WRAP: Wellness Recovery Action Plan

As of summer 2010, I am a Wellness Recovery Action Plan facilitator, so I can help anyone who is interested develop his or her own WRAP. Here are the 5 Key Concepts:

Hope
Personal Responsibility
Education
Self-Advocacy
Support

Just let me know if you're interested and I'll be happy to elaborate.

That's wonderful that you're a facilatator. They have WRAP groups at my day program. I've yet to take it but have heard good things about it.

I've been trained in WRAP as well. I am a peer support specialist and am trying to use it with my clients.

Thanks, adel34. Back when I lived where there is a day program, I went to the WRAP class and almost always found it helpful.

Nice to 'meet' you, buttrfli42481. I hope you're able to help your clients with it. Being a WRAP Facilitator and a Peer Support Specialist must be a great combination.

Hi bipolar, WRAP sounds really interesting I'am quite intrigued.... i'am always up for any thing that can help with the "self" it might be useful to start a sub-forum with this... just a thought ?
I for one would like to know more....

Hello gismo, thanks for your interest. Do you have a spare binder? Or at least several sheets of looseleaf paper? Ideally to make your own WRAP it helps to have both, or a notebook.

On the first page of the looseleaf paper, write:
Wellness Toolbox

After that, write your tools that you use to stay well and relieve your symptoms. You can use this any day, every day. For example:

Take a shower and get dressed in comfortable clothes (you might already do this, but some people - me included - find it hard to do basic hygiene when in a depressed episode)
Talk to a friend
Relaxation exercises
Stretch
Take a walk (and/or your other favorite kind of exercise)
Journal
Attend a support group
Sing and/or listen to music
Take medications, vitamins, minerals, herbal supplements (not all at once of course)
Talk to your therapist or psychiatrist or another health care professional

On the second page of your looseleaf paper or notebook, write:
Daily Maintenance Plan

After that, make a list of what you need to do every day to stay well.

First, though, make a list of what you're like when you're well.
Maybe you're like me and you talk quickly even when you're not manic. That's important for others to know (many people share their WRAP with their therapist and other professionals).
reasonable, responsible, content, capable, easy to get along with, etc. (fill in your own adjectives)

After that, write down what you need to do every single day to stay well.
For example:
change your clothes, take a shower, do your hair
Eat breakfast
Avoid caffeine, sugar, junk foods, alcohol
Take medications
Take vitamin supplements
Pray
Go to work if it's a work day (some people write a separate daily maintenance list for days they do and don't work)

On the page after that, write a reminder list of things you might need to do.
For example:
Get more sleep
Do peer counseling
Write some letters
Buy groceries
Cook and freeze meals
Remember a loved one's birthday or anniversary
Make an appointment with a health care professional

I should note that for these posts, I am using Mary Ellen Copeland's book, "Wellness Recovery Action Plan".

After the Wellness Toolbox and Daily Maintenance Plan, it's time for Triggers. Mary Ellen Copeland says "Triggers are external events or circumstances that, if they happen, may produce symptoms that are, or may be, very uncomfortable."

On the first page in this section of your binder or notebook, write down the things that, if and when they happen, they case an increase in your symptoms. (You'll know because they may have triggered or increased symptoms in your past.)

"If any of the following events or circumstances happen, I will do some of the activities listed on the next page to help keep my symptoms from increasing."
For example:
anniversary dates of losses or trauma
being very over-tired
relationship ending
financial problems
hateful outbursts by others
being the scapegoat
being around an abuser, or someone who reminds me of a past abuser
intimacy
excessive stress
someone trying to tell me how to run my life
substance abuse

The next page is for your Trigger Action Plan. (Basically, the idea is that of any of the triggers you listed happen, you can do one or more of these things to cope with it.)
Deep breathing
Work on changing negative thoughts to positive
Prayer
Journaling
Going for a walk
Seeing or talking to my therapist, case manager, doctor, or sponsor
Going to a community activity
Vigorous exercise

I will post more after you've had a chance to look at these directions and tell me what you think.

Hi,

WRAP plan very interesting. I hope to sit down and write it out. Thanks.

You're welcome, Melissad81.

After the list of triggers and the Trigger Action Plan comes the Early Warning Signs.

From page 19 of the WRAP book:
"Early warning signs are internal and may be unrelated to reactions to stressful situations. In spite of our best efforts at reducing symptoms, we may begin to experience early warning signs, subtle signs of change that indicate we may need to take some further action.

