WRAP

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WRAP

• Wellness Recovery Action Plan

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WRAP Plans

• WRAP is a framework or a tool to help us gain
  more control over our lives and the way we feel
• WRAP belongs to you and you decide how you want
  to use it
• It is designed to help us identify what works and
  what doesn't work and how we can get better at
  staying well
• It can help you communicate with family, friends
  and mental health professionals, to let them know
  what you need them to do
• It can be done alone, with supporters, in a group
  or one to one
• It is practical and based on common sense

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WRAP includes

• Wellness tools
• Daily Maintenance Plan
• Identifying Triggers plus action plan
• Identifying Early Warning Signs plus action plan
• Signs that Things are Breaking Down and action
  plan
• Crisis Plan
• Post Crisis Plan

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Wellness tools

• What am I like when I am well /
• feeling alright?
• e.g.
• active
• calm
• spontaneous
• fun
• creative
• outgoing

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Wellness Toolbox
What are some of the tools you use to keep you
well? What have you found helpful in everyday
life ?

• What works for you?
• e.g.
• relaxation
• phone a friend
• going for a walk
• bungee jumping

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Wellness Tools

• What helps make sense of life for you or gives it
  value?
• e.g.
• creativity,
• religious beliefs
• a philosophy
• special memory
• dancing
• important music

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Wellness Tools

• What are some of the things you feel you may want
  to work on to keep yourself well?
• e.g.
• take a holiday
• eat less chocolate
• eat more chocolate
• drink less

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Daily Maintenance List

• What do I need to do for myself every day to keep
  myself feeling as well as possible?
• e.g.
• get my sleep
• eat properly
• see my friends
• get some exercise
• take vitamins
• take medication

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Maintenance List

• What are some of the things I need to do every
  month / year to keep my overall wellness and
  sense of wellbeing?
• e.g.
• plan a holiday
• see a relation
• keep in touch with a friend
• start a project / course /
• new job
• review life goals / ambitions

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Triggers
Triggers are things that happen to us which may
set off a chain reaction of uncomfortable or
unhelpful thoughts or behaviour

• e.g.
• problems at work
• anniversary of loss or trauma
• way that others treat you
• being overtired / over worked
• family conflict
• physical illness

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Triggers Action Plan
What have you found that controls / reduces
triggers when they occur or helps to avoid making
things worse?

• e.g.
• controlling breathing
• focusing on priorities
• avoiding stressful situations
• talk to a counsellor / friend
• play an instrument

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Early Warning Signs
These are internal, are subtle signs or patterns
of change. They may be very individual to you
and indicate you may need to do something to
avoid things getting worse. What are my early
warning signs?

• e.g.
• reaction to being told off
• withdrawal
• making a drama into a crisis
• strong emotions
• forgetfulness
• being obsessed with thoughts
• being mentally tired

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Early Warning Signs Action Plan
What can you do to make things better when you
notice early warning signs? What has helped you
in the past?

• e.g.
• talking to a friend or counsellor
• rationalising thoughts
• being assertive
• getting organised
• focussing exercises

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When Things Start to Break Down
This is when things are getting bad and you are
having a hard time or the situation has become
uncomfortable, serious or dangerous. It may be
necessary to take immediate, assertive action to
avoid a crisis

• e.g.
• Sleeping all the time
• Not sleeping
• Eating problems
• Obsession with negative thoughts
• Suicidal thoughts or self harm

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When Things are Breaking Down Action Plan
The plan needs to be clear and directive with
fewer choices to prevent things getting worse.
Survival techniques.

• e.g.
• Call a doctor or mental health professional
• take time off from work
• arrange for someone to stay
• stay with someone you trust
• do things on the daily maintenance list

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Crisis Planning

• This part of the plan should be written when you
  are feeling well. It can be given to other people
  to help them look after you when you are not
  well. It gives you more control even when it
  seems that things are out of control.
• It may take time to develop and set up, but can
  save you and others frustration and time, and
  increase the chances that your needs will be met.

