Trick #3

A Crisis Plan

I was required to make a Crisis Plan before being discharged from the psych ward, which really pissed me off. I didn’t want to make any promises about keeping safe. Suicidal thoughts were my drug of choice, and I didn’t want to let them go. Guess what? I didn’t have to. I just had to let go of acting on them.

Nevertheless, making a Crisis Plan seemed like an enormous task. It felt like the doctors and nurses were trying to control me, and beyond that, I was deeply afraid that no one would ever meet my needs again if I could suddenly meet them on my own. In reality, the doctors were teaching me how to manage my feelings. The Crisis Plan gave me choices, my own choices. When my feelings got out of control or I was hit with a suicidal thought, there were simple instructions to follow:

1. Take a deep breath.
2. Pray for help.
3. Ask for suicidal thoughts to be removed from my brain.
4. Choose an activity and pay attention to it.
5. Practice Feelings Versus Facts.
6. Call someone. . . .

The Crisis Plan not only helped me figure out what my needs and feelings were, it taught me how to ask for help without the drama of a suicide gesture.

Despite the severe resistance I felt at first, designing my Crisis Plan became enjoyable. I actually had fun with it. I’ve included various Crisis Plans to show how they changed as I did. I suggest you use Crisis Plan #1 as a guide to create your own.

Take a look at the sample plan opposite and remember—none of this can be learned overnight. “Chunk it down,” as my therapist would say. It’s one step at a time. One moment at a time. Everything in Crisis Plan #1 is discussed in this part of the book. All the elements—the Brady Bunch Syndrome, HALT, and so on—are listed in the table of contents in roughly the same order as they appear in the plan.

Difficult feelings come and go for everyone. A lot of people talk about “feeling their feelings.” I couldn’t afford that luxury; it usually led me into the suicide maze. I had to find the gray area inside my gray matter—black-and-white thinking was too dangerous an option. By using a Crisis Plan, I learned how to shine light on reality and lessen the effects of tunnel vision (either-or thinking). I learned how to distract my brain, shove suicidal thoughts aside, and create a better space for myself. It wasn’t easy by any means, but when I had a plan to follow, I was more likely to do something positive rather than fall into Never-Never Land.

A Crisis Plan is an organizer, a step-by-step recipe for survival. This simple list of activities, phone numbers, and reminders keeps you safe when your brain starts flipping out. This is the one trick I would urge you to follow completely. It is the backbone from which the rest of the book flows.

A Crisis Plan provides clarity when the brain is fogged by emotions. It makes decisions for you: if number 1 doesn’t work, go on to number 2; if 2 doesn’t work, go to number 3; and so on until you reach step 15, “Call an emergency contact,” and step 16, “Put down any weapons and keep both hands on the phone.” Hurting yourself is not an option on the Crisis Plan.

CRISIS PLAN #1

For When I’m Feeling Overwhelmed Angry Helpless Trapped Confused Lonely Possible Activities Take a warm bath. Play word games. Clean my bedroom. Do a puzzle. Go for a walk. Knit or crochet. Shower. Make a gift for someone. Reorganize my closet. Make notecards. Play with the cat. Blow soap bubbles. Draw or color. Plan menus for the week.

Take a deep breath. Ask for suicidal thoughts to be removed from my brain. HALT. Take another deep breath. Identify feelings. Practice Feelings Versus Facts. Write down feeling for later. “Do in spite of how I feel.” Choose an activity or task. Pay attention to that activity or task. Choose another activity or task. Call someone: Jeff 508-000-0000 Julie 508-000-0000 Jen 508-000-0000 Jenny 508-000-0000 Al-Anon 1-888-4AL-ANON Church 508-000-0000 Take a deep breath. Choose an activity or task and pay attention to it. Call an emergency contact: Sylvia (therapist) 508-000-0000 Cape Psych Center 1-800-000-0000 Cape Cod Hospital 1-800-273-TALK (1-800-273-8255) Put down any weapons and keep both hands on the phone.

