“When the group developed WRAP, I was so impressed that I went home and wrote one for myself!”
– Mary Ellen Copeland
As someone who regularly puts almost her entire life out there for the general public to consume, I’m so interested in hearing/reading about the lives of others and seeing inside the most mundane of things! As someone who really struggles with completely mixed feelings of loneliness - sometimes all I want is to be surrounded by people and other times I can only tolerate the company of my pets – I mostly enjoy the YouTube ‘Get Ready With Me’ videos or ‘Speed Clean My Flat’ or ‘Come Shopping With Me’ because they enable me to have control over the company and how long it lasts! The important thing is the impact loneliness can have on a person’s mental health and so, in a desperate bid to help others experience the same positive things I feel when I watch similarly formatted videos. Though, of course I had to make my version mental health themed… Ever since I was discharged from the specialist psychiatric hospital in 2014, I’ve heard so many good things about Wellness Recovery Action Plans, but it wasn’t until recently that I – and my Community Psychiatric Nurse (CPN) – realized that I’ve never done one! And as with most documents in mental health, it has the chance of triggering negative thoughts and feelings by making you think back to hard times so I thought that maybe it’d also be helpful to me to feel that I sort of have someone with me while I complete it...
In 1997, Mary Ellen Copeland and several more inspirational people developed the very first Wellness Recovery Action Plan (WRAP) when they were desperately looking for a way to fulfill their own hopes and dreams by overcoming their mental health problems. A current WRAP has a number of different parts and questions that will help you to do a number of things that will benefit your mental health, such as develop a list of things you can do to stay well, and create a crisis plan. It is because of their original motivation to create WRAP, that it’s designed to do several things for you and your mental health:
1. Decrease and prevent intrusive or troubling feelings and behaviours
2. Increase personal empowerment
3. Improve quality of life
4. Assist you in achieving your own life goals and dreams
My CPN said that I can choose to answer the questions however I like whether it be through writing a few sentences, doing bullet points, making rough notes… I figured that maybe I’ll wait and see what each of the questions are and decide then which way feels best in answering them. So, for this first one, I figure maybe a little paragraph because the first part to a WRAP is the ‘Daily Maintenance List’ which begins by asking what you’re like when you’re well; what sort of person you are, your typical attitude, your usual mood, or general outlook on life when your mental health is healthy and stable.
I know I mentioned that documents like this can sadden you when you’re asked to think about the bad times but actually, thinking about positive times can be hard too. I guess because it can be a stark reminder of what you lose when your mental health has deteriorated; the person you no longer are because the depression, or the anxiety, or the hallucinations have taken hold. And that can make you angry at your mental health disorder for taking those good qualities away from you and making you into a person that you aren’t, and who you don’t want to be.
When my mental health is well, I’m such a positive person who absolutely loves life! Like, so passionately! I want to do all that I can to live life to the full and so I say yes to every opportunity that comes my way with no recognition of just how much I’m agreeing to! I don’t think about the limit on anything because I don’t want there to be one. I have the ‘life’s too short’ attitude that leaves me making some very impulsive decisions, but which are impulsive in a good way because they make things even better, make me even happier. Whilst being impulsive, I’m also more thoughtful of the consequences to unsafe behaviours like drinking alcohol or self-harming. I think ahead to the negative impact those things will have on me; the pain they’ll cause, the danger they can bring, the hospital admissions and occasionally nasty Doctors and Nurses, the hangover… I remember everything that, once I’ve done it, make me think ‘why did I even do that?!’ I’m also much healthier in my diet, exercise, and sleep; I actually have an appetite and don’t calorie count, I don’t mind long walks and getting out the house, and I enjoy getting a good night’s sleep without it taking up half a day or no time at all. I’m more balanced. I also have a whole different attitude to my appearance; I’m not overly confident or secure in my body image but I am content with it and I take time in maintaining my appearance through showers, doing my make-up, and doing my hair. I care what I look like without it being the most important thing in the world. I’m not just productive in my appearance though, I’m also active with I’m NOT Disordered and any other work/projects that I have on at the time. I enjoy doing them, don’t delay them, and don’t procrastinate when I’m supposed to be doing them. Finally, I have healthy, safe, and secure relationships with people who matter very deeply to me, I enjoy spending time with my Mum, I stay in touch with my friends and Aunt, and I love caring for my kitten (Emmy) and bunny (Pixie).
Next, in WRAP is to list the things that you need to do every day to keep yourself well.
