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I'm curious if others have a crisis safety plan for their BPD loved one?

SD22 is about to graduate college in May and this summer will move to a city 3 hours away from us where she will start teaching special ed. I've read that stress levels the first year of teaching can be similar to working in the ER.

I'd like our family to have a safety plan and I'm curious if others have any suggestions for what to include?

Or if your BPD loved one went through a mental health crisis with SI, is there something you would recommend?
 

Hello,

I'm curious if others have a crisis safety plan for their BPD loved one?

We do. If he expresses suicidal thoughts we talk to him and see if he is basically just saying he feels terrible or is seriously in danger of harming himself. It it's the latter we take him to the hospital. It's not fool proof but it is something.

Hi LnL

That is wonderful news to hear SD is graduating, what a fantastic accomplishment  
My DD went into work after graduating and hit her first crisis 3 years later and was dx. So I'm right with you! Prepare  

I'm wondering what presently happens when SD has feelings of SI? Has she a personal safety plan? Or is this new for her?

My DD put her plan together with her medics, its called Patient Safety Plan, (ie she owns it, they were her choices) then shared with me and her friends her plan. The plan commenced with her 1) identifying and writing down the warning signs a crisis may be developing 2) identifying and writing down internal coping strategies 3) list people and places of distraction that may help 4) list of people to call and finally 6) list of medics, agencies, professionals, help lines to contact, her crisis team.

LnL, is SD planning to find a new therapist, having that local support as she settles into new surroundings and her first teaching role? Only this morning my DD and I were talking and she mentioned again    :( about getting in place therapy ahead of her going back to work ...… I'm holding her to this!

My last question, has your SD visited ER for SI?

WDx

livednlearned,

I think putting a safety plan in place is a great idea! (Especially since she will be 3 hrs away.)  Teaching is a stressful job & the "burn out" rate for Special Education is high.

We haven't developed this kind of plan, yet. Still struggling to get DS through high school.

Good luck!

wendydarling, I'm so amazed how much she has accomplished in these past 4 years! At 16 she had a psychotic break and now she's heading into a career where she feels she has a calling  


Last year she had an SI episode where a friend said to call her psychiatrist, which she did. Psychiatrist asked if it was ok to talk to her parents. SD22 only wanted H to know, and wanted it kept confidential. The psychiatrist told H that SD22 is chronically suicidal. H drove up and by the time he was there, she was better and didn't want to talk about it much.

Then over winter break, SD25 told me that SD22 will regularly text, "I'm having those thoughts again." She does this with SD25 but not with H. SD25 has been dealing with this on her own and confided to me because she believes (and I agree) that her dad changes the topic and seems to have a hard time with it. She's worried about SD22 and also exasperated because she feels emotionally manipulated.


Can you remind me if your DD was hospitalized for SI? Your example gives me an idea about what we could work toward but the person to lead this would be H and he unravels when I or anyone else talks about SD22's SI. I have some legwork to do first, I think.


She is pretty good about making sure she has a T and sees one regularly, altho for her it's primarily about managing anxiety. Right now she has two Ts and psychiatrist for meds (dx bipolar). One where she lives, and one in our town, whom she talks to on the phone and when she visits. When she moves to this new town, she'll have the phone T and will probably get some references for a new one close by.

I get the sense she presents falsely to her Ts. For example, SD22 cannot tolerate being alone and yet she will describe how her T gave her advice on how to deal with people being so clingy towards her  :(


She hasn't yet. H is a hospital physician and I think he would do anything he could to keep her out of the ER. I guess we have this added dynamic that is becoming clear as I write this. H is a very competent, capable and effective dad. He is also very emotional about SD22 and it feels to me like he is downplaying facts that he can't deal with, like SD22's history of SI and being prepared for more. SD22 has been in a relative cocoon for the last four years and this transition is going to be a big test. My feeling is let's be prepared for the worst and grateful when we look back and are thankful we didn't need it.

I have to tread all of this with some delicacy because I'm the step parent.


Thanks FHLKC for sharing that. If you don't mind me asking, do you ask him point blank? And has he ever admitted to being a danger to himself or have a plan?

stamping1, I have heard the same thing about special education. The one part SD22 hasn't yet experienced is emotional parents. I think that will be a surprising bit of stress she hasn't been at all prepared for.

I'm trying to think this safety plan idea through and have a conversation with H about being proactive. It's going to be tough...

Yes, we ask him point blank if he is thinking about suiciding, if he has "made plans" etc. He has never admitted to being a danger to himself or of having a plan. But we still keep our ears open.

