Expert chat: Crisis plans

Sam: What is a crisis plan?

Kat: Quite often when you use NHS mental health services you will have what is known as a care plan. This is a document that you write with your therapist or doctor that sets out things like: What to expect from treatment, who to contact in an emergency and also contains a part called a crisis plan. When professionals talk about a crisis, they mean a situation where you need urgent help. This may be because you feel suicidal, out of control or experience really bad anxiety. A crisis plan tends to be a document which says things like: 1. What your triggers are and the warning signs that you might be about to have or be having a crisis 2. Ways to avoid a situation turning into a crisis (for example, talking to others, contacting your therapist or GP, breathing techniques etc) 3. What to do if you have a crisis, including who to contact (for example, a crisis team, friend or family member or perhaps a phoneline like the Samaritans.

Melanie: How do I cope with a mental health crisis at uni?

Kat: Most universities will have welfare officers and a GP surgery attached. Many now also provide a counselling service specifically for students. It's worth looking at your uni's website to find out if there's support available that you could map out for yourself. If you don't want to go through uni, it would be good to find out what else is available in your area via the NHS or through local charities.

Jenny: I sometimes get really anxious to the point where I can't think properly and everything gets really confused in my head, and I think bad things. What can I do to help myself?

Kat: These kinds of symptoms are really appropriate for a crisis plan. There are lots of different types of relaxation techniques which may help, such as meditation, mindfulness, breathing exercises etc. It could be that going on a walk with a friend or talking to someone who has helped you in a similar situation before can help.

Lauren: Writing stuff down can be a great release. Getting stuff out of your head is so important because it stops it spiralling out of control.

Kat: I agree, writing things down can be helpful. It's good to keep a daily mood diary to get in the habit of writing down how you're feeling and also to keep a track record so you can look back and see what's caused a crisis in the past.

Marisa: There have been occasions in the past when I have been in a crisis and had control taken away from me by other people. They have refused to listen and then claimed I'm in denial about being ill. How can I make it clear to people that my decisions about my care need to be respected, even if they don't agree?

Kat: Well, the good news is you are protected by law on this one. Unless a doctor puts you under a section of the mental health act (which would usually only be when you are in immediate risk of harm to yourself or others), you are said to have mental "capacity" to make decisions - especially ones around your treatment. If it's friends or family, it may well be that they genuinely think they are doing the right thing for you which can be difficult. It's a good idea to either sit them down and talk to them or direct them to information around your rights regarding decision-making. For parents in particular, you can tell them to call the YoungMinds Parents' Helpline and speak to a professional. There are some laws around mental capacity, but you should always be given a say in your care.

Helen: If you have adults in your life who aren't specifically parents but feel they have a say in your care, then they can also use the YoungMinds Helpline.

Kat: Mind have some good information on legal issues.

Lucy: What should you do if you are having panic attacks but don't want to tell anyone?

Kat: I know it can be hard to talk about panic attacks but it is a good idea to open up to someone. Places like The Mix are really good for that! If you're talking about not wanting to tell anyone while you're having the actual panic attack, there are some things that can help. When I've had a panic attack and not wanted anyone to know, I usually try and leave so I can go somewhere quiet and be by myself and calm down. Often I make an excuse like I need the toilet or forgot something I needed to do. Sometimes you just need to step away from a situation. You can also find some really good breathing exercises that are quite subtle so no one has to know what you're doing.

John: What would you say is important for an outsider (to the situation) to consider before trying to intervene or help the individual in crisis?

Kat: It's important to treat the person in crisis with compassion. Some people think that you can snap someone out of their crisis or that being "harsh but fair" is the best way. You've got to remember that, whatever behaviour the person is exhibiting (such as shouting or acting in an unreasonable way), underneath that they're a person and they're hurting. Sometimes it isn't grand gestures or hospitals but small things that bring hope and help people in crisis.

Zoe: If you haven't got a crisis plan, what can you do?

Kat: If you don't have a crisis plan and aren't using NHS mental health services, you can write your own. There are some really good templates online. One I see used a lot and have tried myself is called a WRAP (Wellness Recovery Action Plan). This has some good prompts on what you can put in your plan. Google "wrap template mental health" if you want to take a look! There are lots of different types of template so feel free to look around and find one that suits you and tweak it if necessary.