354 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER D. As the client has been provided with straightforward information, his/her ability to distinguish reality from psychosis has increased. E. The client continues to experience his/her hallucinations and delusions as reality-based despite significant information an d clear directives, and continued support and feedback were provided in this area. 31. Identify Hallucinations/Delusions ( 31) A. The client was assisted in identifying the hallucinations and delusions that tend to prompt his/her suicidal gestures. B. As the client discussed his/her hallucinations and delusions, he/she was provided with support and encouragement. C. The client was reminded about the unreality of his/her hallucinations and delusions. 32. Explore Coping Skills ( 32) A. The client's coping skills were explored that could assist him/her in decreasing psychotic thinking. B. The client was taught a variety of interventions to decrease his/her psychotic thinking (e. g., reducing external stressors, implementing distraction techniques, and seeki ng a reality check with caregivers). C. As the client has used his/her coping skills, it was noted that his/her psychotic thinking has decreased. D. The client's psychotic thinking persists, despite the use of coping skills and other interventions, and h e/she was provided with additional support in this area. 33. Identify Healthy Coping Practices ( 33) A. The client was assisted in identifying healthy coping practices that support optimistic, upbeat thinking patterns. B. The client was encouraged to imp lement his/her healthy coping practices (e. g., expressing emotions, social involvement, hobbies, or exercise). C. As the client has used his/her healthy coping practices, he/she has experienced a more positive, upbeat thinking pattern, and this was review ed with him/her. D. The client tends not to use healthy coping practices and was urged to do so. 34. Monitor Sudden Mood Shifts ( 34) A. The client's mood was monitored for sudden shifts from depressed and withdrawn to serene and at ease in spite of previ ously overwhelming problems. B. A significant mood shift was identified, indicating that the client may have decided to pursue a suicide attempt rather than to fight the stressors. C. The client seems to have decided to pursue the suicide attempt; theref ore, he/she was provided with more intensive supervision. 35. Assign a Positive Letter ( 35) A. During the client's period of stability, he/she was requested to write a letter to himself/herself regarding how positive and healthy his/her life could be. B. The client's letter to himself/herself regarding how positive his/her life can be was reviewed. 