Safety Planning for Bipolar “disorder” – creating layers of safety
Why is safety planning so important to me? The more safe I feel, the more I can live my dreams. I don’t create safety for safety’s sake, but for the sake of living life. I will not be a “basement dweller”.
I’ve been feeling good for the past 2 months and all the scary experiences of shitty moods and psychotic bits have faded into the background, while my brain is now able to keep me clean, fed and functioning. The last 2 major “episodes” I’ve had I’ve managed to avoid the psych ward. I must admit this was in reaction to a bad hospital stay where I vowed never to go back. I have post psych ward PTSD. Before that I had 3 mental hospital stays in 14 months. I had become a regular customer, and since the last service did more harm than good, I decided to take madders into my own hands and learn how to navigate a crisis without that kind of help. It’s sort of like how pilots train for all types of emergencies in a flight simulator, so if they happen they will be prepared. I know I will have another emergency, so being prepared is imperative.
I remember doing a safety plan or two after leaving the hospital, and they are pretty generic. “Who are you going to talk to if you are feeling bad”, “here is your clinicians phone number if you need to get into your psychiatrist”, “here is the number for the crisis line” blah blah snore. This was an important phase, but after crawling, I’ve ran by it. The safety plan above serves one purpose; to funnel me back into the mainstream mental health system. If I was struggling, anyone I talk to would direct me back to psychiatry as would the crisis line. It’s important to have these possibilities in mind while realizing that the possibilities for creating safety for oneself are vast and also can be unique. Some things that make me feel safe might be uncomfortable to others. Maybe you only feel safe calling emergency whereas emergency services for mental health is one of my worst fears. The more branches of safety I create, the less likely I will run into something or someone that puts me on the conveyor back to the psych ward.
Early on in my journey, I took a class though community mental health called WRAP, or “Wellness Recovery Action Plan”. The course ran over 8 weeks and we covered a bunch of different sections of the “WRAP” and we were encouraged to create our own plan to enhance our personal responsibility. I won’t go into all the details here, but you can find more information about WRAP here. I bring it up because part of the WRAP included a crisis plan detailing what was acceptable and not acceptable treatment during a crisis. This is supposed to give a certain level of control even when one is out of control and others need to take over. One of my criticisms of the WRAP crisis plan is that psych hospitals don’t ask to see it or refer to it in any way. When I was hospitalized in April of 2016 I had all my wishes detailed in my WRAP plan but the psychiatrist in no way had to look at it or listen to me. The psychiatrist basically started from scratch with types of medications that had been harmful in the past. So my WRAP turned to crap. I went to my preferred hospital but got a paternalistic psychiatrist and all plans got flushed down the toilet.
Happily, I found that there are lots of things I can do to feel safe as a crisis is looming. I will share some of what I have done to ensure my safety during an episode of psychosis whether big or small. Many of these things I’ve never had to use, but by having them, I feel safer. Having that background of safety is so important, so that way I don’t have extra panic because I don’t know what to do. It’s the difference between being a trained paramedic, calm in an emergency, and a civilian, who panics. I have to be my own paramedic and remain calm, or I have few options like calling the paramedics, which I don’t want to do.
So I mentioned the WRAP crisis plan, or doing a full WRAP plan in general. It’s offered widely throughout mental health services and I wouldn’t be surprised if your mental health centre offers it in some way. It’s often facilitated by peers, or at least one peer, which makes it nice. You are allowed to retake the class as many times as you’d like. Another thing that sucks is that I had my whole WRAP plan in the fancy WRAP app but it’s not updated for IOS 10 so I can’t access it. Good thing I have it written down in a book too. I will create a post sharing some of my WRAP bits. Another thing I don’t like about it is most of it is focussed on when things go wrong which could result in us constantly watching over ourselves. It does a great job of building an awareness on how much we can do for ourselves to stay well. I have to thank WRAP on many levels, even though I wish they’d update their app.
