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Posted: September 8th, 2020

Wellness Recovery Action Plan – research paper

Wellness Recovery Action Plan

WRAP Personal Workbook

GR/LD April 2004

The Wellness Recovery Action Plan is a framework with which you can
develop an effective approach to overcoming distressing symptoms, and unhelpful behaviour patterns. It is a tool with which you can get more control over your problems. WRAP was originally developed by Mary Ellen Copleand and a group of mental health service users who wanted to work on their own recovery – this is what they found worked for them. Developing your own WRAP will take time, it can be done alone, but many find it very valuable to have a supporter – someone they trust, and work on it together.

As you develop your WRAP it can become a practical support for your recovery which you refer to daily, as a reminder and guide, and also turn to at times of difficulty. It is designed as an aid for learning about yourself, what helps and what doesn’t, and how to get progressively more in control of your life and your experience. It also includes instructions on developing a crisis plan, as a means of guiding others on how best to make decisions for you and to take care of you, for those times when your problems and symptoms have made it very difficult for you to do this for yourself. Once you are committed to your own recovery, however things work out, they can be an opportunity for learning more about yourself, and improving your WRAP.

A WRAP includes: developing a Wellness Toolbox, and then

1. Evolving a daily maintenance plan

2. Understanding triggers and what I can do about them

3. Identifying early warning signs and an action plan

4. Signs that things are breaking down and an action plan

5. Crisis planning

6. Post crisis planning

The WRAP belongs to you and you decide how to use it. You decide who to show it to and you decide whether you want someone to work with you on it or not. You decide how much time to spend on it and when to do it. It becomes your guide to support your own wellness and recovery.
Developing a Wellness Toolbox – reminders and resources to call on

a. In my experience these are things that support my wellness – this works for me:

b. This is what carries a sense of meaning or significance for me, this is what inspires me and reminds me of my values

c. These are some things that I would like to try to see if they would support my wellness:

a. My baseline: What am I like when I am well ?
When I feel well, I am …………
When I feel well I am active, I smile a lot, socialize with friends, I feel calm and sometimes go to the gym.

b. Daily maintenance Plan
This is what I need to do for myself every day to keep myself feeling as well as possible

Some of the things I need to do for myself to keep feeling well include taking a shower, calling a friend, reading a book, drinking enough water, and eating three meals a day. I can also take a walk alone or with a friend.
c. This is what I need to do, less often than every day, to keep my overall wellness and sense of wellbeing

Some of the things I should continue doing but less often include going on holiday, going to the cinema to a watch a movie, and reviewing my life goals or plans. Others include going home to see my parents and reviewing my previous performance in school work or relationship with others.

d. These are the things that I know I need to do to sustain my wellness, but for some reason do not do them

Some of the things I believe I should do but do not include taking regular breaks, tidying my room, taking regular eervise, going to the gym, keeping a diary of all events and making a study plan.

2. Triggers
a. Recognition
Triggers are things that happen to us that are likely to set off a chain reaction of uncomfortable or unhelpful behaviours, thoughts or feelings – what triggers me?

Some of the things that trigger me include family conflict, illness, problems at work, the way people treat me and memory of losses I have had in life.

b. Action Plan
What can I do about these triggers ?

I can avoid the triggers, replace them with healthy activities, and keep a positive mindset.

Avoiding your triggers: What can I do to avoid or limit my exposure to things that trigger me?

Some of the things I can do to avoid the triggers or limit them include avoiding stressful actions, developing a study timetable, playing music, listening to quality and inspiring music, or talking to a reliable friend. I can also find time to visit a counselor.

Coping with triggers when they occur: What can I do when I
am triggered to prevent things from getting worse?

When I am triggered I can try to take time away from the situation, share my worries with another person, and sing, take a walk, or run.
3. Early warning signs are the subtle signs of changes in our thoughts or feelings or behaviour, which indicate that you may need to take action to avoid a worsening of your condition or situation.

a. Recognition
What changes for me; what are my early warning signs?

