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CG 031 970

Copeland, Mary EllenAction Planning for Prevention and Recovery: A Self-HelpGuide. Recovering Your Mental Health Series.Substance Abuse and Mental Health Services Administration(DHHS/PHS), Rockville, MD. Center for Mental Health Services.

SMA-3720

2002-00-0041p.; Consumer Information Series, Volume 10.99M005957Center for Mental Health Services, Substance Abuse and MentalHealth Services Administration, 5600 Fishers Lane, Room 15-99, Rockville, MD 20857. Tel: 800-789-2647 (Toll Free); Website: http://www.samhsa.gov.Guides Non-Classroom (055)EDRS Price MF01/PCO2 Plus Postage.*Individual Needs; *Mental Health; *Prevention;*Rehabilitation; *Self Help Programs; Wellness

Many people who have troubling emotional, psychiatric, orphysical symptoms have made great advances in learning how to do things tohelp themselves get well and stay well. The action plans for prevention andrecovery described in this booklet were devised by people who experienceemotional or psychiatric symptoms. They developed ways to deal with theirneed for structure in their lives that actively support their health. Theplans are simple, low-cost, and can be changed and added to over time as youlearn more and more. Action plans for prevention and recovery work becausethey are easy to develop and easy to use; are individualized; improve one'sability to communicate effectively with family members and health careproviders; directly address the feelings, symptoms, circumstances, and eventsthat are most troubling with plans to respond to them; renew one's sense ofhope that things can and will get better. This booklet contains information,ideas, and strategies that people from all over the country have found to behelpful in relieving and preventing troubling feelings and symptoms. Theinformation in this booklet can be used safely along with other health caretreatment. (GCP)

Reproductions supplied by EDRS are the best that can be madefrom the original document.

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U.S. DEPARTMENT OF EDUCATIONOffice of Educational Research and Improvement

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

O This document has been reproduced asreceived from the person or organizationoriginating it.

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Points of view or opinions stated in thisdocument do not necessarily representofficial OERI position or policy.

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U.S. Department of Health and Human ServicesSubstance Abuse and Mental Health Services AdministrationCenter for Mental Health Services

3

Action Planning for Prevention and Recovery

ACKNOWLEDGMENTS

This publication was funded by the U.S. Department ofHealth and Human Services (DHHS), Substance Abuseand Mental Health Services Administration (SAMHSA),Center for Mental Health Services (CMHS), and preparedby Mary Ellen Copeland, M.S., MA., under contractnumber 99M005957. Acknowledgment is given to themany mental health consumers who worked on this projectoffering advice and suggestions.

Disclaimer

The opinions expressed in this document reflect thepersonal opinions of the author and are not intended torepresent the views, positions, or policies of CMHS,SAMHSA, DHHS, or other agencies or offices of theFederal Government.

Public Domain Notice

All material appearing in this report is in the public domainand may be reproduced or copied without permission fromSAMHSA. Citation of the source is appreciated. However,this publication may not be reproduced or distributed for afee without the specific, written authorization of theOffice of Communications, SAMHSA, DHHS.

Electronic Access and Copies of Publication

This publication can be accessed electronically through thefollowing Internet World Wide Web connection:

www.samhsa.gov. For additional copies of this document,please call SAMHSA's National Mental Health ServicesInformation Center at 1-800-789-2647.

Originating Office

Center for Mental Health ServicesSubstance Abuse and Mental Health ServicesAdministration5600 Fishers Lane, Room 15-99Rockville, MD 20857

SMA-3720


This booklet is one of six mental health self-helpbooklets:

Making and Keeping Friends

Building Self-Esteem


Dealing with the Effects of Trauma

Speaking Out for Yourself

Developing a Recovery and Wellness Lifestyle.

This booklet contains information, ideas, andstrategies that people from all over the country havefound to be helpful in relieving and preventingtroubling feelings and symptoms. The information inthis booklet can be used safely along with your otherhealth care treatment.

