How to cope with a crisis

Bipolar UK does not offer crisis support.

We do provide free Peer Support services, but if you are in crisis it's important you don't wait for your symptoms to get worse. Reach out for help now. Or if you need someone to call on your behalf, let them. A crisis doesn't mean you do not deserve help.

Where to get urgent help

Contact emergency services on 999 and ask for police and ambulance. Ask someone else to call for you if you are unable to do so.
Contact your local Crisis Team or Single Point of Access
Go to the nearest Accident and Emergency Department or ask someone to take you
Call NHS 111 and ask to speak to a mental health professional
Contact the Samaritans free on 116 123 or via email at [email protected]
If you are under the care of your local mental health team you can contact them
You can request an urgent GP appointment

What is a crisis?

A mental health ‘crisis’ is a time when you or a person you care for might feel out of control, overwhelmed, or at ‘breaking point’. You might be feeling suicidal, have thoughts of harming yourself or someone else or feel extremely anxious or paranoid. You might also be experiencing things others around you don’t, such as seeing or hearing things that aren’t there (hallucinations) or thinking things that might not be true (delusions).

If you or a person you care for is having a crisis and cannot stay safe, reach out for urgent help using one of the resources listed above.

What other resources are there for help?

Hospital care

You might people find it helpful to talk to your care team about spending some time in hospital voluntarily. We know that for some of our community thinking about going into hospital can be scary and overwhelming, but for lots of people it provides a safe space to get better with staff who are there to support you round the clock, which may not be possible at home.

It can also be helpful as it enables you to adjust your medication or other care options under the supervision of a psychiatrist.

Crisis house

A crisis house is based in the community and can offer you (or the person you care for) a safe space to stay with people who can support you. They might be medical staff or people who work for charitable organisations. Crisis houses might have beds where you can stay overnight, or sometimes for longer, and might be open to anyone experiencing a crisis or for certain groups (such as women or people managing addictions).

Day centre

A day centre is a drop-in centre for people who need extra support living in the community. They might be run by the NHS or by a charity or local organisation. Some day centres have clinical staff present who can offer you therapy, counselling or clinical guidance. Others have activities, such as art classes and therapy, opportunities to learn new skills or hobbies or offer you a safe space for some peace and quiet.

Other numbers for help and support

Please note: due to the ongoing coronavirus situation some organisations are closed or working at a reduced capacity. Please check their websites for the most recent update on their services.

Calmzone - provides emotional support for men nationwide. Dial 0800 58 58 58 between 5pm and midnight each evening. They also offer a webchat service.

The Mix - if you're under 25, you can call 0808 808 4994 (Sunday - Friday, 2pm – 11pm), request support via email or use a crisis text messenger service.

Papyrus HOPELINEUK - if you're under 35 and struggling with suicidal feelings, or you're concerned about a young person, you can call Papyrus HOPELINEUK on 0800 068 41 41 (weekdays 10am - 10pm, weekends 2pm - 10pm and bank holidays 2pm – 10pm), email [email protected] or text 07786 209 697

Shout 85258 - a free and confidential text message support service for anyone who is struggling to cope. Staffed by trained volunteers, Shout 85258 can help with issues such as stress, anxiety, panic attacks, depression, suicidal thoughts, relationship problems and bullying. It's free, anonymous and available 24/7. Text SHOUT to 85258

Switchboard - If you identify as gay, lesbian, bisexual or transgender, you can call Switchboard on 0300 330 0630 (10am – 10pm every day), email [email protected] or use their webchat service. Phone operators all identify as LGBT+

How can I look after myself?

Bipolar UK has produced a series of webinars designed to support you or your loved one with the self-management of bipolar disorder. As well as the tips below, these webinars can provide some important advice, ideas and support.

what's the best course of action when you are low?

Very low mood (at a 0-1) on our Bipolar UK Mood Scale may mean you have become very depressed and more withdrawn, lacking in self-care activities such as bathing and eating regularly, or you may have become isolated and feel less hopeful. There is a higher risk of suicidal thinking during this phase of the illness. If this is where you are, you need to seek help and talk to those around you, or reach out to professionals who can help:

Speak to your friends, family, and peer support network if you have one
Reach out to professionals, including your GP, your local mental health service if you're under their care or go to the nearest A&E department and ask to speak to the duty psychiatrist
Talking is important and support from people who understand what you are going through can help reduce difficult symptoms

reducing your risks when you're experiencing mania and hypomania

Hypomania can be a productive phase of the condition, and sometimes people can get things done and enjoy their more elevated mood. However, hypomania can develop into full mania, with risky behaviour and possible symptoms of psychosis.