· Speak to my Mum
· Spend time with my pets
· Message friends
· Take my medication
· Check my social media
· Have at least 8 hours sleep
· Eat whatever I like
· Have time on The Sims!
· Have something to look forward to the next day
I won’t lie, I took inspiration from the ‘example WRAP’ that my CPN gave me because I was a bit confused as to just what counted as a ‘thing’ to do every day. I mean, should that be significant things like taking medication or can it include simple, smaller things like spending time on your favourite game. I also 2hesitated on some of the points… Especially the ‘social media’ one – I initially worried that it would seem superficial and shallow to say that something so simple could have such a positive impact on my mental health. Then I thought that if someone else were to think that, I’d reassure them that different things matter to different people and it’s important to recognize what matters to you, and to not be ashamed in using that knowledge to maintain your mental wellbeing.
The next part of WRAP is named ‘Triggers’ and it defines a trigger as an ‘external upsetting event or circumstance which produces discomfort’ and something which you ‘don’t expect’ and can have ‘little control over.’ WRAP says something very important about this section; that triggers are different for everyone. I think it’s similar to earlier when I voiced my concerns over people’s judgements of my answers to these questions, and if you have this worry then you have to remind yourself that everyone is different and no one’s answers are less important, insignificant, or trivial compared to another person’s. With that in mind, here are my triggers:
· Trauma anniversaries
· Particular words that relate to the circumstances around the abuse I experienced
· Any changes to my support network e.g. staff going on holiday, someone leaving…
· Someone I care about (pets included) being poorly
· Authority figures abusing their position of power
· Being medically unwell
· Visiting particular locations
I think that writing about your triggers is one of the main parts that can actually make you feel worse because sometimes, especially when you’re feeling vulnerable, simply thinking about and writing your triggers can be enough to upset you and deteriorate your mental health. While I’ve completed this section I have Greys Anatomy on in the background, my kitten entertaining me, and a bar of chocolate beside me so that there’s an element of distraction from what I’m writing about and also something to remind me that these triggers aren’t actually happening. I’m really quite safe, I’m in my own home, I’m happy, and those things are not happening to me right now. I guess I’m suggesting maybe having a distraction and a grounding technique to hand when doing this section!
The next part is to devise an ‘Action Plan’ by listing tools that you can use to help you feel better when you’ve experienced a triggering event or circumstance. I think that my Plan is really simple; if I’m triggered – no matter what the trigger – I need to use my Dialectical Behaviour Therapy (DBT) skills. Usually Mindfulness works by mindfully doing another activity that distracts me from the triggering event/circumstance/situation so that absolutely all of my attention and focus is on this one other thing and it means there’s no room in my head for thoughts around the trigger to be there too. Another DBT skill I use when triggered is the ‘Self-Soothe’ skill from the therapy’s Distress Tolerance section, I usually do something like have a shower, read, watch Netflix, or do my make-up; just anything that will make myself feel better. For a long time I had to fight the feeling that I didn’t deserve to be soothed, but now that I know that when I’m triggered my coping skills can be unsafe by self-harming in some way, I feel the need to try harder to do something soothing for myself because I’m desperate to do any alternative to self-harm.
The next section in WRAP is ‘Early Warning Signs’ which it describes at being ‘internal signs’ that you notice but aren’t always sure why you’re experiencing them. For me, an early warning sign is also about it being something that changes, something that you believe, if it didn’t happen or if it did and you could get help for it, then you maybe wouldn’t fall into an episode of depression, or have a panic attack, or hallucinate, self-harm, or attempt suicide. It’s something that leads to something worse.
· Feeling hopeless
· Overwhelming anger
· When I am hugely focused on the abuse
· Missing appointments
· Unable to cry in situations where I usually would have
· Becoming distracted by the hallucinations
· Refusing to take my medication
· Experiencing constant headaches
· Thoughts to self-harm
The second part is to create another Action Plan but because it’s for a different stage in your mental health, I don’t feel that it’s a repetitive step. To me, my reaction to a trigger is an early warning sign so if the action plan for triggers was successful then I shouldn’t experience an early warning sign and it shouldn’t escalate into something a lot more serious and unsafe. It’s also not so repetitive because I would list different ways to manage my poor mental health than I did where the struggle was a trigger. I think that this is because having an early warning sign occur would mean that the action plan for the trigger had failed, so it’s obvious that this would lead me to believe that I needed a whole new list of ways to cope. A list that might hopefully be a bit more robust.