You may want to read through this booklet at leastonce before you begin working on developing yourown action plans for prevention and recovery. Thiscan help enhance your understanding of the entireprocess. Then you can go back to work on eachsection. You may want to do this slowly, working on aportion of it and then putting it aside and comingback to it at another time. After you have finisheddeveloping your plan, you may want to review and

revise it on a regular basis as you learn newthings about yourself and ways you can helpyourself to feel better.

Charles G. Curie, M.A., A.C.S.W.

Administrator

Substance Abuse and Mental Health

Services Administration

Bernard S. Arons, M.D.

Director

Center for Mental Health Services

IntroductionDo you experience feelings and symptomsthat are upsetting, that keep you from being

the way you want to be and doingthe things you want to do? Manypeople who have troublingemotional, psychiatric, or physicaldsrnptoms have made greatadvances in learning how to dothings to help themselves get

.AL well and stay. well. One of the, , most frustrating stages of

recovering your health is when-you realize that you can do manythings to help yourself stay wellbut you can't figure out a way todo-them regularly. It is easy to

forget simplepie things that you know, especiallywhen you are under stress or when yoursymptoms are beginning to flare up. Theaction plans for prevention and recoverydescribed in this booklet were devised bypeople who experience emotional orpsychiatric symptoms. They developed waysto deal with their need for structure in theirlives that actively support their health. Theplans are simple, low-cost, and can bechanged and added to over time as you learnmore and more. Anyone can develop and usethese plans for any kind of health concern.

People using this system report that by beingprepared and taking action as necessary, theyfeel better more often and have improved the


overall quality of their lives dramatically. Oneperson said, "Finally, there's something I cando to help myself."

Action plans for prevention and recovery workbecause they

are easy to develop and easy to use

are individualized. You develop your plan foryourself. No one else can do it for you;however, you can reach out to others forassistance and support

improve your ability to communicateeffectively with your family members andhealth care providers

directly address the feelings, symptoms,circumstances, and events that are mosttroubling to you with plans to respond to them

renew your sense of hope that things can andwill get better, and that you have control overyour life and the way you feel

Le

C.. A .6


Developing aWellness ToolboxTo develop this plan, the only materials youneed are a three-ring binder, a set of fivetabs or dividers, and lined three-hole paper.Before you begin working with the tabbed

sections, you will create a resource list to keep inthe beginning of your binder. This section iscalled the Wellness Toolbox. In it you identifyand list the things you use to help yourself feelbetter when you are having a hard time. Some ofthem are things you know you must do, likeeating healthy meals and drinking plenty ofwater; others are things you could choose to do tohelp yourself feel better. You can also list thingsyou would like to try using to keep yourself wellor to help yourself feel better. You will refer tothis list for ideas when you are developing thetabbed sections of your plan. Some ideas for yourWellness Toolbox might be

eating three healthy meals a day

drinking plenty of water

getting to bed by 10:00 p.m. (or at a goodregular time for you)

doing something you enjoylike playing amusical instrument, watching a favorite TVshow, knitting, or reading a good book

exercising

doing a relaxation exercise

writing in your journal

talking to a friend on the telephone

taking medications

taking vitamins and other food supplements

You can get more ideas for your Wellness Toolboxby noticing the good things you do as you gothrough your day, by asking your friends andfamily members for suggestions, and by lookinginto self-help resource books. Write downeverything, from really easily accessible things,like taking deep breaths, to things you only doonce in a while, like getting a massage. This is aresource list for you to refer back to when you aredeveloping your plans. Your Wellness Toolboxworks best for you if you have enough entries soyou feel you have an abundance of choices. Justhow many entries you have is up to you. If youfeel positive and hopeful when you look at thelist, then you have enough. You can continue torefine your Wellness Toolbox over time, adding toyour list whenever you get an idea of somethingyou'd like to try, and crossing things off your listif you find they no longer work for you.

