Identifying and responding to symptoms early reduces the chances that you will find yourself in crisis. It is important to confront the possibility of crisis, because in spite of your best planning and assertive action in your own behalf, you could find yourself in a situation where others will need to take over responsibility for your care. Writing a clear crisis plan when you are well, to instruct others about how to care for you when you are not well, helps you maintain responsibility for your own care. It insures that your needs will be met and that you will get better as quickly as possible.

Elements of a Crisis Plan:

Part 1 Feeling well—Write what you are like when you are feeling well. This can help educate people who might be trying to help you. For someone who doesn’t know you well—or at all—it is very important.

Part 2 Symptoms—Describe symptoms that would indicate to others that they need to take over responsibility for your care and make decisions on your behalf. This is hard for everyone. No one likes to think that someone else will have to take over responsibility for his or her care. Yet, through a careful, well-developed description of symptoms that you know would indicate to you that you can’t make smart decisions anymore, you can stay in control even when things seem to be out of control.

Part 3 Supporters—In this next section of the crisis plan, list these people who you want to take over for you when the symptoms you listed in the previous section arise. Before listing people in this part of your plan though, talk with them about what you’d like from them and make sure they understand and agree to be in the plan. They can be family members, friends, or health care providers. They should be committed to following the plans you have written.

Part 4 Health care providers and medications—Name your physician, pharmacist, and other health care providers, along with their phone numbers. Then list the following—the medications you are currently using, the dosage, and why you are using them; the medications you would prefer to take if medications or additional medications became necessary—like those that have worked well for you in the past—and why you would choose those; the medications that would be acceptable to you if medications became necessary and why you would choose those; the medications that must be avoided—like those you are allergic to, that conflict with another medication, or cause undesirable side effects—and give the reasons they should be avoided. Also list any vitamins, herbs, alternative medications (such as homeopathic remedies), and supplements you are taking. Note which should be increased or decreased if you are in crisis, and which you have discovered are not good for you.

Part 5 Treatments—There may be particular treatments that you like in a crisis situation and others that you would want to avoid. The reason may be as simple as “this treatment has or has not worked in the past,” or you may have some concerns about the safety of this treatment. Maybe you just don’t like the way a particular treatment makes you feel. Treatments here can mean medical procedures or the many possibilities of alternative therapy.

Part 6 Planning for your care—Describe a plan for your care in a crisis that would allow you to stay where you like. Think about your family and friends. Would they be able to take turns providing you with care? Could transportation be arranged to health care appointments? Is there a program in your community that could provide you with care part of the time, with family members and friends taking care of you the rest of the time?

Part 7 Treatment facilities—Describe the treatment facilities you would like to use if family members and friends cannot provide you with care, or if your condition requires hospital care. Also include a list of treatment facilities you would like to avoid—such as places where you received poor care in the past.

Part 8 What you need from others—Describe what your supporters can do for you that will help you feel better. This part of the plan is very important and deserves careful attention. Describe everything you can think of that you want your supporters to do (or not do) for you. You may want to get more ideas from your supporters and health care professionals.

Part 9 Recognizing recovery—In the last part of this plan, give your supporters information on how to recognize when you have recovered enough to take care of yourself and they no longer need to use this plan.
You can help ensure that your crisis plan will be followed by signing it in the presence of two witnesses. It will further increase potential for use if you appoint and name a durable power of attorney–a person who could legally make decisions for you if you were not able to make them for yourself.

Source: www.samhsa.gov

At what point in your life did you figure out that you have very little control over other people? You can’t control what they think; you can’t control what they feel; you can’t control what they choose to do. And the more you try to control others, the more inadequate, angry, frustrated and depressed you will become.

If this is headline breaking news to you today, don’t despair! All is not lost. The good news is that you do have control over YOU! You can control what you think, what you feel, what you do AND how you choose to respond to what others directly say and do. The magic formula is CBT!

Today that principle is the foundation of a therapeutic model called Cognitive Behavioral Therapy. Ted Faris, a practicing psychotherapist, uses this treatment model successfully with his clients, many of whom suffer from mood disorders and addictions. He says it works because “our thoughts cause our feelings and behaviors, not external things, like people, situations and events. The benefit of this fact is that we can change the way we think to feel/act better even if the situation does not change.”

I asked Faris what motivates a person to make the leap from blaming other people for their problems to take on the responsibility (and the cost) of changing themselves. Faris replied, “Most folks don’t get into therapy until all the different ways they have tried to cope no longer work for them. They get sick and tired of trying to manipulate all the people, places, things, and situations on the outside and come to realize that they will never have any peace of mind until they make changes from the inside out.”

