Our mental health can vary in time, from very healthy all the way to requiring hospitalisation. Each step of the way there are things we can do to help, maintain or hinder our level of wellbeing. As our mental health progress towards crisis, it becomes harder to know what to do to help ourselves, and very difficult for others to know what to do to support our safety and wellbeing without accidentally hindering us instead. Here we cover the best Safety Plan on the internet, which you can download from the link for your own use, for free.

Introductory Skills

Affecting Change

Interoception

Interoception is the ability to look in at yourself and know how you are feeling. Those feelings could be an emotion like fear or happiness, your level hunger, if you need to go to the toilet, fatigue and so on.

We have many internal signal systems that tell us both about ourselves (interoception) and our environment (perception), and our assessment of our perception (interoception specifically emotional feeling). Far too often, people don’t really know what these signals mean and so don’t recognise the clues that interoception is giving them. If this were a video game, it would be the “character status bars”, like health, fatigue, hunger, mana and so on – your current “state of being”. If you were low on health points, you might avoid that next monster, or if your hunger was also low, you might eat to allow yourself to get more health points before you deal with the monster. Connecting to your interoception allows you to connect to your state of being and make adjustments for what to do to keep it optimised and ensure you have the resources to meet the situation, or back off from it.

When we learn to sense these signals and know what they mean, we can take much wiser decisions so that we can optimise our health in balance to our focus and the environment. That is, not spending too much personal resource (spoons) on our self checking, but trying to be good enough for the environment that you are in, and knowing when you need to make some changes.

Stress Mountain

Stress Mountain is a tool for understanding the general phases of becoming distressed to the point of crisis. The important part is understanding how your ability to make decisions becomes more impaired as your Survival Mode brain takes over, meaning that you can’t think things through, you can’t comprehend what people are saying to you and you become more black and white.

Safety Plan

Page 1 – Identifying and Deciding Flowchart

The goal of this page is to identify what part of Stress Mountain we are on, and from that what actions to do and what to avoid.

Phase 1 – Identifying My State of Being

The middle column of Page 1 is articulating what behaviours, beliefs and other ‘tells’ inform you that you are doing well at your Baseline, that the you’ve received some Rumble Warnings, when you are Distressed, when you are in manageable Crisis, and when your type of Crisis needs you to go to hospital

List clear signs that indicate to you what your current state is. That can include feelings, behaviours and environments. Also include ways for a trusted observer to tell that you are doing well (Baseline) or that they need to check in on you (Rumble Warnings & Distressed) or that they need to initiate various Crisis actions.

This allows a quick ‘check in’, so that you tell that things are fine and you don’t have to do too much self monitoring, or that perhaps you may need to take some actions. Some of this will be an internal interoception check, some of this will be an external “how am I doing” that others can see.

Baseline, I am well

The Baseline helps you to identify what it looks like (internally via Interoception and externally as observed by other people) when you are well. Beyond a basic check in and routine maintenance (meds, food, rest etc), most of your actions will be on autopilot, defined by the situation or based on your wants.

The ideal time to create this Safety Plan is while you are at Baseline, or close to it. The worst time is while you are in Crisis.

Internal signs may include:

• I feel happy and content
• I am enjoying the things I usually enjoy
• I am eager to do tasks

External signs may include:

• I feel fine to go to work / school / meet up with friendly people
• Eating 3 to 4 meals a day is easy
• I respond appropriately to questions and can solve 2 stage problems

Adjust the above to suit yourself, add in any that aren’t on the list the help you to identify that you are at your Baseline (prior to any Rumble Warnings). We will address maintenance and avoidances in the next major section.

Distressed, I need some help

‘Distressed’ identifies that you are not doing well. Early Intervention Strategies either failed, or are no longer going to work. You are struggling to return to Baseline.

• It is too late to do Early Intervention Strategies
  • Early Intervention Strategies are useful for making a small difference and addressing the most likely easy reasons why you aren’t coping.
  • Early Intervention Strategies take more cognitive space and greater emotional stability than you have right now.
• It is time to Implement Late Intervention Strategies
  • Remove yourself from dangerous situations
  • Take PRN Medication scripted for this purpose
  • Call a friend, reach out for help, get a body double
  • Harm Minimisation

Reaching out for help can mean your primary trust people, and or your therapist (if you have that arrangement). Self checking should be more regular to determine if you are returning towards your Baseline or if you are increasing in distress. Care needs to be made to ensure you don’t slip down to the next layer and not notice.

This state of being requires more deliberate actions, avoidance of stressors, and reaching out for assistance.

You are not a burden, even if you feel like you are, and
the world is actually better off with you in it, even if you don’t feel that this is true.

Internal signs may include:

• My mood is generally angry / sad / scared / down.
• I am not doing any fun things because they aren’t fun.
• I am thinking of hurting myself and thinking about death, I a may even have a plan, but I don’t intend to do it.
• I find it hard not to think about doing things that are bad for me (state what they are).

External signs may include:

• Not leaving the house or avoiding coming home
• Eating too much junk food or avoiding food
• Moody, reactive, and or paranoid
• Self harm

If the Late Intervention Strategies are unavailable or ineffective, you will need to use your last choices to enact Harm Minimisation Strategies.

Internal signs may include:

• I am easily confused
• Mood is very dysregulated
• Serious thoughts about serious harm, but no to minimal actions taken
• Serious thoughts about killing yourself, but you are able to choose not to do it

External signs may include:

• No self care
• Non compliant with medication, not eating food, not sleeping
• Overly reactive to everything (without a good context reason for the mood)
• Signs of self harm
• Talk of dying, but no actions taken to do so

If you cannot follow your self-containment Safety Plan, then you will need to go to Psych Ward.

