Mental Health Crisis Plan Template & Example

When creating a mental health crisis plan for an individual, consider all the elements enabling an effective, coordinated response amongst caregivers and healthcare providers. The following elements ensure the plan is comprehensive and practical:

Patient Identification and Medical History

A crisis plan must begin with the patient’s essential details to avoid delays in care. Be sure to include the following:

• The patient’s name, address, contact details, and emergency medical data.
• A summary of current diagnoses, allergies, and any history of mental health crises.

Emergency Contacts and Support Network

In times of crisis, having quick access to the right people is crucial. Ensure the plan includes these details:

• Contact details for primary caregivers, family members, and close friends.
• Information about the mental health professionals and community resources involved in the patient’s care.

Recognizing Crisis Signs

Early recognition of a crisis can prevent rapid escalation. This section should highlight:

• Specific behaviors, symptoms, or thought patterns that indicate a potential crisis.
• Personalized notes on unique warning signs tailored to the individual patient.

Crisis Intervention Steps

A detailed crisis management plan minimizes confusion during emergencies. Include guidance on:

• Medications or treatments to administer during a crisis.
• Steps for caregivers or healthcare providers, including contacting emergency services or implementing de-escalation techniques.

Legal and Safety Protocols

Addressing legal and safety considerations helps reduce risks during a crisis. Be sure to document:

• Advance directives or other legal documents specifying the patient’s preferences.
• Safety measures to address risks such as self-harm or harm to others.

Long-Term Crisis Management Goals

A crisis plan is not just for emergencies; it should support long-term recovery and stability. Address:

• Plans for follow-up care, such as therapy or rehabilitation services.
• Key milestones to assess progress and prevent future crises.

Leveraging a mental health crisis plan within your practice involves more than providing a template for patients and their caregivers to fill out. These tips help ensure it becomes valuable for patient care:

• Collaborate with the Patient and Their Support Network: Engage the patient in the plan’s development to ensure it aligns with their needs and preferences. Involve caregivers so they feel confident and prepared to act.
• Use Accessible Language and Formats: A plan is only effective if easily understood and followed. Wherever possible, as the respondent to avoid overly clinical language, and ensure the document is available in digital and printed formats.
• Regularly Review and Update the Plan: As a patient’s condition evolves, so should their crisis plan. Revisit the document during follow-ups to reflect any changes in treatments or contacts.
• Integrate Crisis Plans Into Clinical Workflows: Ensure the crisis plan is easily accessible within the patient’s medical records, and train clinical staff to understand and follow its instructions during emergencies.

Creating a crisis plan from scratch can be time-consuming, especially in a busy clinical setting. Making use of templates offers several advantages:

• Streamline Documentation: Use templates to pre-structure crisis plans, focusing your efforts on customizing them for each patient rather than starting from scratch.
• Standardize Care: Ensure consistency across all plans using a template that includes all critical elements, from emergency contacts to intervention steps.
• Enhance Communication: Simplify sharing and discussing plans with caregivers, support networks, and other healthcare professionals by using templates.

How TextExpander Can Help

Implementing TextExpander in your practice can simplify creating and managing mental health crisis plans. Here’s how TextExpander can help:

• Create Snippets: Save time by developing reusable text snippets for frequently used sections, such as medication lists or intervention steps.
• Share Templates: Encourage collaboration by distributing templates to team members and keeping everyone updated.
• Prevent Errors: Automate repetitive entries to avoid mistakes in crucial details like dosages or emergency contacts.

Mental Health Crisis Plan for an Adolescent Patient

Patient Name: Sarah Lopez
Date of Birth: October 15, 2008
Plan Last Updated: December 1, 2024

1. Patient Identification and Medical History
Address: 1234 Maple Lane, Springfield, IL
Medical Conditions: Anxiety Disorder, ADHD
Allergies: None
Current Medications: Sertraline 50 mg once daily, Vyvanse 30 mg once daily

2. Emergency Contacts and Support Network
Primary Contact: Maria Lopez (Mother), 555-123-4567
Secondary Contact: Roberto Lopez (Father), 555-987-6543
Mental Health Provider: Dr. Allison Grant, Springfield Mental Health Clinic, 555-321-9876

3. Recognizing Crisis Signs
Warning Signs: Increased irritability, refusal to attend school, difficulty sleeping, self-isolation, and frequent crying episodes.
Triggers: Bullying at school, significant changes in routine, academic pressure.

4. Crisis Intervention Steps
Immediate Actions:
Remove Sarah from the triggering environment (e.g., allow her to rest in a quiet room).
Encourage her to use grounding techniques like deep breathing or the “5-4-3-2-1” sensory exercise.
Contact Dr. Grant if symptoms persist beyond an hour.

Medications:
Administer PRN medication: Hydroxyzine 10 mg for acute anxiety (as prescribed).

Hotline/Support Services:
National Suicide Prevention Lifeline: 1-800-273-8255
Local Mental Health Crisis Line: 555-456-7890

5. Legal and Safety Protocols
Advance Directives: None applicable.
Safety Plan: Ensure sharp objects and medications are stored securely and out of reach.

6. Long-Term Crisis Management Goals
Follow-Up Appointments: Weekly therapy sessions with Dr. Grant.
Therapy/Rehabilitation Plan: Focused CBT sessions to address school-related anxiety and self-esteem issues.

Mental Health Crisis Plan for an Adult Patient

Patient Name: John Peters
Date of Birth: March 8, 1985
Plan Last Updated: December 1, 2024

1. Patient Identification and Medical History
Address: 5678 Oak Street, Riverdale, NY
Medical Conditions: Bipolar Disorder Type I, Hypertension
Allergies: Penicillin
Current Medications: Lithium 900 mg daily, Lisinopril 10 mg daily

2. Emergency Contacts and Support Network
Primary Contact: Rachel Peters (Spouse), 555-654-3210
Secondary Contact: Mark Peters (Brother), 555-789-1234
Mental Health Provider: Dr. Jennifer Lee, Riverdale Psychiatric Center, 555-456-3210

3. Recognizing Crisis Signs
Warning Signs: Rapid speech, excessive spending, decreased need for sleep, delusions of grandeur, and irritability.
Triggers: Work-related stress, missed medication doses, overuse of caffeine.

4. Crisis Intervention Steps
Immediate Actions:
Encourage John to rest in a calm and dimly lit room to minimize overstimulation.
Ensure he has taken his medications as prescribed.
Contact Dr. Lee to report escalating symptoms.

Medications:
PRN medication: Lorazepam 1 mg for acute agitation (as prescribed).

Hotline/Support Services:
National Alliance on Mental Illness (NAMI) Helpline: 1-800-950-NAMI
Local Crisis Unit: 555-654-7890

5. Legal and Safety Protocols
Advance Directives: Psychiatric advance directive on file at Riverdale Psychiatric Center.
Safety Plan: Remove access to financial accounts and car keys during manic episodes to prevent harm.

6. Long-Term Crisis Management Goals
Follow-Up Appointments: Bi-weekly check-ins with Dr. Lee.
Therapy/Rehabilitation Plan: Participation in a bipolar disorder support group and monthly sessions with a licensed therapist.