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 can be hard to know what to do to help ourselves, and very difficult for others to know what to do to support our well-being instead of accidentally hindering us.
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Affecting Change
Some things we can change, some things we cannot. It is important to be able to tell the difference.
The Serenity Mantra (prayer) recognises the difference between putting our energy into actions that can affect change, compared to wasting it on things that won’t make a difference. When we are in crisis, it is not uncommon for people to put energy into things that don’t make a difference.
If you can, identify the things that won’t make a real difference and be patient with them. Try to identify the things that will, and consider whether to put energy into doing them, or into avoiding them.
The changes we make can be positive and increase wellness. Some actions can mitigate risk, maintaining our well being. Some can increase risk and should be avoided or managed carefully. These can changes as our state of mental health varies.
A common actively positive experience can be listening to uplifting music. Many people can identify music that can push our mood to a darker place and there are times when it would be wise not to do that. Sometimes we need to eat to give ourselves better energy, and sometimes we should avoid certain foods that make us feel bad.
Interoception
Interoception is the ability to look in at yourself and know how you are feeling. Those feelings could be an emotion, hunger level, if you need to go to the toilet, fatigue and so on.
We have many internal signals that tell us about ourselves and our environment. Often people don’t really know what they mean, and so don’t consider them as clues about our current status. If this were a video game, it would be the “character status bars”, like health, fatigue, hunger, mana and so on.
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.
Wellness & Safety Plan
The “Wellness & Safety Plan” is a formalised system for writing down the most common elements that we come across as our health declines, to remind us what we should do to help ourselves. This is particularly useful when it is hard to think or trust others. We just have to look at the plan we made and trust ourselves.
This document is a dynamic document, that is, it changes over time. After an incident, it is very important to review the plan and change what doesn’t work and emphasise what does.
The Wellness & Safety Plan is a two page document to help guide us from maintaining our health to when we are in crisis.
The first layer is about identifying the layer of current health and what to do or avoid for this layer.
Download the Wellness & Safety Plan as a PDF [788 kB]
Phase 1 – Identifying My State of Wellbeing
On page 1, we have the middle row of boxes (mostly in black). Here we identify how to tell that we are in the current layer of health.
These are signs that you are doing well and life is fine. This allows a quick check in of yourself and you can just tell that things are fine and you don’t have to do too much self checking. Some of this will be an internal interoception check, some of this will be an external “how am I doing” that others can see.
I Am Well
‘I am well‘ helps you to identify what it looks like (internally via Interoception and externally as observed by other people) when you are well. This state of being doesn’t need much care and attention and you can mostly run on autopilot, so long as that is a health set of habits.
Internal signs may include:
- I feel happy and content for most of the day
- I enjoy the things I usually enjoy
- I am eager to do tasks
External signs may include:
- I feel fine to go to work / school
- I don’t have difficulties eating 3 meals a day
I Am Struggling
‘I am struggling‘ helps you to identify what it looks like when you are struggling and need to pay more attention, but not yet needing to get help or go to care. This state of being requires more deliberate actions and choices and less automatic.
Internal signs may include:
- I’m struggling to feel happy
- Things I usually enjoy aren’t as much fun
- I want to put things off until later, because I don’t feel like it right now
- I’ve thought about doing some things that I know aren’t good for me, but they are tenuous thoughts.
External signs may include:
- Going to work / school is a struggle
- I have difficulties eating 3 meals a day
- I am doom scrolling a lot and not wanting to talk to people
I Need Some Help
‘I need some help‘ identifies that you should get in contact with your support network and see them in the next few days. That can mean your primary trust people, and or your therapist. 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. Remember, 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 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 (but don’t have a plan)
- 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 / not coming home
- Eating too much junk food / not eating any significant meal in a day
- Moody, reactive / paranoid
- Self harm
I Need Emergency Help – Right Now
‘I need emergency help right now‘ helps you to identify what it looks like when you can no longer manage on your own and you need to be contained for your own safety. This is when you either need to be directly monitored by a support person (if appropriate) or go to the psych ward for containment. Bring your Safety Plan with you.
Internal signs may include:
- I am easily confused
- Mood is very dysregulated
- Serious thoughts about serious harm
- Taking action on plans of death
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, signs of acting on dying
Phase 2 – Prevention & Improvement
On the left side of Page 1, on each layer, are actions to help you improve your state of wellbeing, or as the top, maintain your wellbeing. These are likely to be different for each layer.
On the right hand side are actions that often decrease your wellbeing. This is what you should avoid doing on your own, and 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 help you.
Listing these when you are well will help you do the good things and avoid the bad things when you are not in a good state of mind. It will also help guide other people how to help you.
Phase 3 – Listing Allies
Page 2 is about listing who your allies are – and who they aren’t.
Write down who your trusted allies are, people that are good at helping you when you are vulnerable. Includes noting their relationship to you, what they are good for helping you with, and what they might not be good for helping you with.
On the right hand side, list who is not safe for you when you are vulnerable. It is also important to note who is not good for you and who you should avoid. You may list why, or it may be safer to not. Just the fact that they are in the “do not contact” list is enough, and explain to your support people why that column is important.
Phase 4 – Medications and Allergies
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
Providing a date on the document lets you know when you created this version and how old the document is.
If it is too old (perhaps 6 months), check through it and see if the details are still relevant.
All things change in time, and it is important that in a crisis this document is as accurate and useful as possible.
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.
This too shall pass – Waiting
Generally, identifying and addressing the list above should help out within about 30 minutes. If it isn’t, then delay things you need to do while you self care and give yourself a half day or so to recover from whatever unidentified thing is affecting you.
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.