Faris describes CBT as “mastering the art of mindfulness.” CBT trains people to analyze the thoughts that run through their head. “It’s like becoming your own self-appointed lawyer, whose job it is to challenge your internal thought process and cross examine your beliefs. The question is ‘what real evidence supports your conclusions?’” Faris reports. Further, the therapist says that, “without this ability we remain like emotionally immature children. We react mindlessly to whatever comes into our head. We respond without thinking. All of life becomes a knee jerk reaction to outside stimuli.

CBT is designed to help clients recognize some of the self-defeating thought patterns and emotional triggers that have kept them caged in behaviors they want to change by being conscious in the present moment and become more flexible in their thinking.

Cognitive behavioral therapy educates clients about habitual patterns of “twisted thinking” that create conflict in their interpersonal relationships. Faris's list includes: 1) Black or White Thinking, i.e. “all or nothing” when shades of interpretation are more likely to give variety and flexibility to the way we interpret situations. 2)Over Generalizing—it is a “you always” or “you never” dialogue instead of the more user friendly “sometimes” or “perhaps.” 3) Mental Filtering occurs when one significant emotional experience blocks our ability to take in new information. The result is obsessive thinking. 4) Jumping to Conclusions sets you up as mind reader or a fortune teller. Not a welcome communication skill. 5) Magnification is a thought habit that makes “mountains out of mole hills.”

Faris says “sloppy thinking allows negative emotions to create a false reality.” For example, if you feel afraid of flying you are likely to conclude, erroneously, that flying is dangerous. Likewise, if you feel angry you may conclude that you have been treated unfairly.
Many people in therapy have learned to recognize how much psychic damage is done by their common mental habit of “shoulding” on themselves and others. Albert Ellis, Ph.D., calls this “musterbation.” We’ve internalized the do’s and don't’s we heard growing up. Now we believe that without the negative self-talk, we wouldn’t get anything done. Faris says, “could’a, should’a, ought’a thinking” is self-defeating. It escalates feelings of guilt and frustration. And when our critical mindset inevitably spills over onto other people, it produces resentment and anger in them.

Cognitive Behavioral Therapy trains us to pay attention to what we are thinking and feeling. “mindfulness” gives us a much greater range of “response-ability.” CBT won’t take always all of life’s problems but gives us many more options to interact with people and be comfortable in situations which used to frighten us.”
Jacqueline Castine, B.A., is a Community Education Specialist at the Oakland County Community Mental Health Authority. She is the author of I Wish I Could Fix It, But … (Phoenix Publishers, 2005).

She can be reached at castinej@occmha.org

The month of May was filled with plenty of activity for the Community Network Services’ Anti-Stigma Program. It was a great way for us to celebrate National Mental Health Month.

The team participated in two special advocacy events. The first was an advocacy training workshop that was sponsored by NAMI Michigan and AstraZeneca. The workshop was held at the historical Central United Methodist Church located right across the street from the Capitol Building in Lansing. The sessions were taught by Gabrielle King, Vice President and CEO of GDK Associates LLC located in Ellenwood, GA. We were excited and ready to engage our legislators with the tough issues that are facing us all.
After the workshop the team was able to join hundreds of consumers for the Walk a Mile in My Shoes Rally on the Capitol Building’s front lawn! This advocacy event was very powerful. It was inspiring to hear stories from several people across Michigan and see each county’s flag displayed.

Some other highlights from the month include:

An information table at the Oakland County Council for Children and Adults with Psychiatric Disabilities (OCAP) meeting

An information table at WHRC Elementary School in Pontiac

Our presentation, “The Power of Recovery”, at the CNS Consumer Celebration of Excellence breakfast

We wrapped up the month by being present at two faith-based events. First, NAMI Downtown Detroit had their faith-based conference. Malkia represented the team at our information table there. The team also spoke at the 2nd Annual Collaborative Mental Health Education Suicide Prevention Conference designed to foster partnerships between the mental health system and the faith-based and educational communities. Margaret and Malkia presented about mental health stigma and how the faith-based community can help those diagnosed with a mental illness.

Our desire is to continue our message of hope, education, and recovery to those throughout Michigan and beyond. If you are aware of any agency, organization, school, or community group you feel would benefit from the workshops that the CNS Anti-Stigma Program shares, feel free to contact us either by phone, 248-409-4227 or email mmaisha@cnsmi.org .