WRAP

1. WRAP Wellness Recovery Action Plan

2. 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

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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’

13. Early Warning Signs Action Plan e.g. • talking to a friend or counsellor • rationalising thoughts • being assertive • getting organised • focussing exercises What can you do to make things better when you notice early warning signs? What has helped you in the past?

14. 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

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

16. 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.

17. Crisis Plan includes:- • What you are like when you are well • Indicators that others may need to ‘take over’ • Who ‘takes over’ and who doesn’t • 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. When I feel better and don’t need this plan e.g. • When I am looking after myself • When I have had a good night’s sleep • When I start planning ahead • When I am able to speak about what happened Develop a list of indicators that your supporters can use to determine when they no longer need to use this plan

27. 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

28. 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

29. 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

30. 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.