With hypomania you may feel agitated, anxious and have lots of energy, talk fast or rush from task to task. You may also find you are spending more or wanting to spend money without worrying about your budget.

The following tips may help:

Slowing things down may stop things getting worse
Speak to someone from your support network, such as a family member or friend.
Do something to help you relax, and take a break from any activities that are stimulating or that feel overwhelming
If you feel the hypomania is building and you are not sleeping call your doctor, GP or mental health team for support. It might be a good idea to request a medication review.

How to plan ahead for a crisis

It can be scary to think about experiencing a crisis, but planning ahead can make it easier to look after yourself or the person you care about. You might include a crisis plan in your self-management plan, or as a stand-alone plan. Having something written down that’s clear and easy to follow can help you recognise a crisis earlier, and access the help needed quickly. Taking urgent action can save a life.

We’ve compiled a list of things to think about when making this plan; you can plan alone, with your friends, family members and loved ones and/or with your clinical team. There is no right or wrong way to plan ahead; it’s about making sure you are safe and that you get the right support

Think about your ‘early warning signs’ and triggers

You might find that your mood changes in relation to certain events or seasonal changes, and that as you start to approach crisis point you notice consistent warning signs that show you need support. You might notice you withdraw socially, you are sleeping less than you did before, you start thinking about what the world would be like without you in it or you have the first changes in sensation that you associate with hallucinations. Keeping note of these and sharing them with your support circle can help you avoid triggers, or if you find yourself triggered can help you get help as early as possible.

Think about which professional you’d most like to talk to

Some people might feel most comfortable talking to a member of their mental health team, whereas others would prefer to go straight to A&E. Keeping note of who you’d like to get support from and how to get in touch with them will make this process easier. This is important when you’re not feeling well. You can think about a back-up option too, to ensure you have as many directions to turn as possible.

Who is in your social circle and how can they help you?

Do you have a certain person in your social circle who you’d like to be involved in your care? A friend who you’d like to drive you to A&E, or a sibling who you’d like to call the Crisis Team for you? Defining who does what in advance helps take the pressure off you in an urgent situation and allows involved loved ones to set boundaries and ensure they feel comfortable with their roles.

How do you prefer to communicate when you’re in crisis?

You can also use this time to discuss what language, communication methods and keywords are helpful or unhelpful for you. This can make sure you’re able to access care in a way that is actively supportive and avoids harm. You might find that there are some words or situations that are triggering for you; if someone closes the door to a room you’re in while trying to talk to you about getting help, does this make you feel trapped, for example? Do you prefer to communicate by writing things down in a text to a loved one, rather than a phone call? Setting this guidance out in advance will make the experience of accessing support as smooth as possible.

Are there treatments you don’t want?

There are a variety of treatment options available for our community, but there might be some that you know you don’t want to have, even in a crisis. As well as speaking to your care team about this, you can also write up an ‘Advance Choice Document’, also known as an Advance Directive. Dr. Tania Gergel has written an excellent guide on doing this here.

How can you keep yourself physically safe?

Some of our community tell us they find that in the lead-up to a crisis their behaviour may change. This can be important to consider when planning for a crisis. You might notice that when you’re unwell you stop taking prescribed medication. You might find you leave the house in the middle of the night without telling anyone where you’re going, or you might be more likely to engage in risky behaviours. Planning for these in advance will help you stay safe and reduce any potential harm to your physical wellbeing. It’s also a good idea to share these details with your support network.

What responsibilities might be impacted if you experience a crisis, and what might help?

If you experience a crisis, your main goal needs to be to look after yourself and make sure you get the right support. While this is your priority, it’s not the only thing you need to think about. It’s also important to plan with other things. For example, if you need to spend some time in hospital, do you have pets that need keeping an eye on? If you’re a parent or guardian and you’re not feeling well, who can support you to take care of your children? Considering any responsibilities you have can help to minimise stress during a crisis period and help reduce pressure afterwards.