Bipolar Crisis Plan: Contacts, Preferences and Support

Plan during a more settled period

A shared crisis plan records preferences, professional contacts and agreed steps when concerns increase. It should be developed with the person and their treating team. This guide is a preparation framework, not a personalised clinical risk assessment or a legal advance directive.

Record the people and services to contact

Include the treating clinician or team, their routine and out-of-hours routes, local urgent services and trusted supporters. Write down each person’s role and an alternative if they are unavailable. Verify numbers and service hours; a general admissions line is not necessarily a clinical crisis service.

Describe personal changes and agreed responses

Discuss which changes have been meaningful in the past and what the team recommends doing when they occur. Separate a routine question from a need for prompt assessment or an emergency. Any medication instructions must be supplied by the prescriber; do not add your own adjustment rules from website information.

Include preferences and practical responsibilities

Ask who the person would like involved, what information may be shared and what helps communication. Consider children, dependants, pets, work contacts, transport and essential household tasks. Record preferences without assuming that every preference can override an urgent clinical need or local legal requirements.

Know the limits of informal support

Supporters should not be expected to provide clinical monitoring, physically restrain someone or manage danger alone. Discuss what help they can reasonably offer and when professionals should take over. Their safety matters as well as the person’s care needs.

Keep the plan available and current

Agree who holds a copy and how it will be stored privately. Review it after changes in treatment, address or clinical team, and after an episode when appropriate. Check that the next clinician has actually received relevant information, not simply that a document exists.

The early-warning-signs guide and aftercare guide help connect this plan with ongoing care.

What a bipolar crisis plan is for

The purpose is to make important decisions easier when a situation becomes difficult. A plan records useful information, preferred contacts and agreed responses so that the person and supporters do not have to reconstruct everything under pressure. It should be developed with the treating team and adapted to the individual’s history and circumstances.

A plan cannot predict every episode or replace a current assessment. It is also not automatically a legally binding advance decision. The NICE bipolar guidance supports jointly developed risk-management planning; questions about legal effect or compulsory treatment require appropriate local professional advice.

Begin with the person’s own priorities

Ask what they most want professionals and supporters to understand during a crisis. This may include how distress presents, what communication helps, which past experiences were difficult and who they trust. Their preferences should remain visible rather than being replaced by a list written entirely by relatives.

Also discuss what supporters can realistically provide and where professional help is essential. A plan is more useful when it acknowledges limits. It should not depend on one person being available every hour, having medical expertise or taking responsibility for dangerous situations.

Create a concise contact section

Include the current treating team, routine contact route, out-of-hours route and local urgent or emergency services. Add trusted supporters with their agreed roles and an alternative when they are unavailable. Verify names, numbers and service hours rather than copying an old document without checking it.

Distinguish clinical contacts from administrative or admissions contacts. A provider’s enquiry form or around-the-clock reception does not necessarily offer urgent psychiatric assessment. The person using the plan should be able to identify the appropriate route quickly without reading the whole document.

Describe meaningful changes in ordinary language

Record the changes that have been important in the person’s own history. Examples might involve sleep, activity, communication, withdrawal, concentration or difficulty managing essential tasks. Use factual descriptions instead of judgements such as difficult or irresponsible. The aim is to help others recognise a concern and communicate it clearly.

Include uncertainty. A change may have several explanations and does not automatically mean that an episode is beginning. Ask the clinician which combinations or patterns deserve routine discussion, prompt review or urgent assessment. The early-warning guide can help prepare this conversation.

Connect observations to agreed action

For each concern, write down the next step and who takes it. This might be contacting the treating team, seeking a same-day assessment or using emergency services when there is immediate danger. The clinician should help determine the appropriate response for the person’s history rather than relying on a generic internet threshold.

Any instructions about extra, reduced or changed medication must come directly from the prescriber and be documented clearly. Do not add informal dose rules, borrow another person’s plan or treat an app score as prescribing advice. Ask how those instructions will be reviewed when the regular treatment changes.

