MANIA OR HYPOMANIA 193 4. Arrange for a More Restrictive Setting (4) A. Arrangements were made for the client to be hospitalized in a psychiatric setting based on the fact that his/her mania is so intense that he/she could be harmful to himself/herself or others or unable to care for his/her own basic needs. B. The client was not willing to su bmit voluntarily to hospitalization; therefore, commitment procedures were initiated. C. The client was supported for acknowledging the need for hospitalization and voluntarily admitting himself/herself to the psychiatric facility. 5. Develop a Short-Term Crisis Plan (5) A. A short-term, round-the-clock crisis plan was developed. B. It was determined that components of the client's short-term, round-the-clock crisis plan must include multiple caregivers, psychiatric involvement, and crisis assistance in order to maintain him/her within the community. C. With the implementation of the crisis plan, the client has been able to remain within the community as he/she stabilizes from his/her period of mania/hypomania. D. The client continues to decompensate a nd is not safe to maintain within the community, despite the use of the crisis plan, and arrangements for a more restrictive setting were initiated. 6. Remove Dangerous Items (6) A. Significant others were encouraged to remove dangerous items (e. g., shar p objects, weapons, and access to motor vehicles). B. Permission was obtained from the client to remove potentially dangerous items. C. Contact was made with significant others within the client's life to monitor his/her behavior and remove potential mea ns of suicide or impulsive harm. 7. Provide a Calm Setting (7) A. A plan was developed with the client that focused on reducing the level of stress that he/she receives in his/her environment. B. The client was assisted in developing a calmer setting fo r himself/herself, including low lighting and decreased stimulation. C. Steps have been taken to change the environment in such a way as to reduce the client's feelings of agitation associated with it. D. Arrangements have been made for the client to be visited, monitored, supervised, and encouraged more frequently by supportive people. 8. Refer for Psychiatric Evaluation (8) A. The client was referred for a psychiatric evaluation to consider psychotropic medication to control the manic state. B. The c lient has followed through with the psychiatric evaluation and pharmacotherapy has begun. C. The client has been resistive to cooperating with a psychiatric evaluation and was encouraged to follow through on this recommendation. 