Advanced Directive or Ulysses Agreement and Representation Agreement
After my terrifying hospitalization, I took time to create an advanced directive also known as a Ulysses Agreement and a Representation Agreement. How does this help me feel safe? By having two representatives in a formal agreement, they can speak on my behalf when I don’t have the right to if I am certified under the mental health act, or sectioned as it’s called down south. I created an Advanced Directive with what I wish to have happen to me or don’t wish to have happen to me in the psych ward. This is better than the WRAP crisis plan, and can be very similar to what is in my WRAP crisis plan with things like preferred hospital, preferred meds etc. I felt safe for a while, but I found out through a complaint process that it doesn’t have to be honoured by a psychiatrist in the psych ward. I’m not surprised as if they’d give up their power to a person/patient who knows themselves and their history. They’d rather role the dice in their head than listen to what’s been helpful in the past. I still think it’s better to have one than not. Perhaps some doctors will feel compelled to collaborate with acute patients to make their job easier and minimize hospital stays. I had two less than 10 day stays and the third one was 33 because the doctor didn’t listen to what helped me in the past and made it worse. That’s a big waste of resources and someone else could have had that be that needed it. I even made a video stating my wishes in short while standing beside my two representatives while perfectly well. I haven’t had to go back to the psych ward since as I don’t feel safe there anymore, but if I ever was dragged there against my will, I’d feel a little more safe than I did last time. I used a document to create mine found at this link though an organization call Nidus. This is good for Canada. There are lots of resources in the USA too. I think these pamphlets should be in every psych ward, and outpatient clinicians and doctors should help people to create these documents as part of the service. Acute care doctors very rarely collaborate with the community doctors that know more of the history. They don’t keep files in the hospital so each time is a new experiment. Hopefully this will change soon and there will be more continuity.
Medical ID Bracelet
I create a medical ID bracelet for when I travel. This way, if I have some kind of freak out and I’m around strangers,
they will know what’s going on, and not think I’m drunk or on drugs or something. Or at least there is a better chance of that. I wore it on a long trip to the USA. Nothing every happened but this made me feel safer knowing there was less chance of being misunderstood. I don’t wear it at home though because I have…
iPhone Medical ID in the Health App
The iPhone has a section in the Health app to fill out your detailed medical ID. You can put your condition and medications in there. You can also add emergency contacts in the medical ID section. What’s handy about this is if you press the power button 5 times in a row, it will send a text to your emergency contacts with your location (along with calling emergency services).
So it I was panicking somewhere, all I’d have to do is press it 5 times and I will get help. It can be so difficult even to dial emergency when panicking. Knowing I have this set up creates another layer of safety. I can get help quickly if I decide that I want it. This trick also works on the Apple Watch. For the most safety, get one with a SIM card so your phone doesn’t have to be nearby. Another thing I learned was to put “ICE” which stand for “In case of emergency” next to your contacts that you’d like contacted in an emergency.
Spiritual Emergency Hotlines
There are crisis lines out there that will talk with you about your experiences through other frameworks. There are “Spiritual Crisis” hotlines. If you google it you might find one for your area. I even found a “Special Messages Support line” out of San Francisco. So if you think about bipolar in other ways besides just the medical model, there might be a listening ear just a phone call away.
Education on Alternate Ways of Looking at Mental Health and Bipolar
It was about 3 years in when I discovered the book “The Spiritual Gift of Madness”. I hadn’t read any alternative perspectives until then, though I remember when I was given a diagnosis of Bipolar Disorder, I felt it didn’t fully describe the dimensions I’d returned from. I read the book and felt so relieved to know I wasn’t the only one who thought there were spiritual elements to the experience. I agreed in my heart with the entire book. I went on to read “Rethinking Madness” and “Recovering Sanity”. There are tons of books that resonate with me much more than the medical paradigm. The more I understand, and understand that there are many people out there that understand in different ways spread across the globe, the less I feel scared of it. I feel safe knowing that even if I’m infront of a psychiatrist who doesn’t “get it”, it’s okay that they don’t speak my language, as others out there do. I feel the more we educate ourselves and start speaking with peers in ways that we want to, the more the medical paradigm will have to adjust to us. They aren’t going to adjust their $100,000 indoctrination unless they have to. So, knowing that the crazy stuff isn’t all crazy nonsense, that it has meaning and can lead to growth and learning helps me feel safe to keep going.
A Zap Strap
So this is a strange one, but it works for me. I keep a zap strap, one of those things you can organize cords with, on my person. I have one in my car and one in my purse. This way, if I feel like I’m going to do something unsafe like harm myself or run off a balcony, I can reach for a zap strap and connect my arm or leg to something out of harms way. I have to remember to have my phone with me so I can call someone to release me from myself. I’ve had it in mind to keep my body safe in this way and not call anyone for help until I ride out the entire wave of scariness. I’ve never done this. And I’ve never had to keep myself safe using a zap strap but having it has helped me on several occasions. Once I jumped out of bed in a panic and I thought I might harm myself. I experience this as dual, not wanting to harm myself but feeling and energy that might drive me to do it. It could be a type of dissociation. So when that happened, I grabbed a zap strap and went to my planned place where I would tether myself. It’s good to have this planned out in advance, so I don’t have to choose while panicking. I picked the pipe under the bathroom sink. I went to the spot and felt I had more time to grab a blanket and a pillow, and then a book, and my computer. And by that time I realized I no longer had to secure myself as the feeling has subsided. I called someone to come and stay with me that night. The same thing happened another time and once I got to my safety spot, I waited until it subsided and didn’t have to zap strap myself. So the key for me is having it in case I need it. Otherwise I might be too scared to wait it out which would lead to calling people for help when it’s something I can handle myself BECAUSE I have these layers of safety plans. If you don’t have 10 layers of safety, it’s best to call for help right away because any amount of waiting could make it too late, especially for those who dissociate or feel that ending ones life is the only way out of the pain and fear.