For example:
anxiety
nervousness
forgetfulness
lack of motivation
avoiding doing things on daily maintenance list
avoiding others or isolating
being obsessed with something that doesn't really matter
beginning irrational thought patterns
feeling unconnected to my body
increased irritability, or negativity, or smoking
not keeping appointments
impulsivity
dizziness
feelings of discouragement, hopelessness
not answering the phone
weepiness
easily frustrated
feeling compelled to take too much pain medication

Ask friends/neighbors for early warning signs they've noticed.

The next page is for what you're going to do about the early warning signs.

Here's a sample plan:
Things I must do
do the things on my daily maintenance plan whether I like it or not
do at least one focusing exercise a day
write in my journal for at least 15 minutes each day
ask others to take over my household responsibilities for a day
go to (number) twelve-step meetings

Things I could do if they feel right to me
check in with my physician or ARNP
surround myself with loving, affirming people
read a good book
exercise

thanks gonna work on that later today. I really appreciate this information.

You're certainly welcome. I'm almost done and you're free to ask questions at any time.

After Early Warning Signs (Wake-up calls) comes When Things Are Breaking Down.

Starting on page 22 of Mary Ellen Copeland's WRAP book:
Make a list of the symptoms which, for you, mean that things have worsened and are close to the crisis stage.

Remember that symptoms vary from person to person so these are only examples.
feeling very oversensitive and fragile
unable to sleep for ... (specify how long)
headaches
avoiding eating
racing thoughts
thoughts of self-harm
inability to slow down
dissociation (blacking out, spacing out, losing time)
taking out anger on others
spending excessive amounts of money (say how much this means for you)
suicidal or homicidal thoughts

On the next page write a plan that you think will help reduce your symptoms when they have progressed to this point. The plan now needs to be very directive with fewer choices and very clear instructions.

Sample Plan
If these symptoms come up I need to do all of the following:
For example:
call my doctor or other health care professional; ask for and follow his or her instructions
call and talk as long as I need to my supporters
arrange for someone to come and stay with me around the clock until my symptoms subside
take action so I cannot hurt myself if my symptoms get worse, such as give my medications, check book, credit cards, and car keys to a previously designated friend for safe-keeping
do three deep breathing exercises
write in my journal for at least 1/2 hour

Other choices for the day might include:
creative activities
exercise

Do I need:
a physical examination
to have medications checked

Thank you for providing this information. I attempted a WRAP plan before my recent spiral and some of it was helpful. I think I will revise my plan based on this detailed information and what worked. I am eternally grateful I healed a smidge using the tools I had.

this is great!!!!!!!!!!!!!!!!

bootsiepries, you're welcome. It's best if you own the red WRAP book by Mary Ellen Copeland, or you are able to be taught by a WRAP facilitator in person, but if you can't afford it and/or don't have a class in your area (with the possible exception of going inpatient, but not all hospitals have WRAP facilitators and it's very expensive to go inpatient!), this is hopefully the next best thing.

Next is Crisis Planning. (starting on page 25 of the WRAP book)
"...A crisis plan needs to be developed when you are feeling well. However, you cannot do it quickly. Decisions like this take time, thought and often collaboration with health care providers, family members and other supporters. Over the next few pages, I will share with you information and ideas that others have included on their crisis plan. It will help you in developing your own crisis plan.
The crisis plan differs from the other action plans in that it will be used by others. The other four sections of this planning process are implemented by you alone and need not be shared with anyone else; therefore you can write them using shorthand language that only you need to understand. But in writing a crisis plan, you need to make it clear, easy to understand, and legible.

write: Part 1 - What I'm like when I'm feeling well

The first step in this process is describing what you are like when you are well. Of course your family and friends know what you are like. But an emergency room doctor may think your ceaseless chatter is a sign of mania when you have been talking since the day you were born and will probably be talking from your grave. Or perhaps you are usually quite introverted. An unsuspecting doctor may see this as depression. Poor decision making or mistreatment could occur.

In the first section write words or phrases that describe what you are like when you are well. Descriptive words might include:
talkative laid back
quiet intellectual
cautious sensible
ambitious energetic

I'm not done yet, I'm just posting this before it logs me out and I have to start all over again.

