Depression can be quite a difficult illness to deal with at times.  It's easy to get frustrated with the constant interference in life to the point where we have nothing left to give.  Unfortunately, for individuals with untreated depression, there is a chance that suicidal ideation will arise.  During these grim times, judgment is impaired to a great degree.  Take the steps necessary to prevent yourself from being placed in a position in which you must make critical decisions about your treatment while your thought processes are hindered.  Crisis planning can be an excellent way to map out instructions for yourself, and also for those who will potentially be making treatment decisions on your behalf during times such as these.

 

"Action Planning for Prevention and Recovery: Crisis Planning"

    Substance Abuse and Mental Health Service Administration

    www.samhsa.gov

 

"Advance Psychiatric Directives"

    Bazelon Center for Mental Health Law

    www.bazelon.org

 

"Common Misconceptions"

    Suicide Awareness/Voices of Education (SAVE)

    www.save.org

 

"Facts About Suicide"

    Suicide Awareness/Voices of Education (SAVE)

    www.save.org

 

"Psychiatric Hospitalization"

    American Psychiatric Association

    www.psych.org

 

"Someone You Know is Suicidal"

    Suicide Awareness/Voices of Education (SAVE)

    www.save.org

 

"Suicide: The Problem"

    Centers for Disease Control

    www.cdc.gov

 

"Understanding and Helping the Suicidal Person"

    American Association of Suicidology

    www.suicidology.org

 

 

 

 

 

 

 

 

 

There is a broad range of ways to cope.  If you know which ones have proven successful for you in the past, try those again.  If one doesn't work, move on to the next one.  Some examples include breathing techniques, journaling thoughts/feelings, and activities for distraction (anything from reading a magazine to punching a punching bag).

 

 

Fight the urge to isolate.  Contact friends, people from your support group, your therapist or psychiatrist, etc.  Not only can this be a welcomed distraction, it can also give you a chance to vent and assess your need for additional assistance.

 

 

Have someone stay with you until you are confident the urge has passed.  Get rid of any means by which you could harm yourself: flush pills down the toilet, get rid of bullets if there's access to a gun, don't get behind the wheel of a car, etc.  Ask the other person to hide or lock away medications, sharp objects, etc.

 

 

If you're not sure whether or not you're safe, chances are you aren't.  You deserve help.  Suicide is what happens when pain exceeds coping resources, so balance the scale by adding to your resources.

 

- call your therapist and/or psychiatrist and let

  them know what's going on

- take yourself in (if you feel safe getting there

  on your own) or call for an escort to the

  hospital

- call the national crisis line 1-800-SUICIDE

  (784-2433) or a local crisis number

(Click here to view a list of crisis lines by state)

 

 

 

1) Begin a direct conversation on the topic 

 

Truly listen to what they have to say and comment in a non-judgmental fashion.  Use some of the discussion to gauge whether or not the person is in immediate danger.

 

 

The stigma of suicidal ideation is present already, so you don't want the person who needs help to distance him or herself from you.

 

 

It's never good to keep someone's plan to kill him or herself a secret.  Be prepared to get the necessary professional help.

 

 

Telling the person that it's really not that bad will only make matters worse.  Instead, offer to discuss the reasons why he or she might be considering harming him or herself.

 

 

If possible, stay with the person and remove dangerous items in proximity to the suicidal individual.  This could include medications, guns, sharp objects, ropes, etc.  Do not let them get in the car and drive.

 

 

Contact a family member, psychiatrist, therapist, community mental health agency, or suicide prevention and crisis center.  If the person is in immediate danger, accompany him or her to a psychiatric facility or hospital emergency room. 

 

 

 

Crisis plans are put in place to both serve as a guide for the individual in crisis and ensure that the individual receives the best care possible (based upon necessity and desires), in the event that he or she is unable to make decisions regarding necessary treatment.  The process of creating an individualized crisis plan is not typically something that happens overnight.  Important decisions, such as those mapped out in a contingency plan, require thought, research, and input from professionals.  The crisis plan should be shared with your treatment team as well as the people who might enact your plan on your behalf in the future.  You may even want to get a few signatures (from your treatment team and others responsible for following your plan) whenever the file is updated and distribute copies of the latest version to those on your list of supporters.  The following represents some ideas regarding information you might be interested in including in your crisis plan: 

 

      - name

      - contact info (address, e-mail, phone numbers, etc.)

      - treatment team info (psychiatrist, therapist, etc.)

      - insurance info

      - last date crisis plan was updated

 

      - descriptions and/or scales to help you determine if you're still the one in control of the situation

      - flow chart of which tactics to try when suicidal (for example, calling a therapist, meditating, etc.)

      - list of people you could call for help

      - list of things to do before checking self into hospital (assuming it's not an immediate emergency)

 

3) Instructions to Hand Over Decision-Making to Someone Else

      - list of treatment centers and/or hospitals that you prefer

              If you have not yet had a chance to look into local treatment facilities, describe what you

              would want from a program (setting, staff, room options/features, daily activities, etc.)

      - explanation of your stance on research and clinical trial participation

      - list of people you would hope could visit you, as well as those you would like to prohibit from 

        visiting you

 

     

 

 

 

 

 

 

Although it's not anyone's favorite thing in the world, sometimes hospitalization cannot be avoided.  Psychiatric care has changed dramatically over the years.  Nowadays, the goal is rapid stabilization, which translates to shorter hospital stays.  The hospital experience will differ among institutions so, if possible, do some research beforehand about local hospitals and programs, in case you need to be admitted in the future.  In addition, there are step down programs (such as partial hospitalization programs) available to facilitate your reintegration back into the community, as well as provide a form of more intense psychiatric care that does not require overnight hospital stays.

 

 

When a person starts developing thoughts of self-harm, the hospital is there to ensure their safety until the episode has passed.  (This applies, in particular, to the patients who don't have adequate support systems at home.)  The following safety measures may be taken at the hospital:

- body search (for concealed objects that could prove dangerous)

- no locks on most doors within the ward (for ready access to a patient in trouble)

- plastic eating utensils (and replacement of any other sharp items)

- 15 minute checks (so staff is aware of patient's activities/whereabouts on ward)

- restraints or isolation (if patient, staff members, or other patients are in immediate danger)

 

 

Patients work closely with psychiatrists, nurses, and social workers each day to try to determine the cause of the recent destabilization.  Psychiatrists might see the patient each morning during rounds, for example, to update medication dosages; nurses might monitor vital signs throughout the day and distribute medication; social workers might engage the patient in individual therapy or counseling.

 

 

Activities may be scheduled throughout the day, sometimes even posted for all patients to view, if they'd like.  The purpose of this routine is to fight the urge of the depressed patient to withdraw from even the most basic activities such as hygiene, meals, etc.  Typically, a portion of the day is spent in individual activities and a portion in group activities, with some free time left over to make phone calls, entertain visitors, or relax into a good book.  Some of the activities you might experience include:

- vital sign checks

- meal times

- medication times

- group therapy

- family therapy

- educational lectures or workshops

- art, music, movement, or pet therapy

- exercise

- entertainment (games, movies, etc.)

 

 

Some hospitals encourage patients and their family members to assume an active role in discharge planning--which could include making appointments for consultations, locating support groups of interest or other resources nearby, picking up new prescriptions, etc.

 

 

Turn your crisis plan into a legal document. Click here for frequently asked questions and templates helpful in preparing advance psychiatric directives.

 

 

 

 

 

 

Navigating through the storm...

The Depression Guide