggest ways you could support them, but let them decide what they want. This approach helps them feel in control and respected, and it gives you a clear understanding of what’s helpful and what isn’t.

Impaired Judgment and Safety. During a crisis, some people experience impaired judgment and may not realize how sick they are. Talk openly about what this might look like for your loved one. Work together to decide ahead of time what actions you’ll take if this happens—like going to the hospital or calling a crisis line. Agreeing on these steps when you and your loved one are calm can prevent conflict and confusion later.

Identifying and Managing Triggers. Triggers are situations, environments, or people that make symptoms worse. As a caregiver, you can help your loved one avoid or limit these triggers. For example, you might help out with chores when they’re feeling overwhelmed or help them avoid people who cause them stress. Triggers can’t always be avoided but knowing what they are can help reduce how often they happen or how negatively they impact your loved one.

Recognizing Early Warning Signs. Everyone has unique early warning signs that they may be experiencing emotional stress. These could include trouble sleeping, withdrawing from others, or feeling unusually anxious or irritable. Work together with your loved one to identify these early signs and make a list of these indicators with them.

What to Do During Early Signs of Crisis. Talk with your loved one about what they want you to do if you see early warning signs. Some people worry that caregivers might overreact or make them feel worse. Having an honest conversation about what helps—and what doesn’t—can build trust and make sure your actions are supportive. You want to raise concerns with your loved one about potential warning signs in a way that feels supportive, not confrontational.

Understanding Lack of Insight (Anosognosia). Some people with mental illness may not realize they’re unwell, even when they’re in crisis. This is called anosognosia. It’s not stubbornness; it’s part of the illness itself. Good communication is key. Many people find the LEAP technique helpful: Listen, Empathize, Agree, and Partner. This approach can help you find common ground and work together more effectively with your loved one (Amador, 2022).

Exploring Coping Strategies. Coping strategies can help your loved one manage stress and early symptoms. These could include deep breathing, journaling, mindfulness, or exercise. Explore different strategies together and figure out what works best for them. Remember that sometimes not doing something—like not arguing or not pushing too hard—can be just as helpful as taking action.

Working with the Treatment Team. Make sure you know how to reach your loved one’s treatment team, even outside regular office hours. If your loved one has a therapist, psychiatrist, or case manager, include them in your crisis plan. Sometimes a medication change or extra support from a professional can help prevent a full-blown crisis.

Decision-Making and Who Will Speak for Them. In some crises, your loved one might not be able to make decisions for themselves. Ask them ahead of time who they want to make decisions if they can’t. It might be you, or it might be someone else they trust. It’s important to respect their choice: Knowing who will step in can bring peace of mind for everyone.

Knowing Treatment Preferences. Ask your loved one about their preferences for crisis care. Do they have a preferred hospital or treatment center? Are there medications they’ve had bad experiences with in the past? What kind of support do they feel most comfortable with? When people feel their preferences are honored, they’re often more willing to seek help when they need it.

Addressing Practical Concerns. For many people, practical worries can stop them from seeking help. They might worry about their pets, plants, or household responsibilities. Talk openly about these concerns and make a plan for how you’ll handle them during a crisis. This reassurance can reduce anxiety and help them feel safer seeking care.

Emergency Contacts and Crisis Resources. Make sure you both know who to call in a crisis. This might include trusted family or friends, a mobile crisis team, or a crisis hotline like 988. Having a clear list of resources can help you act quickly and confidently if things escalate.

Understanding Crisis Treatment Options. It helps to know what treatment options exist if a crisis does happen. These include:

• Peer respites: Voluntary residential programs that provide a safe and supportive space.
• Outpatient or partial hospitalization programs: Programs that offer intensive care while the person lives at home.
• Voluntary hospitalization: Staying in the hospital willingly for treatment.
• Involuntary hospitalization: Being hospitalized when someone is at risk of harming themselves or others. Voluntary hospitalization is usually preferred, as it’s less traumatic.

Knowing these options ahead of time can help you feel more prepared and make decisions that feel right.

Creating a Formal Crisis Plan

Consider putting all this information into a written document called a psychiatric advance directive. This is a legal document that lays out your loved one’s preferences for treatment, who can speak for them, and how they want to be supported. It can be incredibly empowering to see their wishes respected in such a formal way. You can find resources for creating a psychiatric advance directive through the National Resource Center on Psychiatric Advance Directives (NRC PAD).

Conclusion

A crisis plan is a powerful tool for caregivers and people with lived experience. It shows that you’re working together and that everyone’s voice matters. Crises can be scary, but with a plan in place, you can face them with more confidence, compassion, and understanding.