FHLKC, I'm really impressed that you can be so candid with your son and that he seems to respond in kind.

Do you think that this candidness has changed how he responds to his own SI?

I'm wondering about wendydarling's example of creating a safety plan with SD22, altho given our family dynamics I'm not sure I can see that happening right away. I think it's more realistic that SD25, H, and I have one, including language for SD25 to say when her sister is in SI distress.

I hope so. As far as I know he is not cutting now.

LnL ~ has DD presented to ER for suicide ideation/attempt?  Attempt yes (overdoses), Ideation no. Self-harm yes, cutting. Suicide and self-harm while different behaviours can both be present in the same person as with my DD (see article below).  At the commencement of DBT DD explored suicide and self-harm with the DBT therapist. My DD was able to recognize and acknowledge she did not wish to end her life, she wants to live. This removed the elephant from the room for her, me, everyone and helped us all better manage as a team. I feel for your H. Delicate as you say, he needs to lead. That's really hard your DS25 dealing with this, I'm glad she was able to confide in you for support. Does your SD25 often feel manipulated, aside from the suicidal thought texts she’s received?

I found this article helpful.

https://www.psychologytoday.com/us/blog/teen-angst/201210/understanding-suicide-and-self-harm
 (https://www.psychologytoday.com/us/blog/teen-angst/201210/understanding-suicide-and-self-harm)

This answer to a reader’s question is helpful. 
“They are very different behaviours- but they can both be present in the same person. Sometimes a person "discovers" that self-harm can "help" through hurting themselves with suicidal intent that doesn't result in death. Sometimes self-harm can be a release that prevents suicidal behaviour (person wants to die, starts to overdose, cut self, and gets enough relief/validation/shock etc that they don't follow through)- sometimes someone can superficially cut the self (looks like self-harm) but they had been wanting to die.
The message: Don't assume that someone self-harming is suicidal- but also don't assume they're not. Check out what's going on, and involve professionals”.

Do you have any thoughts how to take this forward with H? Does H know about the texts to DS25?

WDx

What a precious moment for her to realize this and then be able to articulate it. I can only imagine your relief, WD. I didn't realize until reading your words how much I wish SD22 could do the same and let us know she recognizes the difference.
 
Yes. The origin of our conversation was SD25 wanting to talk about boundaries and SD22, how manipulated she feels.


I talked to SD25 a few days and asked for her permission to tell H and I felt she was grateful that I would move this forward to her dad. Not just to keep SD22 safe but to also recognize that SD25 is trying to handle this on her own and it's a lot.

I have a rough plan in place to talk to H. I keep thinking there will be a good moment ... maybe it will never come and I just need to pick a time.

I have heard that there are T's who specialize in helping families with young adults prepare for the transition to independence. Knowing H, if I have some names and take the initiative (problem solving), he will find it easier to ride out an emotional conversation about SD22 and SI.

It was a huge relief LnL and I have learnt a lot. The important thing is your SD22 is reaching out, to her friend, to her psychiatrist, to your H by giving her P permission to call your H, to SD25. It makes me wonder if she's also reaching out to her T though I appreciate she may have a history of presenting otherwise, it's a question begging.


This sounds like a great approach for your family situation and the dynamics you describe, "preparing for the transition to independence" exploring what that means for everyone emotionally and practically.


I can only think your H by knowing his DD25 is handling this alone will help him face the facts and his fears to help himself, DD's and you.

You're right sometimes it feels there is never a good time to talk about these difficult and painful feelings. That said your kind and thoughtful approach for everyone, you see and hear where they are and where they need to get to is, a better place. That's a lot to take on, how are you feeling LnL?

FHLKC It's good your DS shares with you how he's feeling and you've your plan. Are you finding there are less trips to the hospital as time goes by, as far as you know he's not cutting. When I read your posts I often think the conversations you have with your son, he's edging nearer to taking on responsibility for his mental health, he wants to be heard, trying to work out what's happening. Keep it going 

WDx

quoteIt's good your DS shares with you how he's feeling and you've your plan. Are you finding there are less trips to the hospital as time goes by, as far as you know he's not cutting. When I read your posts I often think the conversations you have with your son, he's edging nearer to taking on responsibility for his mental health, he wants to be heard, trying to work out what's happening. Keep it going unquote;

He has only been hospitalized once, last year for self harm when he was diagnosed with BPD. He is now living in a new apartment, near us but still his own space. He visits us frequently and shares some of the challenges he is facing. You are right, needing to be heard is very important to him. His father, (my DH) and I are working on our listening skills, both with our DS and each other.