Once you've gotten your Wellness Toolboxunderway, insert it into your notebook. Then,insert your five tabbed dividers, with severalsheets of paper after each tab and a supply ofpaper at the end of the notebook.

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0 0


Daily MaintenancePlanOn the first tab write "Daily MaintenancePlan." If you haven't already done so, insertit in the binder along with several sheets ofpaper.

Feeling Well On the first page, describe yourselfwhen you are feeling all right. If you can'tremember, or don't know how you feel when youare well, describe how you would like to feel.Make it easy. Make a list. Some descriptive wordsthat others have used include: bright, talkative,outgoing, energetic, humorous, reasonable,argumentative. Now when you aren't feeling verywell you can refer back to how you want to feel.

Dreams and Goals Some people use their plansto make a list of their dreams and goals, too. Ifyou think you would find it helpful, make a list ofgoals you could work toward. You can write downfar-fetched goals or more easily achievable ones.It is really helpful to remember your goals anddreams so you always have something to lookforward to. Then, you can identify steps to taketo achieve them and incorporate these smallsteps into your daily maintenance plan.

Daily List On the next pages, describe thosethings you need to do every day to maintain yourwellness. Use your Wellness Toolbox for ideas.Writing these things down and reminding

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9

yourself daily to do them is an important steptoward wellness. When you start to feel "out ofsorts," you can often trace it back to "not doing"something on this list. Make sure you don't putso many things on this list that you couldn'tpossibly do them all. Remember, this is a list ofthings you must do, not things you would chooseto do. Following is a sample daily maintenancelist. eat three healthy meals and three healthy

snacks that include whole grain foods,vegetables, and smaller portions of protein

. drink at least six 8-ounce glasses of water

.1 get exposure to outdoor light for at least 30minutes

- . take medications and vitamin supplements

. have 20 minutes of relaxation or meditationtime or write in my journal for at least 15minutes

. spend at least half an hour enjoying a fun,affirming, and/or creative activity

II check in with my partner for at least 10minutes

. check in with myself: "how am I doingphysically, emotionally, spiritually?"

. go to work if it's a workday

Reminder List On the next page, make areminder list for yourself of things you might needto do. Check the list each day to ensure that you

12


do those things that you need to do sometimes tokeep yourself well. You'll avoid a lot of the stressthat comes from forgetting occasional butimportant tasks. Write "Do I Need To?" at thetop of this page and then list things such as

set up an appointment with one of my healthcare professionals

spend time with a good friend or be in touchwith my family

do peer counseling

do some housework

buy groceries

do the laundry

have some personal time

plan something fun for the evening orweekend

write some letters

go to support group

That's the first section of the book. Cross outitems if they stop working for you, and add newitems as you think of them. You even can tear outwhole pages and write some new ones. You willbe surprised how much better you will feel afterjust taking these positive steps on your ownbehalf.

`1'.rw

f '


TriggersTriggers are external events orcircumstances that may produce veryuncomfortable emotional or psychiatricsymptoms, such as anxiety, panic,discouragement, despair, or negative self-talk. Reacting to triggers is normal, but if

we don't recognize them and respond to themappropriately, they may actually cause adownward spiral, making us feel worse and worse.This section of your plan is meant to help youbecome more aware of your triggers and todevelop plans to avoid or deal with triggeringevents, thus increasing your ability to cope andstaving off the development of more severesymptoms.