Remember Feelings Versus Facts Brady Bunch Syndrome HALT All feelings change Do in spite of how I feel Act as if

I didn’t usually reach the final step in my Crisis Plan. By then, suicidal thoughts and difficult feelings were either gone or shoved aside; I had followed the plan and diverted my brain with simple tasks like washing the dishes, making my bed, or making a card for someone. Or I had used other tricks: turning on all the lights, dancing in the living room, going for a walk, yelling into a pillow, calling a friend, going to a support group meeting.

If the thoughts or feelings hadn’t subsided, then at least I was no longer physically alone. I would have invited myself to someone’s house, or invited them over to mine. Another option was to stay on the phone until it was time to sleep, then plan to call someone first thing in the morning. It may sound tedious, but it worked. For that round I had kept myself safe.

A Crisis Plan helps you find and create relief. I encourage you to make and use one.

STARTING YOUR CRISIS PLAN.

You will need several sheets of notebook paper, a pencil, a phone book, and tape. Before starting your plan, let’s do a stress reliever: Close your eyes or focus them on an object near you. Take several deep breaths and allow your body to sink into the chair or the floor. Then scrunch your shoulders up to your ears while scrunching your face tight, hold for three seconds, then release everything—including your breath—and let your shoulders drop. Take a deep breath. Repeat this exercise three times. Take another deep breath. Let’s begin.

A Crisis Plan follows a basic format and you provide the details, such as names and phone numbers, enjoyable tasks, hobbies, and so on. I encourage you to use your imagination.

SETTING UP A PLAN: REFER TO CRISIS PLAN #1

1. At the top of your paper, write “Crisis Plan” in the middle.
2. Under the heading “Crisis Plan,” write down the first eleven items from Crisis Plan #1.
3. Write “For When I’m Feeling” in the top left corner of the page. Under that heading, write at least four or five feelings that trigger suicidal thoughts for you (anger, sadness, frustration, and so on). Look at the Feelings Galore List here and the Feelings Chart here for ideas.
4. Beneath the “For When I’m Feeling” list, write “Possible Activities.” Then list eight to ten activities that you enjoy—hobbies, household chores, creative projects, sports. These activities need to be easy so that you don’t get stressed out trying to do them. See the Tasks and Activities List here for ideas. Note: drugs, alcohol, sex, cigarettes, and any mind-altering substance don’t belong in your Crisis Plan.
5. Before moving on to step 6, take a little break if you need it. Get up and stretch. Go outside for a breath of fresh air, get a snack. This eases the tension in your body and brain.
6. At the top right corner of the page, write “Remember.” Write down the list of tricks and reminders that appear under that heading in Crisis Plan #1.
7. On a separate sheet of paper, write the names of people you trust, who know what’s going on for you emotionally. Be choosy. If you are a teenager, be sure at least one of these people is over thirty years of age. It’s important to ask these people if they’ll be on your Crisis Plan. Later in this chapter I tell you how to do it. For now, just write down their names. Be sure to pick people who really know how to listen. If you call them and they start offering advice or shut you out, you might feel rejected, and that could make you feel worse.
8. Under that list of names write the names of the support hotlines that apply to you: Alateen, Al-Anon, AA, NA, OA, and so on.
9. Find phone numbers to put next to all the names on your list. For Twelve Step contact information, see part 7 or look in the phone book.
10. Write “12: Call someone:” on your crisis plan, then transfer the names and numbers from steps 7, 8, and 9 above.
11. Continue your Crisis Plan by writing down items 13 and 14 from Crisis Plan #1.
12. Add item 15, “Call an emergency contact:” and write down two or three emergency contact names and numbers, including 1-800-273-TALK (National Suicide Prevention Lifeline), the local hospital, your therapist, and your doctor. See the previous chapter, “Emergency Contacts,” for a list of other options.
13. The final step in the Crisis Plan is item 16: “Put down any weapons and keep both hands on the phone.”

Congratulations! This is your Crisis Plan. You did it. Now the trick is to use it.

