A crisis does not happen at a good time. It does not wait for the right person to be home, for the therapist’s room to open the next day, for the family to have time to get prepared. It shows up quick and noisy and as ordinary life unfolds around you, it is the families who best rise to the challenge who have mostly thought about what they were going to do before it came.
A family safety is a living reference that every person in the household knows exists and knows how to find, built around the individual it protects and what often leads up to an emergency for them.
What a Behavioral Health Crisis Actually Looks Like
People picture crisis as something obvious and dramatic. Sometimes it is. A child threatening to hurt themselves or someone else. A teenager who has disappeared. An adult in a psychotic state who cannot be reached.
But crisis more often looks like something that has been building. A gradual withdrawal over days or weeks. Behavior that has been escalating in ways the family noticed but did not know how to name. Sleep disappearing. Eating stopping. A person who is present in the house but gone in every way that matters. The acute crisis is almost always the culmination of a longer process, and families who know what the first phase looks like tend to be in a much better position to act before this actually becomes an emergency.
A safety plan is to find out what those trigger signs are for this specific person. Not warning signs in general. The specific behaviors, emotions, and trends that have been warning signs leading up to an emergency in the family with this person.
What the Plan Needs to Include
The warning signs that belong to this person specifically. What does early distress look like for them. What does escalating distress look like. The family has this information. It lives in their memory of every difficult episode that has come before. Getting it out of memory and onto paper means it is accessible when the adrenaline is high and clear thinking is harder.
Who does what when those signs appear. A crisis is not the moment to figure out roles. Who talks to the person in distress. Who calls for support. Who manages other children in the household. Who handles communication with the treatment team. These decisions made in advance mean the family is not standing in the kitchen having three different arguments about what to do while the person who needs support is escalating.
The numbers that matter. Your therapist or case manager (if applicable), with their after-hours line, if there is one. The psychiatrist. Mobile crisis line for the county. An emergency room with a psych ward nearby. The Suicide and Crisis Lifeline, 988, a national crisis line that routes callers to local help. This removes the frantic rummaging that happens when a number is required on demand, having these in one spot — in the plan and also saved into each suitable adult’s phone.
What to say and what not to say. Families in crisis often make things worse without meaning to because they do not know how to talk to a person in acute distress. Arguing with the content of a delusional thought. Threatening consequences. Raising their voice. These are understandable responses and they are almost always the wrong ones. The plan can include specific language that tends to help this person de-escalate and specific things to avoid based on what the family already knows about what makes things worse.
Whether to call 911 and when. This decision is harder than it sounds and needs to be thought through in advance rather than in the moment. Calling 911 for a behavioral health crisis can help but it can also escalate a situation depending on how it is handled. In Virginia, mobile crisis teams are available in many areas as an alternative to police response for non-violent mental health situations. Knowing what is available in the community and under what circumstances each option is appropriate is part of a complete plan.
A safe environment checklist. During a crisis, particularly one involving suicidal thinking or self-harm, the environment matters. Medications secured or removed. Items that could be used for self-harm made less accessible. Not as a punishment but as a practical measure that reduces impulsive access to means during the highest-risk window.
What happens after the acute crisis passes. A plan that only addresses the peak moment misses the part that often determines whether it happens again. Who follows up with the treatment team. What changes to the current treatment plan are discussed. Whether the safety plan itself needs to be updated based on what happened. The days immediately following a crisis carry their own risk and deserve their own attention in the plan.
What Families Get Wrong
The most common mistake is not having one. The second most common is having one that lives somewhere no one can find it when it is needed.
Families also underestimate the importance of practicing the plan in a low-stakes moment. Not a drill exactly but a conversation. Walking through who would do what. Making sure everyone who needs to know the numbers has them. Making sure the person at the center of the plan, if they are old enough and well enough to be involved in the conversation about it – has had input into it and understands what the family will do and why.
A plan built around someone without their knowledge can feel like something being done to them. A plan built with them, where possible, is something different. It signals that the family is not frightened of the topic, that crisis is something they can talk about directly, and that the response will not come as a surprise.
When the Crisis Is Happening Right Now
If someone is in immediate danger go to the nearest ER or call 911. For urgent situations that aren’t immediately life threatening, 988 connects users with the Suicide and Crisis Lifeline 24 seven.
Some localities, like those in Virginia could have mobile crisis teams that respond in the community.
Building the Plan With Support
A safety plan built in the middle of a calm period, with the support of a therapist or behavioral health provider who knows the family, is more thorough and more useful than one assembled in a hurry after something has already happened.
Legacy Family and Behavioral Health Services in Richmond, Virginia serves children, adolescents, adults, and families across this very support. The practice includes Crisis prevention, safety planning, intensive in-home services, family therapy, and case management.
legacyfamilybhs.com, (804) 405-6880, or help@legacyfamilybhs.com