Welcome to Bipolar in Focus. I'm Jane Pauley. Bipolar can be managed but there may be a crisis that you as a loved one cannot manage alone.
Dr. Megan Poe from Bellevue Hospital in New York City is here to tell us how to handle a crisis. What constitutes a crisis?
A crisis is defined as a situation in which someone is a danger to themselves or others.
Meaning, they might be suicidal or they might want to hurt other people or they might just be putting themselves at some risk.
What are the first steps you should take in a crisis?
Firstly, the family or the person should call their psychiatrist or the clinician that they are working with and let them know what's going on.
Secondly, they need to go to their nearest emergency room.
If a person isn't willing to do that, then the family needs to call 911 and have them brought to the emergency room.
Underscore, "Don't over think it. Just do it," because?
Yes, absolutely, because what often happens is that families don't want to believe that it's actually a crisis–that things have actually gotten this bad.
And they certainly don't want to feel guilty and responsible for foisting a psychiatric ER setting on somebody that they love. It can be a scary place.
But on the other hand, if you don't step in, something really terrible could happen because here we're talking about either life-threatening conditions
or things that will quickly turn in that direction.
All right. We've survived this… say, first crisis.
Now, it's the time to talk about how to be prepared if it happens again.
A crisis plan.
Yeah. This is crucial.
What's a crisis plan look like?
A crisis plan is something that a person would put in place when they are healthy and they are feeling good from a vantage point of health and having perspective.
And this plan needs to be individualized, it needs to be between a person and their psychiatrist or clinician and the family should be involved.
What it looks like is it's a detailed description of early signs and symptoms, what do I do when I start to feel manic, when I start to talk a little faster?
What do I do next if I'm really starting to get out of control? And each step along the way there is a corollary of an action that should be taking place.
For instance if the family member in the second crisis said, "At this point, in the plan we agreed on, I'm going to call 911."
The loved one says, "This was the deal."
That's right. It's a structured plan so that the family can fall back on it so they don't start heaping on guilt and saying, "Oh my gosh, am I making the right or the wrong decision?"
because part of the definition of crisis is that everybody losses perspective.
And this gives an external perspective and lets you know that this is in place so that you can relax and just follow the plan and it is there for you.
You would recommend this as a written down instrument, if you will?
Yes, I would. Yeah, it's like a roadmap with a legend and it says, "If this happens, then this."
What also was good about it is that it forces people to describe when they start to get sicker, what that looks like for them and what those signs are for them, so it's very personalized.
Give me an example of what would make a crisis plan operative.
In a manic situation, it might be written down that if Bill has indiscriminate spending where he starts racking up a bunch of credit card charges, the plan needs to be activated.
On the flip side, if Bill becomes depressed and starts isolating himself, then the crisis plan gets activated as well.
It's a really, really good idea. Thank you Dr. Poe.
And thank you for watching Bipolar in Focus.