Identifying Triggers Write "Triggers" on thesecond tab and insert several sheets of paper. Onthe first page, write down those things that, ifthey occur, might cause an increase in yoursymptoms. They may have triggered or increasedsymptoms in the past. It may be hard to think ofall of your triggers right away. Add triggers to yourlist whenever you become aware of them. It isnot necessary to project catastrophic things thatmight happen, such as war, natural disaster, or ahuge personal loss. If those things were to occur,you would use the actions you describe in thetriggers action plan more often and increase thelength of time you use them. When listing yourtriggers, write those that are more possible or

15

sure to occur, or which may already be occurringin your life. Some examples of common triggersare

the anniversary dates of losses or trauma

frightening news events

too much to do, feeling overwhelmed

family friction

the end of a relationship

spending too much time alone

being judged, criticized, teased, or put down

financial problems, getting a big bill

physical illness

sexual harassment

being yelled at

aggressive-sounding noises or exposure toanything that makes you feel uncomfortable

being around someone who has treated youbadly

certain smells, tastes, or noises

Triggers Action Plan On the next page, developa plan of what you can do, if a trigger come up, tocomfort yourself and keep your reactions frombecoming more serious symptoms. Include toolsthat have worked for you in the past, plus ideasyou have learned from others, and refer back toyour Wellness Toolbox. You may want to include

16


things you must do at these times, and thingsyou could do if you have time or if you think theymight be helpful in this situation. Your planmight include

make sure I do everything on my dailymaintenance list

call a support person and ask them to listenwhile I talk through the situation

do a half-hour relaxation exercise

write in my journal for at least half an hour

ride my stationary bicycle for 45 minute

pray

play the piano or work on a fun activity for 1hour

If you are triggered, and you do these things andfind they are helpful, then, keep them on yourlist. If they are only somewhat helpful, you maywant to revise your action plan. If they are nothelpful. keep looking for and trying new ideasuntil you find the most helpful. You can learnnew toes by attending workshops and lectures,reading; _1f- -help books, and talking to yourhealth care provider and other people whoexperience similar symptoms.

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Action Planning for Preventionn and Recovery


Early Warning SignsEarly warning signs are internal and may ormay not arise in reaction to stressfulsituations. In spite of your best efforts totake care of yourself, you may begin toexperience early warning signs, subtle signsof change that indicate you may need to

take further action. If you can recognize andaddress early warning signs right away, you oftencan prevent more severe symptoms. Reviewingthese early warning signs regularly helps you tobecome more aware of them. Write "EarlyWarning Signs" on the third tab and insertseveral more sheets of paper in your binder.

Identify early warning signs On the first page,make a list of early warning signs you havenoticed in yourself in the past. How do you feelwhen you know you are not feeling quite right?How did you feel just before you had a hard timein the past or when you noticed that your habitsor routines changed? Your early warning signsmight include things such as

anxiety

nervousness

forgetfulness

inability to experience pleasure

lack of motivation

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feeling slowed down or speeded up

being uncaring

avoiding others or isolating

being obsessed with something that doesn'treally matter

displaying of irrational thought patterns

feeling unconnected to my body

increased irritability

increased negativity

not keeping appointments

changes in appetite

restlessness

If you want to, ask your friends, family membersand other supporters for early warning signs thatthey've noticed.

On the next pages, develop an action plan forresponding to your early warning signs, referringto your Wellness Toolbox for ideas. Some of thethings you list may be the same as those youwrote on your Triggers Action Plan. If you noticethese symptoms, take action while you still can.

The following is a sample plan for dealing withearly warning signs

do the things on my daily maintenance plan,whether I feel like it or not


tell a supporter/counselor how I am feelingand ask for advice. Ask him or her to help mefigure out how to take action

peer counsel at least once each day

do at least three, 10-minute relaxationexercises each day (simple exercises describedin many self-help books that help you relaxthrough deep breathing and focusing yourattention on certain things)

write in my journal for at least 15 minuteseach day

spend at least 1 hour involved in an activity Ienjoy each day

ask others to take over my householdresponsibilities for the day

(I also might, depending on the circumstances)

check in with my physician or other healthcare professional

read a good book

dance, sing, listen to good music, play a

musical instrument, exercise, go fishing, or flya kite

Again, if you use this plan and it doesn't help youfeel better, revise your plan or write a new one.Use your Wellness Toolbox and other ideas fromworkshops, self-help books, your health careproviders, and other people who experiencesimilar symptoms.

