Following the BPD Pathway in Acute Care Meeting I Attended Recently, Below Is the Info

Following the BPD Pathway in Acute Care meeting I attended recently, below is the info on the WRAP Crisis Plan as promised...

I believe that a Crisis Plan is imperative for anyone in Mental Health Services. The way I ‘sell’ a crisis plan is to tell the service user that it is an insurance policy – something we hope never to need but which can be a lifesaver if it is needed. The way I ‘sell’ Wrap is to say that it is my Wrap which gets my feet on the floor of a morning and my day underway as regardless of how much support I receive from Services, medication, friends or family – it will be a complete waste of their time without some level of input, physical input, from me – regardless of how little I may be capable of, at some stage I have find a way to take an action.

I say that Wrap recognises that a crisis rarely arises from nothing. Rather, it is part of a process, which may be predictable, but does not have to be inevitable. With my Wrap I can mitigate a crisis at any time – even during the crisis – it gives me more control - even when it seems that things are out of control for me - by ensuring that I have input into what happens to me even if I am unable to express or effect these things myself. It also informs carers (whoever they may be) of how they may best support me e.g. for me it is to do ‘things’ with me but not for me.

Whilst the Crisis Plan is best if written when feeling well, a simple Crisis Plan may be done at any time (e.g. when an inpatient) and in-so-doing, it will contribute to the advantages mentioned above. I have a simple version towards the end as a way for the service user when either very unwell, before leaving hospital, or to simply ‘dip their toes’ into a Crisis Plan of their own. The reasons for this become clear through the breakdown list of the plan below. When unwell it is preferable for the service user to concentrate on those areas which are of particular concern to them e.g. pets or home support.

The Crisis Plan covers:

• What you are like when you are well - e.g. I am talkative when I am well but find it difficult to speak when very unwell.

• Indicators that others may need to ‘take over’ - e.g. there are signs that my personal hygiene is slipping.

• Who ‘takes over’ and who doesn’t with reasons and their contact details/keyholder details - e.g. one friend would be intrusive and exhaust me further and so deepen my ‘unwellness’.

• Information on health care contacts and medication.

• Acceptable and unacceptable treatments.

• Home/community/respite plan.

• Acceptable and unacceptable hospital facilities.

• Things others can do that would help – e.g. sit with me or let me move around.

• Things others might do that would make you feel worse – e.g. talking over me.

• A list of tasks for others and who I would like to do what e.g. finances or shopping.

• Indicators that the plan is no longer needed so that you may start to take back responsibilities and at what pace.

• How you want supporters to settle disputes if they disagree.

• Signatures of key people – as this will increase the likelihood of the plan being followed if signed in the presence of witnesses.

This ‘traffic light’ exercise is the very simple version which I use as a Crisis Plan ‘taster’ in the form of a colourful sheet with red, amber and green circles beside which the service user may write one thing that they would like to have in their immediate Crisis Plan.

RED: Something others may do that would make the service user feel worse.

AMBER: A task the service user would like done.

GREEN: Something others could do that would improve how the service user feels.

I do remind Service Users to keep in mind that their Wrap/Crisis Plan is a living document so does need updating with new information or, as I change my mind about things I feel would or would not work for me.

I stress that Services and supporters need to know that I have a Crisis Plan or it cannot be used so it should be e.g. entered on RiO if appropriate, given to relevant people (Services, GP, Police, Family etc.) E.g. I don’t have a CPA but my supporters know that my plan is kept in the green emergency bottle in my refrigerator.

I also ensure that the service user understands that whilst there is no guarantee that the plan will be followed (in that it could be overridden by the Mental Health Act or it may not be possible to meet my request e.g. choice of facility) it is my best chance of having my particular needs met and my wishes honoured. SHFT have undertaken to abide by Crisis Plans as much as possible.

By capturing the self-knowledge and experience I’ve garnered during my Wrap – however little this may be at the time, the Crisis Plan provides a practical way of circumventing a lot of the uncertainty that crises, by their very nature, bring in their wake and may significantly diminish the impact of the crisis. It does take time to consider, write, develop and set up - yet it saves the service user, their clinicians and supporters, frustration and time at a difficult time for all. Lastly, a crisis plan Is not just about being ‘in crisis’ but also about the service user moving through a crisis to the other side as seamlessly as possible.

Josanne Clark5th January 2015

Hampshire