My thinking, for either list, is that I try all of the DBT skills that work for me before seeking help from a professional e.g. my CPN or my Richmond Fellowship support worker so I’d initially try some different DBT skills in addition to those in the previous action plan. I’d use the ‘HOW’ skill from the Mindfulness component of the therapy which is all about considering the emotions you’re experiencing without judgement, one-mindfully (which means trying to separate things and experience one thing at a time), and do both of these effectively. I’d also use ‘Pros and Cons’ from the Distress Tolerance part of DBT because I find it particularly helpful where I’m having suicidal thoughts or thoughts to self-harm. It really helps me to sit down and look at the fact that the ‘pros’ of resisting those thoughts far outweigh the ‘cons’ because when I’m experiencing those thoughts I very easily ‘forget’ all of the things that (when I’ve done these things in the past) make me wish I hadn’t done it. I don’t consider the nausea or the judgement from hospital staff. I don’t think about the pain or the scars the self-harm could leave. But if I take the time through the overwhelming urges to think these things through then I usually find that I’ll see that very little good comes from self-harming or attempting suicide. I also use the PLEASE skill from the Emotion Regulation section of DBT. Each letter stands for a different thing that you should or shouldn’t do to help reduce your vulnerability to particular emotions and thoughts. The P and L are (sneakily) taken from Physical Illness so that’s about ensuring your physical health is well and that it isn’t wearing you down and influencing your mental health’s stamina. The ‘E’ is about eating and having a balanced diet with three healthy meals a day, five portions of fruit or vegetables and plenty water. ‘A’ is for Altering Drugs which isn’t just about substance abuse, but also ensuring that you’re taking your prescribed medication and ensuring that missing some doses hasn’t led to your mental health deteriorating. The ‘S’ is for sleep – I do think that this one is definitely an individual thing in that not everyone needs to same amount of sleep; regardless of whether the recommended amount is eight hours. Personally, I need a lot more and if I’m being really honest; if you want me to be happy and fully functioning then twelve would pretty much be my recommended amount! Finally, the ‘E’ is for exercise and again, I think this is an individual one. For me, my exercise is usually in the form of walking everywhere possible. If I have an appointment with my CPN in the town center then I walk there, if I’m going to my Mum’s I’ll walk to that, to my GP, to the pharmacy, for the bus… Of course, others view it more as sessions in the gym but I think it’s what you make of it; it’s about doing a healthy activity that will improve your fitness. Then, where my DBT skills seem insufficient to maintain my safety, I would call either my CPN, Richmond Fellowship, or the Crisis Team. Another back-up I have is PRN medication which is tablets that you only take when you need them e.g. painkillers or anti-sickness drugs. For me though, I have a mild sedative as my PRN medication for in a mental health crisis.
Ok! So, the next part of WRAP is called ‘When Things Are Breaking Down’ and the Plan’s definition of this being the stage where your wellness tools are ‘starting to fail’ and no matter how hard you try you feel worse every day. With this definition considered, I decided to skip the entire section (which was purely listing the signs things are breaking down and devising an action plan for it) because I felt it too similar to the previous one. Perhaps, the Plan means for them to be different but for me, and my mental health, they’re too similar to be able to differentiate them. So, I decided to move onto – what you’ll be pleased to hear is – the final part; Personal Crisis Plan.
There’s a lot of this section that I can’t write on here but I found it a really helpful part so I thought that I’d still tell you all what it contains! The reason I can’t mention most of it is because there are areas about making a list of people you trust to take responsibility for your care when you’re unable to care for yourself, a place to list people you don’t want involved in your care, the contact information for your CPN and GP, the medications you take and their doses, any allergies, and hospitals that you would want to avoid being admitted to and ones that you would find acceptable. These are all fairly confidential bits of information and even though half of my life is online, I still know where to draw the line on how much insight to give people! There’s two parts that I could write about but won’t because they are basically repeats of earlier and this post is getting quite lengthy(!) and they’re bits about what you’re like when you’re well and symptoms that your mental health has deteriorated. What I will complete with you all is the part about listing things that others can do for me that I find helpful:
· Reviewing DBT skills
· Engaging in arts and crafts related activities
· Providing necessary/relevant medication
· Being a listening ear
· Trauma therapy
· Practicing Mindfulness with me
· Feeling validated
And thingsI have found unhelpful:
· The use of restraint, and seclusion or ‘stripped’ rooms
· Being given IM (intra-muscular) medication
· Art therapy(!)
· Taking any anger (from the situation) out on me
And that’s it! I hope that this post has given you all some insight into something that may become part of your life or part of the life of someone you know and so you feel better placed and more able to take on the challenge of either completing a WRAP or supporting someone else to complete one.