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

  1. Triggers

  • Stressful situations at work or home

  • Lack of sleep

  • Changes in routine or medication

  1. Warning Signs

  • Racing thoughts and inability to concentrate

  • Extreme irritability or agitation

  • Changes in sleep patterns (insomnia or hypersomnia)


III. Coping Strategies

  1. Mindfulness Techniques

  • Deep breathing exercises

  • Progressive muscle relaxation

  1. Self-Care Activities

  • Engaging in hobbies (painting, gardening)

  • Spending time in nature

  1. Social Support

  • Reaching out to friends or family for support

  • Attending support groups or therapy sessions


IV. Safety Planning

  1. Identify Safe Spaces

  • Home: Ensure a safe and calm environment

  • Friend's house: Have a trusted friend or family member to stay with

  1. Remove Access to Lethal Means

  • Store medications in a locked cabinet

  • Remove sharp objects or firearms from the vicinity

  1. Emergency Contacts

  • National Suicide Prevention Lifeline: [Phone Number]

  • Crisis Text Line: Text [Text Number] for support

  1. Creating a Crisis Kit

  • Include calming activities (coloring book, stress ball)

  • List of emergency contacts


V. Professional Support Network

  1. Healthcare Provider

  • Regular appointments for medication management

  • Discussing treatment options and adjustments

  1. Therapist/Counselor

  • Cognitive-behavioral therapy sessions

  • Developing coping skills and strategies

  1. Psychiatrist

  • Medication evaluation and monitoring

  • Adjustments to medication regimen as needed


VI. Medication Management

  1. Prescription Medications

  • Lithium: [Dosage and Frequency]

  • Lamotrigine: [Dosage and Frequency]

  1. Side Effects to Monitor

  • Nausea or vomiting

  • Dizziness or blurred vision


VII. Emergency Action Plan

  1. Signs of Acute Crisis

  • Suicidal thoughts or intent

  • Manic or depressive episode beyond control

  1. Steps to Take

  • Contact emergency services or go to the nearest emergency room

  • Inform emergency contacts and healthcare providers


VIII. Follow-Up and Review

  1. Schedule Regular Check-Ins

  • Monthly appointments with healthcare provider

  • Bi-weekly therapy sessions for support and evaluation

  1. Review and Update Plan

  • Quarterly review of triggers and warning signs

  • Adjustments to coping strategies and safety plan as needed


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