I’ve gotten through my last 2 major episodes of psychosis without the hospital by knocking myself out with Quetiapine. In the past I’ve taken extra for 2 weeks, sometimes more. The times I’ve been hospitalized and it worked out well, that is what they did, so I’m doing what they do but without having to go there. This presents other challenges that I’ll talk about later. I have it on hand and I keep extra in my purse. I put it beside my bed if I notice I’m starting to struggle. I take 50mg of Quetiapine daily right now, and that’s the only medication I take. I used to be on Lithium and Trazadone but have replaced them with natural alternatives. I just made 2 separate packs of medications that will knock me out to sleep it off if I have a crisis. One is for my purse and they other for my bedside. By having them handy, I feel safe. I know where they are. They also don’t have enough in them to kill me. That way I don’t have to worry about using that which I designed to help me to harm me. I’ve had the experience of fishing out extra Quetiapine from the big bottle and wanting to swallow them all. Having them separate in smaller doses reduces the urge. However, I’ve never done anything to harm myself. The furthest it’s gone is thought but it’s still very painful. A big bottle of pills creates the thought to possibly swallow them all, which is a scary thought. I don’t need extra scary thoughts when I’m already scared.
I’ve learned about several vitamins and supplements that can help with sleep and knock me out during a crisis. I have used these during a mini crisis and they worked. Whether or not they work during a full crisis I have yet to test out. I’m awaiting that crisis and preparing for it. If I don’t have them separated and handy and study which ones to take, then I could mess it up and end up diverting to medications. I will take extra medications if I have to, but I’m adding the supplements as a less harmful action to take before. I’ll write more on this when I try it out on a big episode. Or you can go to balancingbrainchemistry.co.uk if you want to study it yourself.
Knowing your Bipolar Biorhythm
I seem to experience 5 or so months of wellness, and then I “hit a wall” and go through psychosis and then depression. The psychosis is usually no more than a week. The depression can last up to 3.5 months. So I’m quite sure I’ll experience a major episode of psychosis in mid June. If you go back through your history since diagnosis, you might notice that it’s at regular spaced intervals. If not, it’s good to have your safety plans always available. I feel safe knowing the big one isn’t coming for another 2 months so I don’t have to have everything in arms reach right now. That being said, I know where everything is so it’s important to keep it organized and in places we know. Also, I don’t have to spend the good months being afraid of myself or afraid that something will happen. If there is a little blip, which there has been twice, I can handle it and go on with no being afraid of life. The more I am prepared, the less I’m scared. Hey that rhymes! Being scared when I don’t need to be wastes my life and I have less energy for…
Making Dreams Come True
One thing they talk a lot about in Mental Health is the idea of “hope”. Hope that things will get better. Hope for a better tomorrow. Don’t worry, there is hope. Blah blah blah. I like to think in terms of possibilities and dreams, throwing hope in the garbage can of abstractions. What gives me “hope” is the fact that when I’m well, I live my dreams and push what’s possible. I’ve created so much safety that when I’m well I don’t waste energy on being afraid and I have more energy to live out some dreams. And I have a big list of what I want to do next. And I can do it because I know I’m safe. I don’t live in fear and stay in a small bubble. I do spend quite a bit of time thinking about mental health, and I hope I can put that on the back burner at some point. If I can get through this next crisis with all the planning I’m doing now, hopefully there will be less planning to do in the future. Who knows. This bipolar things is so shifty it’s always tripping me up.
Don’t Believe Thoughts
One thing I learned to do was not to believe any of the crazy thoughts going through my head during a crisis. By not believing them, I don’t act on them, and if I don’t act on them, there is not fuel for them to keep going. The mind might still keep playing different scary thoughts, but if I don’t act on them, I don’t turn them into a story. If there is no story, or storyteller buying into the story it’s trying to create, it also loses fuel. So there still might be a bunch of disjointed scary stuff, but if I stay with it, without doing anything, it subsides and goes away for a time. If I don’t believe it and thus create a story out of it, there is less chance that I will end up making up a crazy story that I eventually just end up telling to a psychiatrist who uses that story as an excuse to medicate me more. It also makes me feel safer in seeing that if I do this process, I might be scared, but I still feel safe. I also find it helpful not to talk about it with anyone as that only makes it worse. So if I am experiencing scary stuff and I don’t engage with it, it eventually goes away. Where as if I tell others, they’ll get involved and they don’t know what to do except send me to a psychiatrist. This only works if I don’t believe the thoughts. If there’s nothing to believe, then why even talk about it. I’ve experienced my brain experiencing killing myself while laying in my bed in agony as nothing is really happening. No one needed to know that.
