Crisis planning | Right Decisions

Crisis planning is important for the care and treatment of people with personality disorder. Both patients and clinician roles are important to the process. The patient’s crisis self-management plan and the clinical crisis care plan should both be seen as dynamic documents to be reviewed and amended as the patient’s self-knowledge and skills develop. Review and update of both plans should occur at the earliest opportunity after a crisis.

Useful telephone support, advice and helplines can be found in the Appendix.

Patient’s crisis (self-management) plan

In assisting a patient to develop their own crisis self-management plan, clinicians support self-management by highlighting the strengths and responsibilities of the patient. The format of a patient’s crisis plan can vary, but will generally include individualised information on crisis indicators, what has helped in the past, what has been unhelpful, useful contacts and specific plans for self-management of future crises. Examples of template crisis self-management plans are available in the appendix for this section.

Patient’s crisis self-management plans should be developed as early as possible in the treatment process, ideally from the point of assessment and diagnosis. It is important that the plan should be developed at a time when the patient is not in acute crisis and can draw upon their baseline capacity for planning and problem solving. The clinician should support the patient to take responsibility for developing their own plan and avoid providing “the answers” as far as possible.

The process itself should be:

a validating one,
promoting the patient’s role of primary responsibility in their own recovery and,
highlighting their ability to at least attempt to resolve what may seem to be overwhelming problems.

In keeping with the principle of self-management, the finished document remains the property of the patient for them to refer to when necessary. Clearly, for the plan to be useful in the process of self-management, it should be kept in a readily accessible place, ideally carried by the patient at all times. It is of particular importance for the patient to be able to locate the document as easily as possible, as the ability to find the document when a crisis is evolving is likely to be much reduced.

Patient’s crisis (self-management) plan is available in the appendix

While it is important that it is recognised that the patient retains ownership of the document, it is recommended that the patient shares it with those involved in their care. Clinicians can then make the important information in the crisis plan accessible to other treating clinicians, for example by keeping a copy in the patient’s medical notes, attaching a copy to clinic letters so that it can be placed in SCI store or scanned into the patient record in Primary Care, encouraging GPs to consider using the ‘Special Notes’ system for NHS24 contacts or similar.

Clinical crisis care plan

A clinical crisis care plan is developed by the treating team with the collaboration of the patient to provide a plan on how the team aims to respond to the patient’s next crisis. Such a crisis care plan may form part of standard care planning but for patients with more severe presentations, the Care Programme Approach documentation may prove useful. The patient’s crisis self management plan is likely to complement a crisis care plan and consideration should be given to keeping a copy of the crisis self-management plan with the crisis care plan or CPA.