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ill


When Things AreBreaking Down orGetting WorseIn spite of your best efforts, your symptomsmay progress to the point where they are

very uncomfortable, serious, and even dangerous.This is a very important time. It is necessary totake immediate action to prevent a crisis or lossof control. You may be feeling terrible and othersmay be concerned for your wellness or safety, butyou can still do the things that you need to do tohelp yourself feel better and keep yourself safe.

Signs that things are breaking down: Write"When Things are Breaking Down," or somethingthat means that to you, on the fourth tab. On thefirst page, make a list of symptoms that indicateto you that things are breaking down or gettingmuch worse. Remember that symptoms and signsvary from person to person. What may mean"things are getting much worse" to one personmay mean a "crisis" to another. Your signs orsymptoms might include

feeling very oversensitive and fragile

responding irrationally to events and theactions of others

feeling very needy

being unable to sleep

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sleeping all the time

avoiding eating

wanting to be totally alone

substance abusing

taking out anger on others

chain smoking

eating too much

On the next page, write an action plan that youthink will help reduce your symptoms when theyhave progressed to this point. The plan nowneeds to be very direct, with fewer choices andvery clear instructions.

Some ideas for an action plan are=

call my doctor or other health careprofessional, ask for and follow his or herinstructions

call and talk for as long as necessary to mysupporters

arrange for someone to stay with me aroundthe clock until my symptoms subside

make arrangements to get help right away ifmy symptoms worsen

make sure I am doing everything on my dailycheck list

arrange and take at least three days off fromany responsibilities

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Action Planning fOr Prevention and Recovery

have at least two peer counseling sessions

do three deep-breathing relaxation exercises

write in my journal for at least half an hour

schedule a physical examination or doctorappointment or a consultation with anotherhealth care provider

ask to have medications checked

As with the other plans, make note of the partsof your plan that work especially well. Ifsomething doesn't work or doesn't work as well asyou wish it had, develop a different plan or revisethe one you usedwhen you are feeling better.Always look for new tools that might help youthrough difficult situations.


9s6

.tAAA A a AA.41

Le


Crisis PlanningIdentifying and responding to symptomsearly reduces the chances that you will findyourself in crisis. It is important to confrontthe possibility of crisis, because in spite ofyour best planning and assertive action inyour own behalf, you could find yourself in a

situation where others will need to take overresponsibility for your care. This is a difficultsituationone that no one likes to face. In acrisis, you may feel as if you are totally out ofcontrol. Writing a clear crisis plan when you arewell, to instruct others about how to care for youwhen you are not well, helps you maintainresponsibility for your own care. It will keep yourfamily members and friends from wasting timetrying to figure out what to do for you. It relievesthe guilt that may be felt by family members andother caregivers who may have wonderedwhether they were taking the right action. It alsoinsures that your needs will be met and that youwill get better as quickly as possible.

You need to develop your crisis plan when you arefeeling well. However, you cannot do it quickly.Decisions like this take time, thought, and oftencollaboration with health care providers, familymembers and other supporters. Over the nextfew pages, information and ideas that others haveincluded in their crisis plans will be shared. Itcan help you develop your own crisis plan.


The crisis plan differs from the other actionplans in that it will be used by others. The otherfour sections of this planning process areimplemented by you alone and need not beshared with anyone else; therefore you can writethem using shorthand language that only youneed to understand. However, when writing acrisis plan, you need to make it clear, easy tounderstand, and legible. While you may havedeveloped other plans rather quickly, this plan islikely to take more time. Don't rush the process.Work at it for a while, then leave it for severaldays and keep coming back to it until you havedeveloped a plan you feel has the best chance ofworking for you. Once you have completed yourcrisis plan, give copies of it to the people youname in this plan as your supporters.

On the fifth tab write "Crisis Plan" and insert atleast nine sheets of paper. This crisis plan samplehas nine parts to it, each addressing a particularconcern.

