Worksheet: Crisis Plan for Your Support System

This worksheet can be used to share with your supportive network of family and friends so that they know how to help you when you are nearing or in crisis.

This worksheet was created by Mental Health Minnesota, an affiliate of Mental Health America.

 

Here’s a web-friendly version of the activity from the worksheet:

Write down your responses to the following. Make copies to share with the people in your circle of support, so that they know how they can help you when you are nearing or in crisis.

  1. This is the list of people in my circle of support. You may call them to let them know that I need help.
    • Name
    • Relationship (friend, parent, etc.)
    • Phone Number
  2. These are my doctors, therapists, and mental health service providers.
    • Name
    • Relationship (doctor, psychiatrist, social worker, etc.)
    • Phone Number
  3. These are the names of my children (if applicable).
    • Name
    • Date of birth
    • School
    • Caretaker
    • Special needs
  4. These are the things I need help taking care of if I am hospitalized.
    • Task
    • When or how often
    • Who is responsible
  5. You can help me by:
    • Examples may include having coffee with me, listening to me, going for a walk with me, helping me challenge negative thinking
  6. Please don’t:
    • These are things that are not helpful to you. Examples may include don’t tell me to just feel better or don’t force me to engage with large groups of people

A psychiatric advance directive can also help you make arrangements about the types of mental health decisions you want made for you, if you are incapable of making your own decisions.