Free Bipolar Safety Plan Template
Bipolar Safety Plan
Written by: [Your Name]
_____________________________________________________________________________________
I. Personal Information
Name: |
[Your Name] |
Date of Birth: |
[Your Date of Birth] |
Address: |
[Your Address] |
Therapist/Counselor: |
[Therapist/Counselor Name] |
Psychiatrist: |
[Psychiatrist Name] |
II. Triggers and Warning Signs
-
Triggers
Stressful situations at work or home
Lack of sleep
Changes in routine or medication
-
Warning Signs
Racing thoughts and inability to concentrate
Extreme irritability or agitation
Changes in sleep patterns (insomnia or hypersomnia)
III. Coping Strategies
-
Mindfulness Techniques
Deep breathing exercises
Progressive muscle relaxation
-
Self-Care Activities
Engaging in hobbies (painting, gardening)
Spending time in nature
-
Social Support
Reaching out to friends or family for support
Attending support groups or therapy sessions
IV. Safety Planning
-
Identify Safe Spaces
Home: Ensure a safe and calm environment
Friend's house: Have a trusted friend or family member to stay with
-
Remove Access to Lethal Means
Store medications in a locked cabinet
Remove sharp objects or firearms from the vicinity
-
Emergency Contacts
National Suicide Prevention Lifeline: [Phone Number]
Crisis Text Line: Text [Text Number] for support
-
Creating a Crisis Kit
Include calming activities (coloring book, stress ball)
List of emergency contacts
V. Professional Support Network
-
Healthcare Provider
Regular appointments for medication management
Discussing treatment options and adjustments
-
Therapist/Counselor
Cognitive-behavioral therapy sessions
Developing coping skills and strategies
-
Psychiatrist
Medication evaluation and monitoring
Adjustments to medication regimen as needed
VI. Medication Management
-
Prescription Medications
Lithium: [Dosage and Frequency]
Lamotrigine: [Dosage and Frequency]
-
Side Effects to Monitor
Nausea or vomiting
Dizziness or blurred vision
VII. Emergency Action Plan
-
Signs of Acute Crisis
Suicidal thoughts or intent
Manic or depressive episode beyond control
-
Steps to Take
Contact emergency services or go to the nearest emergency room
Inform emergency contacts and healthcare providers
VIII. Follow-Up and Review
-
Schedule Regular Check-Ins
Monthly appointments with healthcare provider
Bi-weekly therapy sessions for support and evaluation
-
Review and Update Plan
Quarterly review of triggers and warning signs
Adjustments to coping strategies and safety plan as needed