Keep essential treatment information available

Include a current medication list, relevant allergies, important medical conditions and the clinicians responsible for treatment. Identify where fuller records can be obtained securely. The crisis plan does not need to contain every private detail, but it should help a professional find information that may affect immediate care.

Review the list after medication changes, hospital discharge or transfer between services. An outdated list can create confusion. Ask who maintains the current version and how supporters can tell that they are using the latest copy rather than an earlier draft.

Record communication and sensory preferences

Note what makes communication easier: a quieter environment, short explanations, written information, an interpreter, a particular support person or time to process questions. Explain what has previously increased distress. Preferences can help clinicians adapt their approach, while recognising that urgent circumstances may limit what is possible.

Supporters can use the same principles. Speak about concrete concerns, avoid lengthy arguments about a diagnosis and do not try to prove or disprove unusual beliefs through confrontation. If the situation exceeds what can be managed safely, contact professionals rather than expecting communication techniques to resolve it alone.

Consent, privacy and information sharing

Discuss who may receive updates, attend meetings or help with practical arrangements. Specify the purpose and limits of their involvement. A partner, employer, adviser or payer does not automatically need unrestricted access to the full clinical record.

Ask the service to explain confidentiality and circumstances in which safety or legal obligations affect information sharing. Preferences should be recorded, but a plan should not promise that every disclosure can be prohibited in every emergency. Keep jurisdiction-specific legal advice separate from general website guidance.

Plan for dependants and practical responsibilities

Identify who can care for children, other dependants or pets when the person cannot manage their usual responsibilities. Include essential household tasks, transport and a limited work contact where appropriate. Confirm that the people named have agreed to the role rather than assuming they will be available.

Keep this section practical and proportionate. The plan should not make children responsible for monitoring symptoms or place all domestic and financial duties on one supporter. When arrangements are complex, ask relevant professionals to help develop a realistic backup.

Boundaries for supporters

State clearly that supporters are not expected to provide clinical observation, physically restrain the person, administer secret medication or manage violence alone. Their role may be to communicate concerns, help obtain care and provide agreed practical support. Their own safety and wellbeing remain important.

Discuss what they should do when the person disagrees that help is needed. The plan can identify a professional advice route without asking the family to make a legal or diagnostic decision. Immediate danger calls for emergency services, not a requirement to achieve unanimous agreement first.

Store and share the plan deliberately

Keep a short version accessible to the people who may need it, while storing more detailed records privately. Decide whether a paper copy, secure digital copy or both is appropriate. Consider access when a phone is lost, a password is forgotten or the usual supporter is away.

Give copies only to agreed recipients and ask relevant clinicians to acknowledge receipt. A document is not useful merely because it exists on one person’s device. Label the version and review date so outdated copies can be replaced.

Review after a crisis without assigning blame

When the person is ready, discuss what helped, what was confusing and where access to care broke down. Ask whether the plan reflected their experience and whether supporters had enough guidance. Focus on changes that can improve the next response rather than deciding who should have predicted everything.

Update contacts, roles and treatment information after a move, a new clinician or a change in support. Connect the crisis plan with aftercare arrangements so routine reviews and urgent responses are not treated as unrelated systems.

Frequently asked questions about crisis planning

Can I write a plan without a diagnosis?

You can record useful contacts, preferences and practical support needs while seeking assessment. Clinical risk-management and medication instructions should still be developed with appropriate professionals. Do not wait for a final diagnosis before seeking urgent help.

Does signing a plan mean agreeing to every future treatment?

Not automatically. Consent and legal effect depend on the document and the relevant jurisdiction. Ask a qualified professional to explain those distinctions rather than assuming a general planning worksheet has a particular legal status.

What if the plan is unavailable during an emergency?

Seek help anyway. Give the information you know and explain what is missing. A crisis plan supports care; it must never become a condition that delays emergency assessment or treatment.