Mental Health
Care Plan
Planning for Your Loved One’s Mental Health Crisis
Developed by NAMI-San Antonio
Written by Mary E. Jensen, LCSW
Executive Director –NAMI San Antonio
Mental Health
Care Plan
Planning for Your Loved One’s Mental Health
Crisis
Introduction
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Learning the components of a crisis plan,
Understanding provider resources,
Advocating for loved ones in crisis, and
Utilizing considering tools provided
A mental health crisis is just as important to address as any other
health care crisis. It is difficult to predict just when a crisis will
happen. While there are triggers and signs, a crisis can occur without
warning. It can occur even when a person has followed their
treatment or crisis prevention plan and used techniques they learned
from mental health professionals.
We all do the best we can with the information and resources we
have. Some days we can handle more than other days; this is normal
and to be expected, especially for those living with mental illness. You
or your loved one may need help when you have exhausted all your
tools or means of coping with the crisis.
We hope that this booklet will help guide you in creating a crisis plan
for you or your loved one BEFORE a crisis during which it may become
more difficult to think and plan.
Your NAMI-San
Antonio
Provides free education
classes and support
groups to help
strengthen families
through education
www.nami-sat.org
Mental Health Care Plan
This booklet is intended for families and friends of individuals living
with mental illness. For the critical times, it is our hope the reader is
able to recognize a crisis including:
Table of Contents
Recognize ...................................................................................... 4
Mental Health Care Plan
Prevent .......................................................................................... 4
Plan................................................................................................ 6
Reflect ........................................................................................... 7
Advocacy ....................................................................................... 8
Sample Plan ................................................................................. 10
Resources .................................................................................... 11
RECOGNIZE-What is a mental health crisis?
Definitions
Crisis: any situation in which a person’s thoughts, feelings, or behavior put them
at risk of hurting themselves or others: and/or when they are unable to resolve a
situation with skills and available resources.
Mental Health Crisis: a behavioral, emotional, or psychiatric situation, which
could result in, reduced levels of functioning in primary activities of daily living
(bathing, eating, working, etc.) an emergency situation in the need for placement
in a more restrictive setting, including but not limited, to inpatient hospitalization.
Many things lead to a crisis:
Stress
Physical illness
Work/school problems
Family changes
Community/personal violence/trauma
Substance use
“These issues are difficult for everyone, but they can be especially hard
for someone living with mental illness” – A NAMI Family to Family
participant
Documenting changes in behaviors by keeping a journal or making notes on a
calendar may help you recognize when a possible crisis is building
PREVENT-
Mental Health Care Plan
Symptoms can sometimes appear unexpectedly. It is possible for people living
with mental illness to experience a crisis even when they are following their
treatment plan. The best way to prevent a crisis is to develop a treatment plan
with a treatment team and support network everyone is comfortable with
following. Before a crisis occurs, ask:
LEAP
Dr. Xavier Amador, in his book, I Am Not Sick, I Don’t Need Help, outlines a
communication skill that can be used to engage your loved one and help them to
calm down. LEAP stands for Listen, Empathize, Agree, and form a Partnership. It
is a family-friendly version for a form of therapy called Motivational Enhancement
Therapy.
Mental Health Care Plan
Partner
Agree
Emphasize
Listen
The first step when taking a leap is to “Listen”. There are some key elements to
the art of listening. It is one of the first things we do as human beings. Listening is
how we learn and mimic what others do.
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Listen and Learn:drop your agenda
Use questions, not statements
State what you heard – all of it (reflecting)
Let the person correct you
Don’t avoid listening to scary topics or thoughts
(Even delusions)
Know your “hot-button” fears
Don’t rush it
Don’t have an emotional reaction to what you hear
Don’t try to problem-solve while listening initially
Avoid going right to empathy
Empathy
 Express empathy for feelings
 This doesn’t mean you have to agree with beliefs
 Normalize: “I think I would feel that way too
(If I had those beliefs).”
 Listening + empathizing = “What do you think?”
Common feelings and experiences to empathize with:
Only if Asked
Delay 3 times before
answering
Follow the 3 “A’s”:
o Apologize
o Acknowledge
fallibility
o Agree (to
disagree)
How to
delay your
Opinion:
“I promise to answer
your question. If it’s
alright with you, I
would like to first
hear more about
. Okay?”
