What to Do If You Have an Ongoing Psychiatric Crisis + Planning Ahead – Bipolar Burble Blog

MEEFRO March 28, 2023

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In an ongoing psychiatric crisis, you’re in extreme distress, but your life is not on the line. It’s not an acute psychiatric emergency. (For information on acute psychiatric emergencies, please see here.) While an acute psychiatric emergency almost always requires a stay in a treatment facility, an ongoing psychiatric crisis doesn’t necessarily. The idea here is to get help as soon as possible to prevent the crisis from becoming an acute psychiatric emergency that does require hospitalization. You also want to think about planning ahead for psychiatric crises/emergencies.

Considerations During an Ongoing Psychiatric Crisis

Consider these things to do if you’re having an ongoing psychiatric crisis:

Call your prescribing practitioner (assumed to be a psychiatrist here) immediately. Make sure you make it clear that you’re in a crisis and that you need a call back as soon as possible. This call is not just a question for them; this is a required, critical intervention. Don’t beat around the bush with what you need.
When you contact your psychiatrist, don’t hesitate to ask for an emergency number or ask them to be paged. That is what those options are there for.
If you can’t get a hold of your psychiatrist, find out if another doctor is covering for them. Again, you need timely help no matter what.
You can also contact your general practitioner (GP). If your psychiatrist isn’t calling you back, get your GP to talk to them. A doctor’s request may trump yours (unfortunately).
Contact your therapist. In an ongoing psychiatric crisis, a psychotherapist might be the best person to pull you back.
When you talk to a doctor or therapist, don’t hold back. Make sure and be 100% honest about what is happening to you. Again, use the word “crisis.”
When you talk to a doctor or therapist, make sure you make a plan for how to handle your ongoing psychiatric crisis, including what to do if things don’t improve.
Think about when you can and cannot go to work or school. Also, consider how you will communicate this information to your workplace or school.
Get yourself to a safe place. While you may not be in acute danger now, things can change. Make sure you’re in a safe place with safe people.
Call 9-8-8 if you need to. Remember, while waiting for your psychiatrist to return your call, you can reach out to others.
Call one or more loved ones for help. They can help by staying with you, making calls for you, picking up medications for you, cooking for you, and so on. They can be critical supports during this time.

And if things get too bad while you’re waiting, then start to consider what’s happening in an acute psychiatric emergency and think about these steps instead.

You Should Plan for a Psychiatric Crisis/Emergency

As I said earlier, most of us with a serious mental illness have had a psychiatric crisis or emergency — some of us have had many. And while you might not want to believe that and while you might not want to think about that, the time to deal with a psychiatric crisis emergency is actually before it happens. When you plan ahead, your outcome in the moment will be much better.

Before a psychiatric crisis/emergency, think about the following:

What are all your medications? Write down all your medications (including over-the-counter) and their dosages. Keep this in a convenient location so you can communicate this information or take it with you if needed.
What does a psychiatric emergency or crisis look like for you? What kind of symptoms indicate that a crisis is brewing? What can other people watch for to indicate a psychiatric crisis or emergency? Are there different kinds of psychiatric crises/emergencies for you?
Have you ever experienced anosognosia? Anosognosia is a clinical lack of insight wherein the sufferer believes they are not sick. If you have ever experienced this, make a plan for what you want others to do if it happens again.
What is the difference between a psychiatric crisis and an emergency to you? When do you need a call from a psychiatrist as opposed to a trip to the emergency room? How can other people tell which of those you are having?
What steps do you want to be taken in the event of a psychiatric crisis? Who should be called? What else should be done? Where should you ride it out? With whom? How will you communicate your needs? Put the numbers you need to know in a safe, easy-to-access place so you’re not searching for them in a crisis.
What needs to be taken care of if you need a stay in a treatment facility? Think about your pets, plants, who will alert your job, etc. What do you need to take with you for a hospitalization?
Do you have a psychiatric advanced directive in place (more on this in a moment)? Have you communicated this advanced directive to everyone involved? Is there a paper copy of it somewhere that is easily accessible?

What you’re doing when planning for a psychiatric crisis or emergency is considering all the ramifications of an event like this. You’re preparing for what some might say is inevitable. Making all these decisions ahead of time and getting the materials together ahead of time means that you have less to do when your brain isn’t working well. This will improve your outcome and is much more likely to get you what you really need.

More Planning for Psychiatric Crises — An Psychiatric Advanced Directive

A couple of commenters on the last post specifically mentioned psychiatric advanced directives. This type of advanced directive communicates your wishes in the event that you can’t communicate them at the time (because you are experiencing psychosis, for example). Psychiatric advanced directives are legal documents, which means their rules vary by state, and you should have a legal professional help you draft one. See here for state-by-state information.

Things to put in a psychiatric advanced directive include:

The hospital/facility to which you want to be taken
The treatments you do and do not want
Your healthcare proxy

Keep in mind that while it’s critical to communicate your desires, a psychiatric advanced directive can be overridden at times if it’s in your best interest. Much more information about psychiatric advanced directives can be found here.