Some of the signs include generating strong emotions, feeling left out and rejected, and overthinking about a situation. I also feel like nobody likes me or appreciates my capabilities. I feel ‘told off’ making me avoid contributing to a conversation or communicating with people.

b. Action Plan
What can I do about this?
What action can I take when I recognise the early warning signs?
Some of the actions include taking to a reliable friend or counselor, focusing on the positive events or activities, and rationalizing my thoughts. I also need to be assertive and focus on exercises that make my mind to relax.

4. When things start breaking down or getting worse
a. Recognition
This is how I think and feel, and how I behave when the situation has become uncomfortable, serious or even dangerous:

I think that the situation will not get better. I also feel that the situation is beyond my strength and nothing will be done to restore it.
b. Action Plan:
When things have progressed this far caring for myself is my top priority. What can I do to reduce these difficult and unpleasant experiences, and prevent things getting worse?

I can prevent things from getting worse by taking a positive mindset in life. I should also keep myself engaged with activities such as reading books, visiting friends, taking a walk or running to avoid an idle mind. I also need to give other people the benefit of doubt and love them despite their problems.
Wellness Recovery Action Plan

PERSONAL CRISIS PLAN

This plan was made on…6/9/2020.. date

And it takes over from any other plans with earlier dates.

This 10 point plan can be just for your own use and reference or can be shared with others involved in the plan. It will take time to set up, and can be changed whenever you have new ideas or information. When you change it, consider sending updated versions to those it involves

Part 1. Remembering What I am like when I’m feeling well

When I am well I am………..

When I feel well I am active, I smile a lot, socialize with friends, I feel calm and sometimes go to the gym.

Part 2. When it gets too bad
Describe how others would know that they need to take over some or full responsibility for your care and make decisions on your behalf, what are you like?
When it gets too bad I ………….

When the situations are bad I am moody, I isolate myself from others, I feel tense and just stay indoors without any specific plan.

List those people you want to take over for you when the symptoms you
listed above are obvious. They can be family members, friends or health care professionals. You may want to name some people for certain tasks like taking care of the children or paying the bills and others for tasks like staying with you and taking you to health care appointments.
These are my supporters:

Bereta Mills
A friend who can stay with me and discuss the issues I am going through
Phone number

Perry Jakes
My brother who understands me better when I am not in the right moods or angry.
Phone number

Jimmy Karter
A counselor who can understand the warning signs and take the necessary steps to prevent harm.
Phone number

Mike Muer
A friend who is concerned about my welfare and a childhood friend. He knows everything that happens in life.
Phone number

Perry Cate
An old school teacher who has been a mentor and godfather. He has been talking to me about life issues for a long time.
Phone number

There may be health care professionals or family members that have made decisions that were not according to your wishes in the past. They could inadvertently get involved if you do not 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)

Cate Myra

Why you do not want them involved (optional)

I do not want her involved in my life since she did not appreciate that I was going through difficulties. She is an ex-girlfriend of my brother and thus her presence triggers negative emotions.

It would only be human nature if sometimes your supporters had
different opinions on what should happen. It could be helpful to your supporters if you describe how you want possible disputes between them settled. For instance, you may want to say that a majority need to agree, or that a particular person, or two people you name can make the decision.

When my supporters disagree amongst themselves, this is how I would like the dispute settled:

I would like the disputes to be handled in the following way. I will request Perry Jakes my brother and Jimmy Karter my counselor to take the leading role in resolving the agreement. I have interacted with them for long and I believe they know what is best for me.

My General Practitioner is Jeff Lee
Contact Phone no.

My Psychiatrist is Julia Hills
Contact Phone no.

My Care co-ordinator is Peter Alex
Contact Phone no.

List the medications you are currently taking and why you are taking them. Include the name of who prescribes them.

1. Olanzapine (Zyprexa)
I am taking the medication to control mood and mental conditions due to the bipolar disorder.
2. Carbamazepine
I am taking the anticonvulsant medication due to the brain injury. The purpose is to decrease brain impulses that cause seizure.

List those medications you would prefer to take if medication or additional medications became necessary, and why you would chose those

Naltrexone is one of the medications I would like to take to control alcoholism and the desire to indulge in alcoholism when I am angry.
Zoloft is another important medication I would like to take when it becomes necessary to treat depression or tendencies of overcoming arguments or disagreements with other people.