“I will tell you what I
think. I would like to
keep listening to you
first because I am
learning a lot. Can I
tell you later what I
think?”
I will tell you. I want
you to know that I
think your opinion is
more important than
mine and would like
to learn more before
I tell you what I think.
Okay?”
Mental Health Care Plan
Listen
Give your
Opinion:
Agree
 Stick to perceived problems and symptoms only.
 Review advantages and disadvantages of treatment or adherence from the
person’s perspective.
 Agree to disagree when needed. It’s Okay to set boundaries.
 You can try to correct misinformation gently.
 Reflect back and highlight the advantages. Use this as the basis for a plan.
Partner
Mental Health Care Plan
 Move forward with agreed-upon goals
 Use phrases that support feelings of control and safety:
o “Would that be all right?”
o “Do I have that right?”
o “So, let me see if I got this straight. Are you saying that….”
o “Would you mind if I ….”
o “I can see why you’d feel that way….”
o “I am sure that is upsetting to hear and I know you don’t agree. It’s
just how I feel. Can we agree to disagree on this one?”
Practicing these strategies before a crisis occurs will make them easier to
use when needed.
PLAN – Create a Crisis Plan
People can still experience a crisis when they have utilized the best resources
available. It is important to have a written plan in place in case of a crisis. A good
plan will:
It is important to involve your loved one in the creation of the crisis plan. The
plan should be distributed to family, friends, and professionals with permission
from your loved one. It should be updated whenever there is a change in the
person’s diagnosis, medication, treatment or health care providers.
Other important steps include:
Contact your local police department; provide them with a copy of the crisis
plan.
Create a safe environment by removing any and all weapons and sharp
objects.
Lock up all medications, both over-the-counter and prescription medications.
Talk with others in the household about how to stay safe during a crisis; and
Post the phone number of the mental health crisis team and/or crisis line.
Crisis Kit
A crisis kit should include the crisis plan, medical information, snacks, music,
books, a change of clothes and basic hygiene supplies. This kit should be kept in
an easily accessible place.
Mental Health Care Plan
Identify people willing to help
List the phone numbers of the mental health providers and the mental
health crisis team
Include a list of current medications and their dosages
List treatments that have been used in the past (e.g., talk therapies such as
CBT, DBT, medications, peer support, crisis lines, etc.)
Identify key words or calming techniques that have worked in the past
Identify ones’ preferred treatment facilities
Include a copy of their advanced psychiatric directive (if available)
REFLECT- What Has Happened
Following a crisis, it is important to reflect on what can be done to potentially
prevent or minimize future crises. Some important questions to ask include:
What situations or triggers led to the crisis?
What worked to reduce tension or avoid a conflict?
What steps did we or could we have taken to keep everyone safe and calm?
Mental Health Care Plan
Write down the results of this reflection and include it in future crisis plans.
Review with your treatment team. The more you understand the underlying
causes and triggers of a crisis and what strategies helped, the more prepared you
will be in case of future crises.
If possible, have the person living with a mental illness provide cues to help others recognize when
the crisis has passed. Some examples might be eating at least two meals a day, sleeping regular
hours or taking care of personal hygiene needs.
Invite your loved one to develop a list of things you can do to help them feel more
comfortable and recover as quickly as possible. Including your loved one in this
process helps the family and other care givers feel good about the support they
offer. No one likes to think that someone else will have to take over responsibility
for their care. A mental health crisis is a difficult situation – one that no one likes
to face alone.
Organization
Things you need to keep:
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Current diagnostic
assessment and current
diagnoses
Copy of current crisis plan
Notes from phone calls and
appointments
Hospitalization history
List of medications and
dosages
Copies of their advanced
psychiatric directive, and
Names and phone numbers
of mental health
professionals and mental
health agencies working
with your loved one.
ADVOCACYAdvocating for a person living with mental illness in the
midst of a crisis can be extremely frustrating and
difficult. It is not easy to navigate the health care and/or
mental health system or obtain appropriate services for
your loved one. You may require help learning how to
advocate appropriately and effectively. Learning to be a
strong advocate and developing these skills takes time.