Part 1 Feeling well Write what you are like whenyou are feeling well. You can copy it from Section1, Daily Maintenance Plan. This can helpeducate people who might be trying to help you.It might help someone who knows you well tounderstand you a little better, for someone whodoesn't know you wellor at allit is veryimportant.

Part 2 Symptoms Describe symptoms thatwould indicate to others that they need to takeover responsibility for your care and makedecisions on your behalf. This is hard foreveryone. No one likes to think that someone

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else will have to take over responsibility for his orher care. Yet, through a careful, well-developeddescription of symptoms that you know wouldindicate to you that you can't make smartdecisions anymore, you can stay in control evenwhen things seem to be out of control. Allowyourself plenty of time to complete this section.Ask your friends, family members, and othersupporters for input, but always remember thatthe final determination is up to you. Be very clearand specific in describing each symptom. Don'tjust summarize; use as many words as it takes.Your list of symptoms might include

being unable to recognize or correctly identifyfamily members and friends

uncontrollable pacing; inability to stay still

neglecting personal hygiene (for how manydays?)

not cooking or doing any housework (for howmany days?)

not understanding what people are saying

thinking I am someone I am not

thinking I have the ability to do something Idon't

displaying abusive, destructive, or violentbehavior, toward self, others, or property

abusing alcohol and/or drugs

not getting out of bed (for how long?)

refusing to eat or drink


Part 3 Supporters In this next section of thecrisis plan, list these people who you want totake over for you when the symptoms you listedin the previous section arise. Before listingpeople in this part ofyour plan though, talk withthem about what you'd like from them and makesure they understand and agree to be in the plan.They can be family members, friends, or healthcare providers. They should be committed tofollowing the plans you have written. When youfirst develop this plan, your list may be mostlyhealth care providers. But as you work ondeveloping your support system, try to add morefamily members and friends because they will bemore available.

It's best to have at least five people on your listof supporters. If you have only one or two, whenthey go on vacation or are sick, they might not beavailable when you really need them. Ifyou don'thave that many supporters now, you may need towork on developing new and/or closerrelationships with people. Ask yourself how bestyou can build these kinds of relationships. Seeknew friends by doing things such as volunteeringand going to support groups and communityactivities. (See Making and Keeping Friends aMental Health self-help booklet in this series)

In the past, health care providers or familymembers may have made decisions that were notaccording to your wishes. You may not want theminvolved in your care again. If so, write on yourplan, "I do not want the following peopleinvolved in any way in my care or treatment."Then list those people and why you don't wantthem involved. They may be people who have

30

treated you badly in the past, have made poordecisions, or who get too upset when you arehaving a hard time.

Many people like to include a section thatdescribes how they want possible disputesbetween their supporters settled. For instance,you may want to say that if a disagreement occursabout a course of action, a majority of yoursupporters can decide or a particular person willmake the determination. You also might requestthat a consumer or advocacy organization becomeinvolved in the decisionmaking.

Part 4 Health care providers and medicationsName your physician, pharmacist, and otherhealth care providers, along with their phonenumbers. Then list the following

the medications you are currently using, thedosage, and why you are using them

the medications you would prefer to take ifmedications or additional medications becamenecessarylike those that have worked wellfor you in the pastand why you wouldchoose those

the medications that would be acceptable toyou if medications became necessary and whyyou would choose those

the medications that must be avoidedlikethose you are allergic to, that conflict withanother medication, or cause undesirable sideeffectsand give the reasons they should beavoided.


Also list any vitamins, herbs, alternativemedications (such as homeopathic remedies),and supplements you are taking. Note whichshould be increased or decreased if you are incrisis, and which you have discovered are notgood for you.