I went to see my T today to discuss having a safety plan. Her suggestion is to contact a suicide intervention specialist who helps families with loved ones who are chronically suicidal.

She did not recommend we involve SD22 in creating the plan, and to talk to the specialist first so we can get a better sense of what the best approach is for SD22.

Livednlearn:

Has your SD25 been to counseling? I think it might help her since she receives texts from SD22 & SD25 needs to learn about boundaries, etc.

I think that SD22 will find that dealing w/ all kinds of parents will be an adventure.

Best Wishes,
Stampingt1

Yes, SD25 has been to counseling. She had a traumatic romantic relationship with someone that her counselor identified as uBPD, and SD25's mother appears to be uBPD, too.

I get the sense SD25 reads a lot about boundaries and she does a pretty good job setting limits for herself, like sticking to her plans even when SD22 dysregulates. Maybe that's why SD22 expresses SI more readily with SD25?

That's sound advice from your T  LNL  
Interesting, perhaps so. As a parent (and here thinking of your H and SD22) it was devastating (I've previously shared my ritual how I faced my fear to acceptance) the beautiful woman I created was in so much pain, she wanted the pain to end, not her life and I know for my DD she was equally devastated, she needed me to be there, listen, like you are FHLKC There is no bond like a parent and child.

Here's our protocol (link can be found at the foot of our home page)
SUICIDE IDEATION EMERGENCY PROTOCOL (https://bpdfamily.com/discussions/search-info3.htm)

Yesterday at work I received this text "Hey mum, I'm having an off day and will probably stay upstairs this evening. I'm ok, I've just had a lot of anxiety and paranoia and want to be by myself. I've had dinner. Might have a bath later. Just letting you know in case I seem withdrawn when you get home. Starting an audio book. Love you. xxx" DD's reach out to say everything is ok, self soothing and using her skills, sitting with and riding out her distress. DBT has helped her take control, manage her emotions and communicate how she feels. She's still learning as am I.

WDx

You must be one proud mama wendydarling 

I have high hopes that SD22 will be able to do the same, to communicate what she's feeling and send out a signal. That's part of what the hope is with the safety plan, to address it directly and not tiptoe around it and stick our heads in the sand.

I'm also hoping one day SD22 will get DBT skills and have a feeling she will really dive into them.

As a step mama I make it my job to tread light as a fairy, so if it happens, it will have to come when they feel ready. H is aware of what DBT is and knows it's a tool box out there for SD22 when she's ready.

I am proud LNL   

     You're right it'll will come when they feel ready. Were you able to share with your H about SD25?

That's heartening to hear you have a feeling SD22 will dive into DBT skills. Do you think she's heard of DBT?

WDx

Hi all,

I just wanted to tell you that I appreciate this thread and it has got me thinking.  My SO's D18 has been hospitalized and in an inpatient facility twice for suicide threats once at 13 and again this year.  She does not have BPD, but is highly sensitive, emotionally needy, has self esteem issues, anxiety, depression, is on medication and has been diagnosed with PTSD. Also has a Therapist and Psychiatrist.

She is getting ready to graduate High School this year and head off to college in the Fall.  With the help of her Therapist we were able to arrange for D18 to have her own room in the dorm which will help but I love the idea of a safety plan.  I'm going to suggest to her dad that he speak to her therapist about something like this for her.  I'd like to see something in place that can support her in between "I'm fine" and "I want to kill my self" that can give her tools or steps she can take before escalating to a suicidal place.

LNL I appreciate you bringing up the top and all the feedback from everyone else.  You got this Panda thinking. 

Panda39

Hi Panda39 I'm sorry your SD's been struggling recently and I hope things are looking up for her following her stay as an inpatient. It is such a helpful thread. I'm glad you were able to gain a single dorm for SD, I can see it'd suit my DD in that situation, a place to be quiet and peaceful and also able to open up to friends for company and some fun. Look forward to hearing how you get on.

WDx

I did. It went ok, tho I think he processes this stuff slowly. And maybe he kicks it back out when he can't land on something that makes sense to him. SD22's psychiatrist said she's chronically suicidal, then H said SD22 isn't suicidal, then SD25 said she talks about it regularly.

That tells me H has an acceptable narrative about SD22 in which his love makes her feel well enough. He probably senses what's true and it's too painful so he chooses a reality that's easier for him to tolerate. I can't say I would be any different, tbh 

She has a counselor who is trained in DBT. I don't know if SD22 is aware that some of what she's learning could be DBT. I don't think she knows there is an evidence-based and structured DBT program that could help her.