Health care privacy laws and the interpretation of them
by providers may make advocacy especially difficult.
Providers are generally not permitted to give
information to family members without the written
consent of the patient unless there are concerns about
safety or abuse. Individuals may choose not to give
their family access to their full medical records. You
may want to ask your loved one to sign a release giving
you access to communicate with their treatment team.
NAMI suggests family members write down concerns
and give them to your loved ones’ treatment team.
Focus on the signs and symptoms you are concerned
about so that the treating providers have this
information to allow for the best assessment possible.
Your loved one may not be able to provide as a reliable
history while in a crisis as they would when more stable.
Stay Calm
When meeting with professionals, remember that you
attract “more bees with honey than vinegar”. Try to
keep the conversation focused, objective and stay in the
present. As hard as it can be, try not to get overly
emotional. The more you can stay calm, the more
control you can have in the situation and the easier it
will be for you to stay involved in decisions about your
loved one.
Mental Health Care Plan
Over the course of your
loved one’s illness, they
will receive and need to
keep track of a great deal
of information. It is
important to keep all this
information together in
one central place where it
is easily accessible.
Get Support
To be an effective advocate, you need to take care of yourself. You will need to
make sure that you eat, sleep and take a break from the crisis when your loved
one is safe. Consider joining a support group. NAMI support groups help you deal
with the stresses of advocating for your loved one. At a support group you meet
with others who have similar experiences, and you gain knowledge and skills to
help in future crises. You also get a chance to support others by sharing your
experience. For a list of current support groups in the San Antonio community
please visit www.nami-sat.org and click on the support group link to find a
location near you.
Mental Health Care Plan
Communicate Effectively
Effective communication helps ensure that your loved one receives the
appropriate services. Good communication is a two-way street. Be aware of how
your words and actions influence how others perceive you.
Your message will be clearer and more powerful by providing information about
your loved one that is current and in the here-and-now. Avoid the temptation to
tell the whole story. When information is kept to what is needed now and based
on facts, not feelings or emotions, you are more empowered. Remember to keep
an open mind and listen to what the other person says.
Legal Considerations in an Emergency:
While NAMI-SAT does not provide legal advice, there are certain legal processes
that can be helpful when a crisis arises.
If you or your loved one is experiencing a mental health crisis that is causing an
immediate risk of danger to self or others, you can call 911 and request a Crisis
Intervention Trained (CIT) officer. If one is not available, the police will respond
anyway (many officers are trained in crisis intervention). Law enforcement can
issue a warrantless emergency detention and transport you or your loved one to a
facility for evaluation where further treatment can be discussed.
There are other ways for you or your loved one to plan ahead in the event of a
mental health crisis. There are several advanced directives that allow your loved
one to authorize consent to mental health treatment when he or she is
incapacitated; these include Declaration of Mental Health Treatment and
Designation of Guardian in Event of Later Incapacity. Your treatment provider can
give you information and resources regarding these advanced directives.
CONCLUSION
If you have comments or suggestions for future printings of this publication
please contact the NAMI San Antonio office at:
NAMI-SAT
510 Belknap Place
San Antonio, TX 78212
(210) 734-3349
www.nami-sat.org
NAMI-San Antonio Community
NAMI4SAT
Mental Health Care Plan
Advocating and caring for someone experiencing a mental health crisis can be
extremely stressful. Have a plan in place, know the best techniques to deescalate the situation and know where to turn when you need help. Following
the steps outlined in this guide can help you support a loved one when they
experience a crisis and ensure the safety of everyone involved.
SAMPLE CRISIS PLAN
Individual /Family Information:
________________________
Date of Plan: ____
Person’s Name:
D.O.B.