Part 5 Treatments There may be particulartreatments that you like in a crisis situation andothers that you would want to avoid. The reasonmay be as simple as "this treatment has or hasnot worked in the past," or you may have someconcerns about the safety of this treatment.Maybe you just don't like the way a particulartreatment makes you feel. Treatments here canmean medical procedures or the manypossibilities of alternative therapy, (such asinjections of B vitamins, massages, or cranialsacral therapy). In this part of your crisis plan,list the following

treatments you are currently undergoing andwhy

treatments you would prefer if treatments oradditional treatments became necessary andwhy you would choose those

treatments that would be acceptable to you iftreatments were deemed necessary by yoursupport team

treatments that must be avoided and why

Part 6 Planning for your care Describe a plan foryour care in a crisis that would allow you to staywhere you like. Think about your family andfriends. Would they be able to take turns

Describea planfor yourcare ina crisis


providing you with care? Could transportation bearranged to health care appointments? Is there aprogram in your community that could provideyou with care part of the time, with familymembers and friends taking care of you the restof the time? Many people who would prefer tostay at home rather than be hospitalized aresetting up these kinds of plans. You may need toask your family_ members, friends, and health careproviders what options are available. If you arehaving a hard time coming up with a plan, atleast write down what you imagine the idealscenario would be.

Part 7 Treatment facilities Describe thetreatment facilities you would like to use iffamily members and friends cannot provide youwith care, or if your condition requires hospitalcare. Your options may be limited by the facilitiesavailable in your area and by your insurancecoverage. If you are not sure which facilities youwould like to use, write down a description ofwhat the ideal facility would be like. Then, talkto family members and friends about theavailable choices and call the facilities to requestinformation that may help you in making adecision. Also include a list of treatment facilitiesyou would like to avoidsuch as places whereyou received poor care in the past.

Part 8 What you need from others Describe whatyour supporters can do for you that will help youfeel better. This part of the plan is veryimportant and deserves careful attention.Describe everything you can think of that you

33

want your supporters to do (or not do) for you.You may want to get more ideas from yoursupporters and health care professionals.

Things others could do for you that would helpyou feel more comfortable might include

listen to me without giving me advice, judgingme, or criticizing me

hold me (how? how firmly?)

let me pace

encourage me to move, help me move

lead me through a relaxation or stressreduction technique

peer counsel with me

provide me with materials so I can draw orpaint

give me the space to express my feelings

don't talk to me (or do talk to me)

encourage me and reassure me

feed me nutritious food

make sure I take my vitamins and othermedications

play me comic videos

play me good music (list the kind)

just let me rest

34

Includea list ofspecifictasksyou _

wouldlikeothers todo foryou.


Include a list of specific tasks you would likeothers to do for you, who you would like to dowhich task, and any specific instructions theymight need. These tasks might include

buying groceries

watering the plants

feeding the-pets

taking care of the children

paying the bills

taking out the garbage or trash

doing the laundry

You may also want to include a list of things thatyou do not want others to do for youthingsthey might otherwise do because they think itwould be helpful, but that might even beharmful or worsen the situation. These mightinclude

forcing you to do anything, such as walking

scolding you

becoming impatient with you

taking away your cigarettes or coffee

talking continuously

Some people also include instructions in thissection on how they want to be treated by theircaregivers. These instructions might includestatements such as "kindly, but firmly, tell mewhat you are going to do," "don't ask me to make

35


any choices at this point," or "make sure to takemy medications out of my top dresser drawerright away."

Part 9 Recognizing recovery In the last part ofthis plan, give your supporters information onhow to recognize when you have recoveredenough to take care of yourself and they nolonger need to use this plan. Some examplesare

when I am eating at least two meals a day

when I am awake for six hours a day

when I am taking care of my personal hygieneneeds daily

when I can carry on a good conversation

when I can easily walk around the house

You have now completed your crisis plan. Updateit when you learn new information or change yourmind about things. Date your crisis plan eachtime you change it and give revised copies toyour supporters.

You can help ensure that your crisis plan will befollowed by signing it in the presence of twowitnesses. It will further increase potential foruse if you appoint and name a durable power ofattorneya person who could legally makedecisions for you if you were not able to makethem for yourself. Since power of attorneydocuments vary from state to state, you cannotbe absolutely sure the plan will be followed.However, it is your best assurance that yourwishes will be honored.

