How do I know I’m headed for a mental illness episode or crisis?

Knowing when you're headed for a mental illness episode or crisis is critical to minimizing their impact.

Am I headed for a crisis?

Developing a crisis plan when you and your loved one have clarity of mind, without the pressures of an unfolding crisis, can help mitigate and manage the challenges and uncertainty of mental illness in your family. The biggest uncertainty may well be how you will be impacted and behave in a mental health crisis. A crisis plan can also make both you and your caregiver feel better about the treatment process as you’ll have a say and sense of ownership in the process.

The best way to assess whether or not you’re on the verge of a crisis is to analyze your daily behavior when you are well. What are you like when you are well? Are you friendly, relaxed? What do you do when you are well? Do you exercise, eat well? When your behavior deviates from your typical activities that may be a sign that something is not well. Then consider your triggers. These could include a wide variety of stressors, including school or work pressures or even a medication adjustment.

If you’re unable to return to your usual behaviors and coping strategies (such as meditation and talking to friends and family) don’t work, this could be an indication that you are at higher risk of an episode developing.

If this is not your first episode, it can be very helpful to consider your past episodes for detectable patterns and signs of prior episodes. Such a pattern might be a fixation with particular topics and activities. Are you able to develop any rules based on past patterns such as how long does the fixation last before I should become concerned?

Are third parties such as your caregiver noticing a change? It is often helpful to rely on a caregiver to help you determine if you’re not well, behaving as usual. People with mental illness often lack insight or they are unaware when they are not well. It’s helpful to discuss all of the above with close friends, family members, caregivers – whoever you feel comfortable discussing your health with – and asking them if they’re picking up on any signs. Try not to be defensive when they identify concerns.

Action steps to manage a crisis

Keep an up-to-date list/record of:

1/ your medication and doses and also note medications you have tried in the past, which have not been helpful (such as causing bad reactions); note the contact information for the pharmacy you use who can provide on your medication history

2/ your health care providers – psychiatrist, psychologist, therapist

3/ insurance information

4/ who to call in case of an emergency and note who you would like to take over if you do become incapacitated – discuss the responsibility with them in advance and make sure they have an up-to-date list of your medications, health care providers, and key contacts

5/ treatments that you prefer such as medication and those that you would like to be used only as a last option such as ECT

6/ the place where you’d like to recover in order of preference such as home, respite, hospital. Try to research facilities in advance beforehand to inform your preferences

7/ do’s (what people looking after you should do/let you do that helps): art activities, restrict access to social media etc.

8/ don’ts (what people looking after you shouldn’t do):  threaten to call 911

9/ chores you want to be taken care of while you can’t do them yourself, especially if you don’t live at home such as caring for a pet, paying bills, etc

10/ things people can do for you after the crisis is over to provide you with continuing support until you’re fully back to “normal” as sometimes it takes a while to recoup from a crisis. Also, it’s always nice to thank people when you feel well for the help they offered you when you were well.

This is also a helpful article.

Psychiatric Advance Directives

All of the above may be included in a Psychiatric Advance Directive or a PAD. “PADs are relatively new legal instruments that may be used to document a competent person’s specific instructions or preferences regarding future mental health treatment. PADs can be used to plan for the possibility that someone may lose capacity to give or withhold informed consent to treatment during acute episodes of psychiatric illness.” A good and reliable source of information on PADs is available on the National Resource Center on Psychiatric Advance Directives. Carefully prepare and seek guidance when you’re preparing one if you’re uncertain.

My preferred approach is to have a cooperative team approach with my primary caregiver, my spouse. It took it took me a couple of crises to truly appreciate the valuable role my spouse could play in my care during a crisis. I didn’t accept it early on. I was argumentative. I disagreed with him. I got angry with his decisions. However, when I was well I came to appreciate that he had my best interest at heart. He may not have done everything as well as he could have, but a crisis can be very difficult to respond to. Now, my spouse, psychiatrist and I have a plan for dealing with crises. I have relapsed 4 times and there’s no guarantee, no matter how well I am, that I won’t relapse again. Carefully preparing for a crisis is invaluable and I wish I had done so all along.

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