List those medications that must be avoided and give reasons

One of the drugs I should avoid is fluoxetine since it can trigger manic episode when taken without a mood stabilizer. The antidepressant medication can trigger mania in patients.

List other treatments that help reduce your symptoms and when they
should be used:

The medications include mood stabilizers such as lithium (Lithobid). The medication should be taken immediately after meals to avoid stomach upsets. The tablets should be swallowed with water.

List treatments you would want to avoid, and why:

The treatment to avoid is antidepressant since they can worsen the treatment of bipolar. Unlike treatment of depression, antidepressants can cause more harm to patients including manic episodes.
Part 6. Alternatives to being in hospital: staying at home or using other safe places

Set up a plan so that you can stay at home or in the community and still get the care you need

The best care is staying at home to ensure the support of the family. Patients with bipolar disorder require support such as listening and caring people who will understand their condition and be there to prevent eventualities.

If it becomes necessary to have treatment somewhere or to attend
hospital where would you prefer to be?

The best place to attend a public hospital is the nearest healthcare center. They have a department that takes care of patients with mental illnesses such as bipolar disorder. It will also be effective since they have counselors who can help overcome problems such as alcoholism or anger.

List treatment facilities you want to avoid and why

The treatment facilities I want to avoid is private institutions that focus on money and not the health or life of a patient. Public hospitals have the best doctor and all facilities are effective. They have qualified professionals and their services are affordable.

List those things that others can do for you that would help reduce
your symptoms or make you more comfortable when you are in crisis – This is what helps me:

Spending time with friends or taking a walk will really help me. For example, a friend took a walk with me to the lake last month and it was the best refreshing event. Another help is watching soccer with a friend. The energy in the sportsmen helps me forget all my troubles.

List those things you need others to do for you and who you want to do what:

What I need done Who I’d like to do it

Spending time together such as taking a walk or watching soccer Perry Jakes

Chatting about life and recounting childhood memories Mike Muer

List those things that others might do, or have done in the past, that would not help or might even worsen your state

Question my behavior with empathy or willingness to understand the cause of the troubles

Condemning me because of the negative decisions I have made in the past.

Comparing me with other people who are excelling or behavior better than me.

If my behaviour endangers me or others I want my supporters to:

I want my supporters to always check on me since sometimes I feel lonely and rejected.
I would also like them to spend time with me such as visiting me or going to a walk with me.
I would also like to celebrate special moments with them including birthdays.

How will your supporters know when it is safe to stop this Crisis Plan?
Describe what positive changes indicate to your supporters that you are in control of things again, and they no longer need to use this plan.

You will know it is safe to cease using this plan when:
I will know its safe when I start connecting with people such as visiting them, calling them, expressing a joyful mood for weeks, and abstaining alcohol. I will know I am okay when I stop getting angry at people or at myself.

You can help ensure that your crisis plan will be followed by signing it in
the presence of two witnesses. It will further increase its potential for use if you identify your supporters and name people who are prepared to back up your needs and preferences.

I developed this plan on (date) With the help of:

Signed Date Witness Date Witness Date

This plan takes over from any with an earlier date

If despite your best efforts at caring for yourself and working with
others, you still go through a crisis – this is not the end of the world, nor does it mean you cannot recover. Recovery is a process that you can get back to at any time and after any experience, no matter how bad. But in order to do so it will be very helpful to reflect on what has happened to you and learn from it. Some can do this alone, most of us are greatly helped by having someone we trust to turn to, and talk it over together.

After a crisis you may be exhausted and badly shaken, so pick your time when you are ready and willing to make sense of it, and you have the energy to do so.

Then talk and think through what has happened, and compare this with the WRAP you have written so far.

What have you learned about yourself and others through this crisis?

Some of the lessons that I have learned is that medications should be combined especially for patients with bipolar disorder. For example, they require mood stabilizer to avoid causing more problems such as manic episodes.

Are there parts of your WRAP that didn’t work out as you had hoped?

All the parts worked effectively well. The only medications that did not work well was antidepressants.

What changes can you make now to your WRAP to make a further crisis less likely?
One of the changes is to avoid prescription of antidepressants. The drugs can cause manic episodes among patients.

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