WRAP: A Tool for Recovery For many years stabilization was the goal for individuals experiencing psychiatric symptoms. Based on the medical model and professional intervention, the focus was on helping individuals understand and accept their illnesses, stay on medication and keep appointments, reduce hospitalizations, and perform the activities of daily living. This approach left little hope for the millions of Americans with mental illness and by the early 1990s a new concept had emerged.
Across the nation, individuals and peer groups began embracing the belief that people can and do recovery from mental illness and that essential components of that recovery include restoring hope, assuming personal responsibility, educating and advocating for oneself, and developing a support system. A group of psychiatric survivors in Vermont began devising a system for recovery,
which has been taught to consumers of a variety of healthcare services across America and published as "Wellness Recovery Action Plan" (WRAP). WRAP is a structured system for monitoring uncomfortable and distressing symptoms and, through planned responses, reducing or eliminating them. The symptoms may be from a wide range of illnesses or disturbances, from depression to diabetes, panic attacks to fibromyalgia. This plan can be utilized by anyone who wants to create positive change in the way they feel and their enjoyment of life. The WRAP system requires a one-inch thick binder, five tabbed separators and plenty of lined three-hole paper. At the front of the binder, before the action plan, is the "wellness toolbox," in which individuals identify and list the things they use to help themselves feel better during difficult times. New ideas can be gained from family, friends, healthcare professionals, and self-help resource books. This resource list can be refined over time and referred to when developing the system's actions plans. The action plan is divided into five tabbed sections: Daily maintenance plan - includes a list of words that describe you when you are feeling well; a list of things you must do every day to maintain wellness, such as taking vitamins or medication and eating nutritious meals; and list of things you must do periodically, like pay certain bills. Triggers - includes a personalized list of thing that have occurred or are likely to occur that cause an increase in symptoms, such as anniversary dates of losses or trauma or being treated disrespectfully, and a plan for what to do when those triggers occur. Early warning signs - includes a list of early and subtle signs of trouble and an action plan for response. A person may be very aware of his or her red flags or may want to consult with loved ones for the early warning signs they have observed. When things are breaking down - includes a list of symptoms when they are at a serious level and an action plan for response. This action plan needs to be clear and concise, with fewer choices for response. Crisis planning - specific instructions to those who must take over responsibility for the individual's care when he or she is unable, including the descriptors of the person when well (copied from the daily maintenance plan); a list of symptoms that would indicate to others that they need to take over responsibility for the person's care; a list of preferred and/or unacceptable options in terms of health care provider and facility, medication, and treatment; a list of at least five supporters who understand the person's crisis plan and have agreed to take over responsibility for the person and to represent his or her best interests; a list of things the supporters can do to facilitate recovery, from taking care of children or pets to simply being available to listen in a nonjudgmental manner; and a list for the supporters that lets them know how to recognize when the person has recovered enough to take care of himself or herself and no longer needs the crisis plan. The Wellness Recovery Action Plan is an ideal addendum to a psychiatric advance directive or another durable power of attorney document. It works because it is easy to develop and use, it is highly individualized, it directly addresses the symptoms and circumstances that are most troubling with specific response plans, and renews a sense of hope for and control over one's life. The Washington County Mental Health & Addiction Recovery (MHAR) Board is working to obtain funding to train WRAP facilitators in the county. For more information, call me at 374-6990 or visit the following websites: www.mentalhealthrecovery.com (provides recovery information and sells the WRAP book) www.mentalhealth.samhsa.gov/publications/allpubs/SMA-3720/introduction.asp (provides a copy of "Action Planning for Prevention and Recovery: A Self-Help Guide")