Diagnosis(s)
Diagnosis(s)
Medication:
Dosages
Medication:
Dosage:
Medication:
Dosages:
Medication:
Dosage:
Description of immediate needs: ___________________________________________________
Safety Concerns: ________________________________________________________________
Mental Health Care Plan
Treatment Choices:
Interventions preferred: ____________________________________________________
Interventions that have been used with good results: ____________________________
Interventions that should be avoided if at all possible: ____________________________
Professional involvement:
Psychiatrist Name / Phone:
Therapist Name
/Phone:
Work/School Contact/
Phone:
Case Mgr. Name /
Phone:
Crisis Team Phone:
Medical Doctor
Name / Phone:
Hospital Name /
Phone:
Other:
Supports to use in crisis resolution:
Name / Phone:
Name /Phone:
Name/Phone:
Name / Phone:
Name / Phone:
Name /Phone:
Name/Phone:
Name / Phone:
Support Group:
MH Agency:
Other:
Community Resources:
Advocacy Group:
CRISIS PLANNING RESOURCES
UNABLE TO GO TO A PSYCHIATRIC EMERGENCY ROOM or CHCS CRISIS CARE CLINIC
San Antonio Police Crisis Intervention Team
(210) 207-7273
(Trained mental health police officers respond anywhere in the City)
Bexar County Sherriff’s Office Mental Health Unit Dispatch
(210) 335-6000
Monday – Friday ask for a Mental Health Deputy
Saturday-Sunday inform dispatch you have an emergency so patrol will respond
(Respond to all areas within Bexar County including municipalities and unincorporated areas)
UNFUNDED or NON-RESOURCED PSYCHIATRIC CARE
The Center for HealthCare Services (CHCS)
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Adult Crisis Care Clinic
Adults’ phone line
(210) 225-5481
601 N. Frio
(Screening/assessments 24/7)
1-800-316-9241
Children’s Crisis Care Clinic
Children‘s phone line
(210) 223-7233
227 West Drexel (Screening/assessments 24/7)
Mobile Crisis Outreach Team (MCOT)
(210) 223-7233
(Licensed professional meets adults at the scene of the crisis)
Children’s Mobile Outreach Team (CMOT)
(210) 223-7233
(Licensed professional meets parents/children at the scene of the crisis)
PSYCHIATRIC EMERGENCY ROOMS
Clarity Child Guidance Center
Child/Adolescent Psychiatric Emergency Service (24/7)
8535 Tom Slick Drive, 78229
(210) 616-0300
Nix Behavioral Health Center
Psychiatric Emergency Service - Adults (24/7)
1975 Babcock Rd, 78229
(210) 579-3800
Mental Health Care Plan
(24-hour access to mental health crisis services)
ACUTE CARE HOSPITALS WITH BEHAVIORAL HEALTH PSYCHIATRIC UNITS
Mental Health Care Plan
Hospital Name
Methodist Specialty &
Transplant Hospital
8026 Floyd Curl Drive, 78229
(210) 575-0500
Nix Health
4330 Vance Jackson, 78230
(210) 579-3800
Christus Santa Rosa
2827 Babcock Rd, 78229
(210) 705-6620
Southwest General Hospital
7400 Barlite, 78224
(210) 921-2000
Baptist Medical Center
111 Dallas Street, 78205
(210) 297-2000
NE Baptist Hospital
8811 Village Dr., 78210
(210) 297-2000
University Health System
4502 Medical Drive, 78229
(210) 358-4000
Emergency
Room
Evaluations
Yes
Children
Yes
Yes
Adolescents
Adults
Seniors
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Free Standing Psychiatric Hospitals (without emergency rooms)
Hospital Name
Clarity Child Guidance Center
8535 Tom Slick Dr, 78229
(210)616-0300
Laurel Ridge Treatment Center
17720 Corporate Woods Dr.
78259
(210) 491-9400
SA Behavioral Hospital
8550 Huebner Rd, 78240
(210) 541-5300
Admissions
Departments
Yes
Yes
Yes
Children
Adolescents
Yes
Yes
Yes
Adults
Yes
Yes
Seniors
Additional Resources
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National Suicide Prevention Lifeline 1-800-273-8255
Bazelon Center for Mental Health law - www.bazelon.org
National Institute of Mental Health- www.nimh.org
Substance Abuse Mental Health Services Administration - www.samsha.org
www.dshs.state.tx.us/mhsa/suicide/suicide-prevention.aspx
www.TexasSuicidePrevention.org
Mental Health & You (MHU) mobile application can be downloaded from the Apple
store for free.
Twitter: @StopTXSuicides
Mental Health Care Plan
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