From page 27 of Mary Ellen Copeland's WRAP book

write: Part 2 -- Symptoms
"You may find that this is the most difficult part of developing your crisis plan. Describe those symptoms that would indicate to others that they need to take over responsibility for your care and make decisions in your behalf. This is hard for everyone. No one likes to think that anyone will ever have to take over responsibility for them or their care. And yet, through careful, well developed descriptions, you stay in control even when things seem to be out of control.
Allow yourself plenty of time to complete this section. When you start to feel discouraged or daunted, set it aside for a while. Ask your friends, family members and health care professionals for input. However, always remember that the final determination is up to you. It may take several months to complete this section.
Be very clear in describing the symptom. Don't try to summarize. Use as many words as it takes to describe the behavior.
Your symptoms might include:
unable to recognize (or incorrectly identifying) family and friends
severe pain
inability to control body functions
unusual skin tone
high fever
unconscious or semi-conscious
uncontrollable pacing; inability to stay still
very rapid breathing or seeming to be gasping for breath
severe agitated depression - unable to stop repeating very negative statements like 'I want to die'
catatonic - unmoving for long periods of time
neglecting personal hygiene
not cooking or doing any housework
extreme mood swings daily
destructive to property (throwing things, etc.)
not understanding what people are saying
thinking I am someone I am not
self destructive behavior
abusive or violent behavior
criminal activities
substance abuse
threatening suicide or acting suicidal
not getting out of bed at all
refusing to eat or drink

On your crisis plan, list those symptoms that would indicate to others that they need to take responsibility for you and make decisions for you.

There is more to the Crisis Plan but I need to go now. I will be back tomorrow night (Saturday) at the earliest. God bless you all & have a great weekend!

I totally believe in the five concepts

Thank you for this information. I think it will be very helpful.

hmm..
its very interesting..

You're welcome, CloudyDay99.

I believe it is important to remember that writing a WRAP is not a guarantee that you will stay out of the mental hospital. However, if you do end up going in (or going back in, if you're like me), it will not be the end of the world, and you might even be able to work on your WRAP while you're inpatient. I've been to 3 different hospitals in two states that had WRAP facilitators come in and work with the patients.

Now to continue where we left off.
Write: Part 3 - Supporters

"The next section of the crisis plan lists those people who you want to take over for you when the symptoms you list come up. They can be family members, friends, or health care professionals. When you first develop this plan it may be mostly health care professionals. But as you work on developing your support system, try and change the list so you rely more heavily on family members and friends. Health care professionals are not consistently available. They move on to other positions. Using natural supports is less expensive, less invasive and more natural.
Have at least five people on your list of supporters. If you have only one or two, they might not be available when you really need them (e.g. on vacation, sick). If you don't have that many supporters now, you may need to work on developing new and closer relationships with people by going to support groups, community activities and volunteering. But for now, list those supporters you do have.

Following are some examples of attributes people want from those who take over and make decisions for them:

responsible honest
sincere knowledgeable
calm compassionate
understanding trustworthy

You may want to name some people for certain tasks like taking care of your children or paying the bills and others for tasks like staying with you and taking you to health care appointments.

When you list them, you may use the following format:

Name Connection/role Phone number"
Example
Billy Joe Best friend 573-4298

"There may be health care professionals or family members who have made decisions that were not according to your wishes in the past. They could inadvertently get involved in your care again if you don't include the following:

I do not want the following people involved in any way in my care or treatment:

Name Why you do not want them involved (optional)

Many people like to include a section that describes how they want possible disputes between supporters settled. For instance, you may want to say that majority need to agree, or that a particular person or two people made the determination in that case. Or you may want some organization or agency to intervene in your behalf.

Page 30 of Mary Ellen Copeland's WRAP book

"Part 4 - Medication

List the name of your physician or physicians and your pharmacy along with their phone numbers and any allergies you may have.

List the medications you are currently taking and why you are taking them.

List those medications you would prefer to take if medications or additional medications became necessary and why you would choose those.

List those medications that would be acceptable to you if medications become necessary and why you would choose those.

List those medications that should be avoided and give the reasons."

"Part 5 - Treatments

There may be particular treatments that you would like in a crisis situation and some that you would like to avoid. For instance, people have very strong feelings about electroshock therapy - both positive and negative. Let your supporters know whether or not you want this treatment. The reason may be as simple as "this treatment has or has not worked for me in the past", or you may have some stronger reservations about this treatment.

You may have also found some alternative therapies that have helped as well as some that have not, e.g. acupuncture, massage therapy, homeopathy, herbal supplements, chiropractic. List those you prefer and those you want to avoid."

Still on page 30, going onto page 31 of Mary Ellen Copeland's WRAP book

"Part 6 - Home / Community Care / Respite Center

Many people are setting up plans so that they can stay at home and still get the care they need if they are in a crisis by having around-the-clock care from supporters and regular visits with health care professionals. Many community care and respite centers are being set up around the country as an alternative to hospitalization where you can be supported by peers until your symptoms subside. Set up a plan so that you can stay at home or in the community and still get the care you need. You may need to talk with others about this and explore options that are available in your community."