It can be hard to know who to trust when we are in Crisis.

The Protective bubble is a message to Crisis You from Calm and Rational You. Hopefully, someone that you can trust when you aren’t really sure of who to trust.

This is the place to write down a few good reasons why Calm and Rational You wants to remain unharmed. Aim for reasons that are really important to you, that aren’t too complex.

For example:

• The animals / children need you alive and safe
• It is against your fundamental beliefs
• You promised X that you wouldn’t, and you want to keep that promise

While these are suggestions to give you some ideas, this really had to be something that is fundamental to you.

Phase 2 – Prevention & Improvement

On the left side of Page 1, on each layer, are actions to help you maintain or improve your state of wellbeing. Each layer is likely to be different.

Early Intervention Strategies

In the Rumble, Early Warning phase, we have most of our cognitive faculties and our emotional balance shouldn’t be too disturbed. This allows us to use semi-complex Early Intervention Strategies that minimally interfering with our normal function.

The Safety Plan has pre-populated the most likely causes of a shift from the Baseline to prompt you to consider these first.

• Meds
• Food
• Rest
• Manage Sensory

Pre-populated are some other strategies that can be helpful in this phase.

• Mindfulness
• Meditation
• Breathing Exercise
• Centring Exercise
• Take a walk
• Read
• Play a brain game

Space is left for you to add in any other strategies that work well for you to recover your calm.

Late Intervention Strategies

When you are Distressed, your cognitive ability has been significantly compromised. That means that semi-complex actions like meditation, breathing exercises and brain games are probably beyond your ability. Pushing people to do these at this point often causes meltdowns.

The Safety Plan has pre-populated a few Late Intervention Strategies to consider.

• Call a friend, including who and their number
  • This is someone who is usually available and is good at helping you stay in control.
• PRN Medication
  • If your doctor or specialist has scripted some medication for you to use in distressing times like these, this is when you should be taking it.
  • If you haven’t been scripted medication, don’t take it.
• Leave the situation
  • If the factor that is compromising you is situational, it is best to move away from the event, person or thing that is exacerbating your situation.
• Isolation
  • If it is safe to do so, decrease social complexity by being alone.
  • If this is not good for you, then put a line through this.

Add in other strategies that have worked for you before, or that you would like to try when you are feeling Distressed.

Harm Minimisation

If you have entered into Crisis, then on Stress Mountain you are at the top of the peak. In the time that you have left with any cognitive control, it is time to get safe. That is, minimise harm.

Consider what kinds of physical, bodily or social harm you have done before and work out how to add distance between you in the Crisis state and that thing. Write down how to block or mitigate the risk so that you or your support person can enact these safety protocols.

For example:

• Cutting
  • Lock up the sharp objects you tend to use
  • Move to a known safe room.
• Hanging
  • Lock up the things you might use as cords.
  • Move to a known safe room.
• Pills
  • Lock the med safe.
  • If you don’t have a medication safe, perhaps it is wise to invest in one.
• Calling ex’s
  • Block or delete the ex’s number in your phone.
  • If safe to do so, turn your phone off.
  • Install a “drunk text blocker” app, where you need to solve a problem before you make a call.

Phase 3 – Avoidance

When we are in our right minds, we can often tackle some fairly tricky topics and tasks. As we become less cognitively and emotionally functional, there are things that we can’t handle well without making ourselves worse. These could be memories, photos, songs, people, foods and so on.

As our ability declines, there may be more things that we really should avoid.

The Avoid blocks are to remind ourselves NOT to do these things when we are feeling compromised.

On the right hand side are actions that often decrease your wellbeing and increase your risk. List actions, foods, substances and people that you should avoid doing on your own. If you need to do them (such as contact an ex regarding a child in common), do so with a trusted safe person present to support you.

Listing these when you are at your Baseline will help you do the good things and avoid the bad things when you are not in a good state of mind and it will also help guide other people how to help you. When you are in Crisis and can’t rely on the quality of your decision making, you can trust your younger self, who made wise decisions in calm times.

Page 2 – Allies and Medical

Page 2 is about listing who your allies are, who is not safe to contact when you are dysregulated and information that is helpful if you do need to go to hospital.

Listing Allies

Whenever you change your medication, it is important to update your medication list. Your Wellness and Safety Plan is a good place to do that, especially as if you do need to go to hospital or some other health service, you can bring it with you and then they’ll know what you are prescribed.

List the name of your medication, when you take it, how much you take and also list why you take that medication or any other important note about it.

If you are in hospital, then it is also wise to bring your list of allergies – if you have any. List what the allergy or intolerance is, and whether that is a medication, a food or something you may be in contact with. Also list what your known reaction to that is so that the medical staff can ensure you are kept safe.

Date Reveiwed

Dynamic Documents Need Review

After you have used this document to improve your health, it is important to make time to review how effective the document was. That use might be a crisis, or just a health check.

This is the dynamic aspect of the document.

What worked? Keep that.

What didn’t work? Modify that.

How would you do things better next time? Make the change, make a new date and try it again.

Beyond This:

Calming Down / Regainig Control

If you have accidentally triggered a fight/flight reaction, or are generally struggling, take a look at how to Calm Down.

If this is uncomon, probably a virus; if common, find out why

If it is uncommon for you to field weird like this, then you are likely coming down with a viral infection. If this is common for you to go through, talk to your GP and get some investigations going to find out why.