36


Using Your ActionPlansYou have now completed your action plansfor prevention and recovery. At first, youwill need to spend 15-20 minutes each dayreviewing your plans. People report that the

morning, either before or after breakfast, is thebest time to review the book. As you becomefamiliar with your daily list, triggers, symptoms,and plans, you will find the review process takesless time and that you will know how to respondwithout even referring to the book.

Begin with Section 1. Review the list of how youare if you are all right. If you are all right, do thethings on your list of things you need to do everyday to keep yourself well. Also refer to the pageof things you may need to do to see if anything"rings a bell" with you. If it does, make a note toyourself to include it in your day. If you are notfeeling all right, review the other sections to seewhere the symptoms you are experiencing fit.Then follow the action plan you have designed.

For instance, if you feel very anxious and knowthat it is because one of your triggers happened,follow the plan in the triggers section. If thereweren't any particular triggers but you noticedsome early warning signs, follow the plan youdesigned for that section. If you notice symptomsthat indicate things are breaking down, followthe plan you developed there.

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If you are in a crisis situation, the plans can helpyou realize it so you can let your supporters knowthey should take over. However, in certain crisissituations, you may not be aware or willing toadmit that you are in crisis. This is why having astrong team of supporters is so important. Theywill observe the symptoms you have reported andtake over responsibility for your care, whether ornot you are willing to admit you are in a crisis atthat time. Distributing your crisis plan to yoursupporters and discussing it with them isabsolutely essential to your safety and well-being.

You may want to take your plan or parts of yourplan to the copy shop to get a reduced-size copyto carry in your pocket, purse, or glovecompartment of your car. Then you can refer tothe plan if triggers or symptoms come up whenyou are away from home.

People who are using these plans regularly andupdating them as necessary are finding that theyhave fewer difficult times, and that when they dohave a hard time, it is not as bad as it used to beand it doesn't last as long.

3$


Further ResourcesIt is always a good idea to learn all you can abouttaking good care of yourself. Your book of actionplans is a great place to keep notes about thingsyou want to try and new information you learn.You may want to contact the followingorganizations for more information.

Substance Abuse and Mental HealthServices AdministrationSAMHSACenter for Mental Health ServicesWeb site: www.samhsa.gov

SAMHSA's National Mental Health ServicesInformation CenterP.O. Box 42490Washington, D.C. 200151 (800) 789-2647 (voice)Web site- www.mentalhealth.org

Consumer Organization and NetworkingTechnical Assistance Center(CONTAC)1036 Quarrier StreetCharleston, WVA 253011 (888) 825-TECH (8324)(304) 346-9992 (fax)Web site- www.contac.org

National Alliance for the Mentally Ill (NAMI)(Special Support Center)Colonial Place Three2107 Wilson Boulevard, Suite 300Arlington, VA 22201-3042(703) 524-7600Web site: www.nami.org

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National Depressive and Manic DepressiveAssociation (National DMDA)730 N. Franklin Street, Suite 501Chicago, IL 60610-3526(800) 826-3632Web site: www.ndmda.org

National Empowerment Center599 Canal Street, 5 EastLawrence, MA 018401-800-power2u(800)TTY-POWER (TTY)(978)681-6426 (fax)Web site: WWW. nec.org

National Mental Health Consumers' Self-HelpClearinghouse1211 Chestnut St., Suite 1000Philadelphia, PA 191071-800-553-4539 (voice)215-636-6310 (fax)email: [email protected]/mha/cl_house.html

Resources listed in this document do not constitute an endorsement by CMHS/SAMHSA/HHS,nor are these resources exhaustive. Nothing is implied by an organization not being referenced.

0

Center for Mental Health Services

Substance Abuse and Mental HealthServices Administration

Consumer Information SeriesVolume 10SMA-3720

Printed 2002

41.

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