Panda39, I didn't realize your D18 had been suicidal and was emotionally sensitive. I knew she had been through a lot and hope she is finding a path through the chaos with her mom.

My T gave me a number for someone at NAMI who helps families develop safety plans. I was clear with T that my goal is to develop a family safety plan with and mainly for H and SD25. I think they should do family counseling and focus on their relationships with SD22 but that isn't something I want to or should be a part of, except to support them.

T also recommended a program that includes a 12 week class. I think it was initially designed for people who suffered from suicidal ideation but it seems there is one for family members.

Panda39, do you think D18 would co-develop a safety plan with your SO? Similar to what wendydarling's D did?

Yes, I think she would be open to it.  In some ways the ball is already rolling.

She will be going to college a few hours away, so far enough away to be away but close enough to home if she needs to duck out for a little bit of a break (or do some free laundry   Like I said before we were able to get her, her own room which will help, my SO also will be suggesting that she start with a minimum number of classes so she can get acclimated without being overwhelmed. She will have regular appointments with her current Therapist via Skype.  Her school has a student counseling center so I suggested to my SO that they check that out and connect D18 with someone there that she can see in real-life if she needs to. 

I also suggested that SO work with D18 and her therapist to develop tools and steps she can take when things start getting difficult for her.  Stress is her enemy and unfortunately we don't live in a stress-free world.  Like I said before what can she be doing in between "I'm fine" and "I want to kill myself".  It really is about self-care and yes she has to buy in or there is no point and she needs to be able to act when it's required. 

The most recent suicide threat came to a head due to being stressed and overwhelmed...

She has PTSD, she's a Senior in High School looking at going to college, which college was up in the air due to financing at the time, after graduation her family will be moving to my area and we are all moving in together, she is the President of the LGBT club at school, she is in AP Classes, she has a part-time job, she has a few close friends, and an uBPDmom.  More than enough stuff on her plate.

During this time she wasn't sleeping up all night sleeping a few hours or during the day (the lack of sleep seemed to have been due to several things...she has to share a room with her sister, she has nightmares tied to her PTSD, and some of it was just teenage late night TV watching) and during this time her best friends started smoking pot (something she didn't want to do...she was concerned about the interaction with her prescription drugs for anxiety, smart kid ) At the time I tried making several suggestions regarding the sleep issue because I knew being exhausted wasn't going to be helpful.  But all I got was ya ya I tried that those things and they didn't work, so I let it go.  So we had stress and lack of sleep and finally conflict with her friends and that was the tipping point.  Her mom is still in the picture and can show up with FOG and we all know that can mean pressure too.

So for me I see self-care as really important and I see getting enough sleep as really important (Yay! room of her own).
I see starting off with a smaller number of classes initially at least as a good idea.
I see her using tools (that she knows but doesn't always use) to manage stress as important. I see her support system available to her...listening/validating/supporting her as she problem solves important.  Continued Therapy is important.

Friendships are tricky both girls have picked friends with dysfunctional families/backgrounds...children of alcoholics and drug users, children of neglectful parents, children with mental illness bi-polar, BPD, Depression.  The interesting thing is that recently both girls have shown that they are outgrowing those friends, they are moving forward where sadly their friends are stuck.  The move and college mean a fresh start, my hope is that D18 will make some healthier choices going forward (but I also know old patterns can be hard to shake)

My SO thought a safety plan was a great idea and will be talking to D18's therapist about it initially and we will see how it goes from there and what the plan they come up with looks like.

Panda39

That's a lot of change for you and your family, panda! And for D18.

Some of the things that were suggested to put in the family plan included what was fairly obvious stuff (I thought), like medication (because once SD22 became an adult that information wasn't available to H), name of psychiatrist to call (she had two), how 911 handles SI in the state where she lives, which family member/s would respond, names and numbers of friends, her current address (because that stuff is hard to remember during a crisis). I'm trying to remember what else...

Our situation is a bit different, it sounds like, because your SO is proactive. I'm not sure how H is doing with this. I think he believes he has this handled and sometimes it feels like he is talking himself into believing SD22 is ok, even when she is calling 4 times a day 

 :check: :check: :check: 

. 

Some denial, some taking the road of less demands maybe.  I would let him chew on it a little bit and then have another conversation. Open communication is key (I know you know that  )

My SO can sometimes feel overwhelmed by D18's needs so he isn't always pro-active sometimes it can be letting some things slide or the flip side which is stamping out fires.  I hope that I can help take some of the pressure off him when we move in together and be more of a presence for his daughters, it's gonna be interesting 

Panda39