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					   WRAP

Wellness Recovery
   Action Plan




                    1
        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


                                       2
     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



                                 3
      Wellness tools

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


                                  4
    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




                                    5
        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

                                6
       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



                                  7
 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




                                        8
     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


                                      9
             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


                                       10
  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



                                  11
  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‟

                                       12
  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

                                   13
 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


                                     14
     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

                                    15
      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.

                                 16
  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



                                         17
 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




                                    18
            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

                                            19
         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



                                        20
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



                                21
      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

                                22
 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




                                23
        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



                                      24
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




                                25
 When I feel better and
  don‟t 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
  night‟s sleep
• When I start planning ahead
• When I am able to speak
  about what happened

                                    26
    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


                                     27
   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



                                       28
         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

                                     29
         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.


                                            30

				
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