How to make a bipolar crisis plan

A crisis plan is one page, written on a good day, that tells the people around you — and your future self — what to do when things go wrong. It isn’t paperwork and it isn’t pessimism. It’s a way of making sure that the decisions get made by the steady version of you, not by the version in the middle of an episode.

That’s the whole logic of it. An episode doesn’t just make things harder in general; it affects the exact equipment you’d need to handle it — sleep, judgement about risk, and insight into the fact that anything is wrong at all. Deciding in advance is how you get around that. You’re not writing rules for a stranger. You’re leaving instructions for someone you know very well.

Step 1 — write it while you’re well

Timing is the part people get wrong. A plan drafted in the middle of a rough stretch tends to be either panicked or bleak. Write yours during a settled period, when you can look at your own history calmly and remember what actually happened last time.

Keep it to one page. If it runs to three, nobody reads it at eleven at night — least of all you. Write in plain first person, in short lines. Twenty minutes gets you a usable draft; you can sharpen it later.

Step 2 — fill in the seven boxes

1. My early warning signs — high and low. Two or three each, written as things someone could actually observe. Not “I feel off,” but “I’m sleeping five hours and I’m not tired,” “I’m messaging people at three in the morning,” “I’ve stopped answering the phone,” “I’m not showering.” Specific beats poetic here.

2. What I want people to do. “Ask me directly how much I’ve slept.” “Call my clinician’s office even if I say not to.” “Come over rather than text.”

3. What I don’t want people to do. Just as important. “Don’t discuss it in front of the kids.” “Don’t threaten to leave.” “Don’t argue with me about whether I’m ill — just ask about sleep.”

4. Contacts, in order. Your prescriber or clinician, with opening hours and how to reach the service out of hours. Your trusted person. Your local emergency number and your local crisis line. Write the numbers out in full — don’t assume anyone can get into your phone.

5. Medication — exactly as my prescriber already agreed it. List what you take. If your prescriber has already put a plan in place for early warning signs, write down that plan in their words. Never invent an action here. If no early-signs plan exists, the line simply reads “contact my prescriber” — and asking whether they want to agree one is a good question for your next appointment.

6. Practical safeguards we agreed. Money (a card held, a spending cap, a second signature), car keys, social media and email, work (who gets told and what they’re told), childcare and pets. These only work if they’re agreed in advance, time-limited, and have a clear way back. A safeguard you consented to while well is protection; one imposed on you mid-episode is a fight.

7. What calms me and what makes it worse. Calms: a dark room, one walk, familiar music, one person at a time. Worse: crowds, alcohol, driving at night, being told to calm down.

Step 3 — agree it with the people in it

A crisis plan naming someone who has never read it isn’t a plan; it’s a wish. Sit down with each person you’ve named and check two things: that they accept the role, and that they’re allowed to state their limits. “I can drive you to appointments and I can call your clinic. I can’t hold your bank card.” A limit named in advance is far kinder than a promise that collapses at the worst moment.

Then give them the sentence that makes the whole document work: “If I tell you I’m fine and you can see three of these signs, believe the list, not me.” You wrote it while you were well. That’s exactly where its authority comes from.

Step 4 — decide where it lives, and review it

Copies go to you (a photo on your phone and something printed in a drawer), your trusted person, anyone you live with, and your clinician for your notes. Some people keep a card in their wallet with the three key numbers.

Date it and review it — every six months, and again after any episode. Episodes are useful teachers about what your real early signs were, as opposed to what you assumed they’d be. A plan listing an ex-partner’s number and a clinic you left three years ago isn’t a plan.

What this is not

A crisis plan is not a safety plan for suicidal thoughts. That’s a specific tool with its own structure, and it’s best built with a professional who can tailor it to you. If self-harm or suicidal thinking is part of your picture, ask your clinician to make one with you — and keep both documents.

It’s also not automatically a legal document. Some countries recognise psychiatric advance directives or advance statements; others don’t. If you want your wishes to carry legal weight, ask locally what exists. And none of it replaces treatment — it works alongside your care, not instead of it.

Start smaller than you think. Set aside twenty minutes this week and fill in box one: three early warning signs for high, three for low. The page you write today is a message to the version of you who won’t be able to write it.

If you are in crisis or worried about your safety right now, don’t wait for the plan. Contact your local emergency number or a crisis line — our crisis page lists options by country, and findahelpline.com can find a line where you live. In the United States and Canada, you can call or text 988, or 911 if it’s an emergency.

Common questions

What goes in a bipolar crisis plan?

Your own early warning signs for both high and low, written as things someone could observe; what you want people to do and specifically not do; contacts in order, including your clinician and your local crisis line; medication exactly as your prescriber already agreed it; practical safeguards you've agreed in advance; and what calms you versus what makes things worse.

Who should have a copy?

You, the trusted person named in it, anyone who lives with you, and your clinician for your notes. A plan nobody can find at eleven at night isn't doing its job. Keep one on your phone and one on paper.

Is a crisis plan the same as a legal advance directive?

Not necessarily. Some countries recognise psychiatric advance directives or advance statements with formal legal weight; others don't recognise them at all. A crisis plan is a practical, shared document — if you want something legally binding, ask a clinician or legal adviser in your own country what's available.

Read next

• Bipolar: 3 Early-Warning Checks for Hypomania/Mania
• When someone you love has bipolar disorder
• My loved one is manic — what do I do?
• Setting boundaries with a loved one who has bipolar

Sources

• NIMH — Bipolar Disorder
• DBSA — Crisis Preparation and Management
• Find a Helpline — crisis lines by country

If you’re in crisis or thinking about harming yourself, you’re not alone and help is available right now. In the US & Canada call or text 988. In the UK & Ireland call 116 123 (Samaritans). Elsewhere, contact your local emergency services — Get Help Now lists lines by country.