ASKING PEOPLE TO BE ON YOUR PLAN

Yikes. For my first Crisis Plan, I had about five people to ask: my sisters, my niece, two friends. Since I like to get these things over with, I did it as soon as possible. I was still in the psych ward when I made the calls. It was hard. I felt embarrassed by what I’d done, angry that I had to call them, afraid of their possible rejection, and generally confused. But hearing their acceptance gave me hope and connection.

HOW TO ASK PEOPLE TO BE ON YOUR CRISIS PLAN

1. Ask one or two people each day, either over the phone or in person. If you phone, try to call when you know they’re not busy; if they’re in a hurry, you might feel rejected. Avoid dinnertime. If you know they’re home during the day, call then.
2. Try to have people nearby when you are making the calls. If you’re in therapy, try calling from your therapist’s office so that you’ll have support.
3. If you decide to ask in person, try to arrange a walk or some kind of activity. It’s easier than asking face-to-face at a dinner table. What you’ll probably find is that once you’ve talked to one person, the rest will seem less frightening.
4. Plan to do something enjoyable after you finish: listen to some great music, play with the dog, watch a movie.

WHAT TO SAY

1. “Hi. Do you have a minute to talk?” With luck, it will be a good time. If not, say, “Okay. When would be a good time for me to call you back?”
2. “I’m making a Crisis Plan to help me get through difficult moments, and I was wondering if you’d be willing to be part of my support system. Could I put your name on my phone list? I just need you to listen, rather than offer answers or advice. I just need support.” If the person says yes, that’s all you need do for the moment. Thank that person and either chat or say you’ve got other people to call.
3. If that person says no, thank him or her for being honest and take several deep breaths. You might feel rejected, which stinks, but it just means there’s someone more suitable to ask. It’s better for someone to say no now than it is for that person to say yes and then not be able to hear you later when you need help the most. Thank that person for listening to your request and say you have other people to call. Call the next person, then do something nice for yourself.

USING YOUR CRISIS PLAN

1. Make copies of your Crisis Plan. I even shrunk mine on the copier and kept it folded in my pocket. This way I always knew answers were at hand. Most libraries and schools have copiers.
2. Post your plan. Post copies of your plan wherever it will reinforce its presence in your life. Keep a copy by your bed on your nightstand. Tape a copy inside your journal or inside your locker door. Keep a copy in your desk. Keep a copy in the glove compartment, and another in your wallet. Tape one to the refrigerator and one to the bathroom mirror. Even if it feels threatening to put the plan everywhere, I encourage you to do it and simply glance at the plan when you walk by. You don’t have to become a Crisis Plan wizard. Simply bring it into your life. The information will gradually sink in, and it will become a habit. Remember: I don’t need one anymore. The Crisis Plan is not forever.
3. Show the plan to someone. If you’re in therapy, definitely give a copy to your therapist. When I called my therapist in crisis—a common occurrence—it was helpful for her to walk me through the plan over the phone. If you’re not in therapy, give a copy to at least one person you trust so that person can remind you to use it if you fall into crisis and are asking for help.

CRISIS PLAN #2

I used this plan in addition to my regular Crisis Plan when I was going through a phase of severe instability and testing (of others). I was determined to be hospitalized.

Cape Psych Center	508-000-0000
Mass Mental Health	617-000-0000
Mass General	617-000-0000
Beth Israel Hospital	617-000-0000
St. Elizabeth’s Hospital	617-000-0000

1. If Dad and Bert (wife) are home:
   1. Sylvia calls hospital and finds bed.
      1. Bed available: Dad and Bert drive me to hospital.
      2. Bed not available: I go to emergency room if I don’t feel safe.
2. If Dad and Bert are not home:
   1. Sylvia calls hospital and finds bed.
      1. Bed available:
         1. Calls Sally (her phone number) to drive me.
         2. If no #1, call Bob (Bob’s home and work numbers).
         3. If no #1 or #2, call Dave (Dave’s phone number).
      2. If I have to wait:
         1. If I feel safe, go to Sally’s, or . . .
         2. Go to Sylvia’s office and wait.
         3. If I don’t feel safe, go to emergency room.