Taking Good Care of Yourself
The more gestures of health I do towards myself, the more I engrain in my being and nerves that I want to live. Also, the more healthy I am, the less chance of experiencing side effects when I need to take extra medications. For example, taking extra Quetiapine makes me want to over eat. If I keep myself slim, this isn’t a big deal. Also, if I overcome my food addiction, I can say f*ck you to the hunger and actually under eat when taking extra Quetiapine so my liver can deal with the extra toxic load of medication. It’s a big win if I can get through a crisis and not have to buy a new wardrobe like the first time. I’ve pretty much mastered this. During my first hospitalization I gained 50 pounds in 2 months. Now I my weight varies between 105 lbs and 120 pounds. It doesn’t go up to 150 lbs like before. I’ll talk more about strategies for keeping slim while being a mental patient later. I remember the first time I did physical activity after gaining all the weight, I took one step and fell over as my knees buckled under an unfamiliar body. At some point, I’m going to talk about all the ways I take care of myself.
Sanctuary for a Full Blown Crisis
Last time I had a crisis, I didn’t go to the hospital, but it was still so challenging in so many ways that I couldn’t predict, partly because I was thinking it wasn’t going to happen. I didn’t have quiet space to go through the misery and so I ended up bringing it into all my interactions with the people I was living with. This resulted in a prolonged hell. At least in the hospital I have permission to be internally miserable, confused, angry, sad, scared and everything else. Everyone else is too. But I was at home, and I tried to hide it. I tried to hide that I was doing so badly so I wouldn’t get dragged to the psych ward. But since I didn’t go to the psych ward, and I had all these people around that didn’t know I was doing so badly, they chalked it up to “attitude”. I was trapped and it was really hard to get through. So, not going to the psych ward doesn’t make it a cake walk. It was way harder in many ways. This time, I’m going to plan to be somewhere peaceful where their aren’t people around that I can project the terrible internal states onto. I found out how important it is to have people around me that understand during a crisis the hard way. Or it’s better to be alone, maybe. That’s what I’m going to try next time since I felt alone with it around others who didn’t understand last time.
I have many people in my life who I can talked to about all different levels of my experience. There are so many alternatives. For more, see my resources page.
If you are supporting someone in a crisis
Good for you! There is a great document created by Michael Cornwall PhD on how to orient your energy when helping someone in a crisis. Here is the link. Don’t forget to relax your perineum.
A Note on Safety Plans
Safety plans aren’t actually plans. They are actions and gestures on things placed strategically. Having everything written on a piece of paper is not going to help if I don’t know what actions to take or where the things are that will help me. For example, if I write down or have in mind that I’ll use a zap strap if I feel like I might harm myself, and I don’t actually have one handy, the plan is useless. If I say I’ll take extra Quetiapine, but I don’t have extra with me, or I don’t know where it is, then it doesn’t help. If I don’t fill out my iPhone medical ID and put my emergency contact in there, the plan won’t work. Even as I go about my day, I see elements of my safety plan around me. I keep it visible and it’s on the back of my mind. After each crisis, I learn something that I wasn’t able to do during the last crisis, and when I’m feeling better, it’s important that I put those learnings into action and into place. If I get complacent and I just wait for the next time it will always happen in the same old totally uncontrollable way.
Everyone is Unique
What makes you feel safe? Maybe the thought of zap strapping yourself is crazy or terrifying. I find it helpful. It’s good to figure out what actions and gestures make you feel safe when you are starting to experience a crisis or while you are in a crisis. The more we plan it out before hand, the more likely we will be able to utilize it during a crisis. I have a few new layers of safety I will be testing out next time. Who knows, I might think it was a mistake to go through a crisis by myself with no one around. I might find out the supplements that are supposed to help me sleep some of it off don’t work. I will have my back up though of extra Quetiapine and Trazadone, if I really need it. It’s important to have backup plans if what I’m trying doesn’t work. When I travelled, I had a friend who agreed to come and get me if I had an episode while I was away.
I hope you feel safer after reading this. Don’t be tricked out of living your art. Go for your dreams! Holographic-Hugs!