Avoiding suicide: writing a crisis plan

An article by Kim Rosenthal, MD
Kimrosenthalmd.com

Sometimes life can be overwhelming, painful even, and you feel like you’ve been run over by a freight train.  It’s too much to handle.  You feel helpless.  You feel hopeless too.  Thoughts are dangerous.  That’s crisis mode, and that’s when you need to read this article.

Whether you hear that freight train coming you way or not, it’s a good idea to have a crisis plan at the ready.  The best time to write a plan is when you’re doing well.

→If you’re not doing well, call someone and get help.  Don’t be alone.  If needed, call the suicide hotline at 800 273 8255 or go to the nearest emergency room.  Please get help.

→If you’re safe, stable, and ready to work on a crisis plan, find yourself a notebook, pencil, and comfortable spot, and go over the outline below. Consider printing this article and circling options that might help you.

Place your hand over your heart,
can you feel it? That is called purpose.
You’re alive for a reason
so don’t ever give up.
-www.geckoandfly.com

Personal Crisis Plan

You’ll need:

• A few pieces of paper or legal pad
• A pen or pencil
• Optional: a support person

How do you deal with the difficult moments, the ones that seem intolerable?  If you can, come up with strategies ahead of time. The goal is to write a crisis plan and hopefully never use it.  The other goal is, if you do have a crisis, to survive the storm.  Peace and safety aren’t far away, as long as you reach for them. 

The questions and lists below will help you pull together a personal crisis plan.  Your job is to get pen to paper, write it all out, and end with a signature!

The plan includes three sections: recognizing early on when you’re in crisis (to avoid things from escalating), finding ways to help yourself, and what to do if you become unsafe.

(1) How do you know you’re in crisis?

Write “EARLY WARNING SIGNS THAT I’M NOT DOING WELL…” in your plan and answer with a list.  What are your early warning signs?

This might be a funny statement.  You’re in crisis when everything falls apart, right?  It’s not that simple.  Think of painful emotion and overwhelming situations as a spectrum.  There are small crises, and there are big ones, and there are a thousand grades of crises in between.  Sometimes small whirlwinds lead to bigger ones, sometimes they don’t.  The trick is to catch things early, to pick up on the warning signs before you’re so overwhelmed you can’t move.  For you personally, what are your early warning signs?  Make sure to write them out in your plan. Here are some common symptoms.

• Feeling anxious, down, or irritable
• Being shaky
• Physical symptoms, like a headache, sore stomach, or diarrhea
• Worrying more than usual
• Having panic attacks
• Wanting to cry all the time
• Negative, hopeless thoughts
• Withdrawing from others
• Clinging to others
• Insomnia or sleeping too much
• Feeling hopeless and helpless
• Having problems concentrating, or making unusual mistakes
• Losing things
• Feeling like a failure
• Loss of interest in fun things
• Start using or drinking
• Self-injurious behaviors

The next time you experience any of these symptoms, take note.  It’s your mind telling you that you need to make things better.  Do something to calm yourself before a little crisis becomes a big crisis.  We’ll take that on in the next section.

(2)  What can help you feel better?

Next, complete the following: “WHAT I SHOULD DO WHEN I FEEL MYSELF SLIPPING/WHAT I CAN DO TO FEEL BETTER DURING ROUGH MOMENTS…”

This is a hard one.  How do you deal with difficult moments?  Make a list, and make it as long as you can.  Not sure which way to turn? We’ve included a list of ideas below to augment your list.  Choose those that might help you and add them to your ideas. *If you’re having suicidal thoughts, skip ahead to #3*

• Call someone you trust
• Hold your hands under running water
• Watch TV
• Read something funny or soothing
• Listen to uplifting music
• Take a warm bath
• Sing in the shower
• Go for a walk
• Write in a diary
• Try out one of these relaxation techniques.
• Play with a pet
• Think about good memories
• Take  good memories and project them into the future
• Drink a cup of hot chocolate, tea, or coffee
• Search for funny or inspiring pictures online
• Write a gratitude list
• Grasp the moment with mindfulness
• Go see a movie
• Go to a bookstore, pet store, art store, or coffee shop
• Go to a place of worship or read the Bible
• Eat out at your favorite restaurant
• Go to a comedy show
• Color in a coloring book
• Make or buy a gift for someone
• Invite someone to do something
• Do something that makes you feel useful (pay your bills, do household chores, etc)
• Call your case manager, counselor, or psychiatrist
• Check out more things to do by clicking here.  

(3)  Emergency: reach out for help

If you’re having thoughts of suicide, if you need help urgently and need it NOW, call the suicide hotline at 1-800-273-8255, call 911, or go to the nearest emergency room (ER).  The hotline and 911 can help you through the crisis or connect you with help if you need it.  The providers at the hospital will help you feel better and stay safe.  

Write this number on your plan. 

National Suicide Prevention Lifeline
1-800-273-8255

If you need help, don’t delay.  Believe that everything is going to be okay.