CRISIS PLAN #3

This is a later, more fine-tuned plan that I used after I began to understand my feelings and knew more options. You can tell I was really getting into it.

CRISIS PLANS #4 AND #5

Both of these plans illustrate how my Crisis Plan changed as I did. The one on the left was designed specifically to deal with anger once it started to surface around the sexual abuse, my mother’s death, and so on. The other is an abbreviated version of the original plan that I used much later, after most of the original had become automatic.

Second-Stage Anger HALT. Make food (eat) if necessary. Ask god what to do. DO IT! Talk about it: Karen 508-000-0000 Sam 508-000-0000 Linda 508-000-0000 Marie 508-000-0000 Get anger out of my system: Throw rocks, eggs, or pillows. Pound pillows. Stomp around. Scream in the car or into a pillow. Rip up paper. Do something physical. Go to a meeting—SHARE! Pray about it. Turn anger over to god, ask god to distance me from anger. Go walking on the beach or in the woods.

Crisis Plan “Stop.” HALT. Get out of self. Get up and do something: Go to Animal Rescue League. Walk on the beach or in the woods. Color, draw. Straighten up. Take a shower. Go to a meeting. Call someone: Jeff 508-000-0000 Julie 508-000-0000 Jen 508-000-0000 Jenny 508-000-0000 Call Sylvia 508-000-0000. Call Emergency Services 1-000-000-0000. Call Cape Cod Hospital (1-000-000-0000). Call 911 (see note here).

SOMETHINGS TO THINK ABOUT

• I was an excellent martyr. I forced myself to suffer unnecessarily until the misery grew so great it was all I saw in front of me. Finally, I would let go of the misery and turn to the plan. I’d reach out for help—from myself, other people, or the Divine. Gradually the feelings would lessen, and in turn the intensity of the suicidal thought would lessen, or it would go away altogether. Sometimes it took an hour, sometimes it took two days or a week, but it always passed, 100 percent of the time. If I experienced the “I want to die” moment thousands of times, then suicidal thoughts have passed just as many times.
• When I was first out of the hospital, I turned to my Crisis Plan several times a day, every day. I carried it with me, kept a copy in my pocket, in my car, on the refrigerator, and in my journal, and gave my therapist a copy. Today I don’t use a Crisis Plan at all. I stopped needing one years ago. Using it was like strengthening the muscle of life. The more I used it, the stronger I got. I got better at managing my feelings and thoughts. I fell down less and got up faster.
• One day I realized, “Why be miserable if I have a choice not to? What am I trying to prove by hanging on to misery?” I was trying to be in control, but like I said, I was completely out of control. When I thought I wanted to die, my brain was in control. When I chose to change, my heart and spirit were in the driver’s seat.
• As I already mentioned, most suicidal thinkers don’t want to die, they want their feelings to change or go away; all feelings change, with or without any help from us. You can use the Crisis Plan to get you through difficult feelings, but you don’t have to wait until you’re having suicidal thoughts to use it. As you’ll see, the trick to all of this is to stop the domino effect before it reaches the suicide level.
• As when you learn any new skill, it can feel awkward when you first start using a Crisis Plan. The first time I rode a bike without training wheels I was thrilled—until I lost my balance and crashed on the pavement. I cried and didn’t want to get back on the bike because I didn’t think I could do it. Still, I kept trying and eventually found the balance to ride without crashing. I quickly discovered that to stay upright I had to move forward. Or if I slowed to a halt, I had to put my feet to the ground for stability. Healing from suicidal thoughts is a lot like learning how to ride a bike. We ride. We crash. We get up and ride a little farther. We have to move forward to stay upright. If we slow down we need to find support. We ride up hills, panting; we coast down the other side. Our legs and lungs get stronger, and pretty soon the hardest hill becomes a piece of cake. Eventually we learn how to ride with no hands, but it all takes practice and reinforcement.

Take a look at other Crisis Plans to see how things changed as I did.