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Connect & Grow Magazine: Issue 14 October - November 2024
In previous months, I have written about mental health safety plans. We learned that they are crucial both as a suicide prevention strategy (by identifying early warning signs) and as a tool to prevent lapses from becoming relapses in people who struggle with addiction.
This month, we will examine mental health safety plans in more detail and use a case study to illustrate their effectiveness. Our case study is based on a real-life participant who explicitly consented to write this article. A pseudonym is used throughout, and all other identifying information has been changed for privacy purposes.
Debbie was diagnosed with borderline personality disorder at 16, after years of intense emotional instability following her parents’ divorce when she was only 9 years old, and subsequent abuse by her stepfather and severe neglect from her mother. By her early 20s, Debbie found herself locked in a constant cycle of brief hospital admissions to treat one crisis after another. She had short-lived periods of relative stability only to be plunged into another crisis for which she found herself overwhelmed and out of control. Over time, her condition evolved into chronic depression, marked by severe mood swings and inability to concentrate, which impacted her ability to hold down a job, which in turn led to social isolation. As the depressive episodes increased in frequency and intensity, she experienced suicidal ideation and thoughts of self-harm. Struggling to cope, Debbie turned to alcohol and recreational drugs, developing a pattern of misuse that worsened her mental health.
What is a Mental Health Safety Plan?
After years of battling depression and addiction, Debbie found herself wanting to break this cycle of hopelessness. She was eventually approved for NDIS funding and was able to access a therapist. Her therapist introduced her to something called a "mental health safety plan", and it was explained to her that this personalised guide could help her manage a crisis and take back control of her life. Debbie was unconvinced at first, unsure how something on paper (or on an app) could make a difference. However, encouraged by her therapist, she was willing to download the app at least and give it a try.
Key Elements
As she sat with her therapist, they broke down each element of the safety plan. Together, they identified early warning signs that indicated her mood was dipping, such as Debbie skipping meals, isolating herself from friends, losing interest in pleasurable activities or spending time ruminating on the past. Next, they discussed coping strategies she could use in stages when things get tough. The first stage starts with things she can do independently when she first notices early warning signs, like taking a walk or practising mindfulness. Gradual increased support at the next stage as more early warning signs, such as spending time with friends and family, are noticed. Each element was described as a small lifeline she could cling to in distress. The safety plan outlined clear instructions on what to do when the previous stages had not worked. It also provided a list of commonly recommended emergency contact numbers to call when needed.
Relapse Prevention
After a while, Debbie noticed the subtle shifts in her behaviour earlier than before. One day, after realising she had cancelled plans with her friends for the third weekend, she opened the app and looked at her safety plan. Seeing the early warning signs spelled out helped her understand she was heading towards a crisis. Instead of spiralling further, Debbie reached out to her therapist. By using the plan, she was able to prevent what could have escalated into another episode of binge drinking, self-harm or suicidal ideation. For Debbie, it was about catching herself in the moment before she took action.
Support Networks
An important part of Debbie’s safety plan involved effectively communicating her distress to the people in her life. Her friend Lily was a key support. She knew about Debbie’s struggles from the start, and Lily encouraged Debbie to check in with her when the first early warning signs were noticed so that they could act proactively.
One evening, after an especially hard day, Debbie noticed fleeting thoughts of self-harm and felt the pressure to act on these thoughts building. She sent Lily a text: "I’m not okay." Within minutes, Lily called her back, reassuring her and reminding her she wasn’t alone. Debbie was reminded that her safety plan wasn’t just about her but about connecting with people who cared about and loved her.
Updating the Plan
As Debbie continued her recovery journey, she noticed that her triggers and early warning signs had changed. The things that caused her stress and anxiety in the past were seemingly unimportant to her now. As much as her early warning signs had changed, so too had her coping strategies. Initially, staying busy with exercise and having an active social life were her go-to coping methods, but as she developed and was more comfortable in her own company and grew in confidence and self-awareness, she found that calm, quiet reflection time helped her relax and ultimately worked better for her.
She updated her safety plan, adding new strategies and removing those that no longer helped. The plan wasn’t static. It was dynamic and evolved with her, adapting to her needs as her mental health fluctuated.
Conclusion
For Debbie, the mental health safety plan became a tool for managing her depression and substance misuse. It wasn’t the cure but a guide, reminding her she had ways to cope when things felt overwhelming and out of control. She finally felt like she had the power to face her struggles head-on.
Lifeline Australia: 13 11 14 (24/7 crisis support)
Beyond Blue: 1300 22 4636 (24/7 mental health support)
Suicide Call Back Service: 1300 659 467 (24/7 counselling for people affected by suicide)
Kids Helpline: 1800 55 1800 (24/7 support for young people aged 5-25)
SANE Australia Helpline: 1800 187 263 (Monday to Friday, mental health support)
Emergency Services: 000 (for immediate danger or crisis)
If you have an NDIS plan and need mental health support, please reach out to Mark
Written by Mark Bint
Mental Health
On Your Marks Care
(c) Break Free Consultancy 2024
Disclaimer: All information is accurate at the time of publication and subject to change