Bipolar Safety Plan

The Bipolar Safety Plan should be copied and filled out when you are doing relatively well.

It is important to develop a well-defined safety plan before the next episode of depression or mania. Statistics show that each time an episode occurs, it will be a shorter period until the next one, and they usually increase in intensity. Therefor prevention is critical.

When you are already depressed or manic, you will not be thinking clearly and rationally, and it may be too late to come up with a sensible bipolar safety plan at that point.

The bipolar safety plan should be shared with several key people in your life....

I will give copies to:

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The triggers (stressors) most likely to cause an episode are:

1._____________________________ mania / depression / both (circle one)

2._____________________________ M / D / both
3._____________________________ M / D / both
4._____________________________ M / D / both
5._____________________________ M / D / both
6._____________________________ M / D / both
7._____________________________ M / D / both

My warning signs/symptoms that I’m becoming seriously depressed:

1. __________________________ 2. __________________________

3. __________________________ 4. __________________________

5. __________________________ 6. __________________________

My warning signs/symptoms that I am becoming manic or hypomanic:

1. __________________________ 2. __________________________

3. __________________________ 4. __________________________

5. __________________________ 6. __________________________

If I become aware of any signs of mania/ hypomaniaI will do the following things to “ground” myself or calm my mind:

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If I become aware of signs of depression, I will do the following things to take care of myself:

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Mania or Hypomania (low level mania), and Mixed Episodes (both mania and depression) often involve racing thoughts, disorganized thinking, agitation, inability to focus or concentrate on one thing, feelings of being internally out of control, impulsivity, and sometimes suicidal thoughts or behavior.

My support people can help me through manic or mixed episodes by:

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Depressive episodes are different than the normal feelings of sadness, loss, or disappointment. Symptoms may include deep despair, hopelessness, helplessness, feeling worthless, confused and desperate, seeing only the negative aspect of a situation, thoughts of suicide, extreme fatigue, loss of motivation, social withdrawal and crying spells.

My support people can help me most through depression by:

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If I show any of the above symptoms, I will call or confide in these people first:

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If I am experiencing uncontrollable thoughts of suicide, or impulses to harm myself or others,or show poor judgment, I will request these people to stay with me for my safety. In addition, I will call my therapist and/or psychiatrist for guidance or an emergency session if they are available.

If my support person/people feel unable to ensure my safety, I agree to go to the nearest Psychiatric Crisis Unit or Hospital Emergency Room.

Local Hospital - First Choice: _________________________________
Phone: _______________________ or call 911.

Second Choice Hospital: ______________________________________
Phone: ____________________________

Other Facilities: ____________________________________________
Phone: ________________________

I will also call my therapist/s and Psychiatrist/prescribing MD:

Therapist: _____________________ phone: _________________

_____________________ phone: _________________

Psychiatist/MD: _____________________ phone: _________________

Preferred Pharmacy for MD to call in new prescriptions or med changes in an urgent/emergency situation:

___________________________ Phone: _________________________

Copywrite 2009 - All Rights Reserved.
Benjamin Schwarcz, MFT -AlternativeDepressionTherapy.com

This bipolar safety plan may be copied for your own personal use and may not be used commercially or distributed without permission of the author. 707/326-5566

Get ideas for your Bipolar Safety Plan

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