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Crisis Plan includes-

• What you are like when you are well
• Indicators that others may need to take over
• Who takes over and who doesnt
• Information on health care contacts and
  medication
• Acceptable and unacceptable treatments
• Home/community/ respite plan
• Acceptable and unacceptable hospital facilities
• Things others can do that would help
• Things others might do that would make you feel
  worse
• A list of tasks for others
• Indicators that the plan is no longer needed
• Signatures of key people

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What I am like when I am feeling well

• Repeat the first section of the WRAP to ensure
  that others can identify what you are usually
  like when you are well

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Symptoms
What are the signs that indicate that others may
need to become involved. 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
you need help?

• e.g.
• Unable to stay still
• Compulsive behaviour
• Self neglect
• Self harm
• Not performing routine tasks
• Self destructive, abusive or violent
• behaviour
• Substance abuse

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Supporters

• List the key people you want to be involved or
  take over. You could include family members,
  friends or health professionals.
• Ask the people involved if it is OK to include
  them on your list. Tell them what would be
  involved. Show them a copy of your crisis plan
• You may wish to set up a meeting to talk the plan
  through
• You may want to name some people for certain
  tasks such as taking care of children or pets

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Those you do not want involved

• Make a list of people you do not want involved
  with reasons if possible
• Include a section on how you want supporters to
  settle disputes if they disagree. You may want to
  say that a majority need to agree or that a
  particular person or persons can make that
  decision

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Medication and Treatments

• Give phone numbers of key people such as GP or
  mental health worker
• List the medications or treatments you would
  prefer or are acceptable with reasons
• Medications or treatments that should be avoided
  and why
• Include complementary or alternative therapies
  which you have found helpful / unhelpful

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Alternatives to hospital

• Develop a plan so that you can stay at home or at
  a place of your choice within the community. This
  may be for a crisis or can be for respite to
  avoid a crisis
• You may wish to spend time reviewing or even
  visiting the options open to you

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Help from Others
List things others could do for you that would
help

• e.g.
• Listen without interrupting
• Hold me, or let me move around
• Take me for a walk
• Reassure me
• Keep me from hurting myself or
• Others
• Pay my bills
• Child or pet care
• Buying groceries
• Talking to employer
• Cleaning the house

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Things that would not help or could worsen my
symptoms

• e.g.
• panicking
• using force or restraints
• not listening
• getting angry with me
• patronising me
• not keeping me informed
• making plans behind my back

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When I feel better and dont need this plan
Develop a list of indicators that your supporters
can use to determine when they no longer need to
use this plan

• e.g.
• When I am looking after myself
• When I have had a good
• nights sleep
• When I start planning ahead
• When I am able to speak about what happened

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When you have completed your crisis plan

• Update it when you learn new information or
  change your mind about things
• You can increase the likelihood of your plan
  being followed by signing it in the presence of
  witnesses. Give your supporters a new copy every
  time you revise it
• There is no absolute guarantee that the plan will
  be followed, and it could overridden by the
  Mental Health Act. However, it is your best
  chance for your wishes to be honoured

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Post Crisis Planning

• Each crisis, though painful, may
• provide new insights into developing
• your crisis plan
• e.g.
• what you have learned from the
• crisis
• changes you need to make in your life as a result
  of what you have learned
• if you have been hospitalised where you will go
  when discharged and who you want to be with you
• things that would help your recovery if they are
  taken care of

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WRAP and carers/supporters. 1. Maintaining
wellness for ourselves

• WRAP is for you just as much as the person you
  are supporting. We can all use WRAP to help us
  maintain our wellness.
• WRAP recognises that there will be times when you
  will be supported by the person you are
  supporting. They can be part of your WRAP plan as
  much as the other way round.
• It recognises and values the important role that
  carers play in keeping people well
• It can give us more control over our lives and
  more choices

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WRAP and carers/supporters. 2. Providing support

• I have heard carers wring their hands and say so
  many times during a crisis, what can I do?,
  what can I do? This is a way to get round some
  of that. Mary Ellen Copeland
• It recognises that crises rarely come out of
  nothing and are part of a process. That process
  may be predictable, but does not have to be
  inevitable
• It offers a way of capturing the knowledge and
  experience in a way that may be able to diminish
  the impact of, or even avoid, the next crisis.