Wellness Recovery Action Plan: Opening the Door to Relapse Prevention and Recovery

by Mary Ellen Copeland, MS, MA

I have been working with people for over 12 years, teaching them skills and strategies that others have found to be useful in relieving and preventing psychiatric or mental health-related symptoms. I began this work out of my own frustration with not finding simple, safe, effective ways to relieve the extreme swings of mood that were destroying my life. In my ongoing research on this topic, I have interviewed thousands of people. I have used my findings to develop numerous mental health-related resources, in leading workshops all over the country, and for my own healing. Several state departments of mental health and various regional mental health organizations have used the wellness model I have developed throughout their mental health systems.

The most exciting discovery I have made during this journey has been the “Wellness Recovery Action Plan” or “WRAP.” This monitoring system was devised in 1997 by a group of people I was working with who experience psychiatric symptoms. They felt the need for a more structured way of addressing and relieving their symptoms.

The enthusiasm for this program has been overwhelming! People who experience psychiatric symptoms are desperate to find effective, safe things that they can do for themselves that will improve their level of wellness and quality of life. I later developed two books that describe the system and facilitate its use. These are listed at the end of this column.

You must develop your own WRAP. No one can write your WRAP for you. This article is a summary of the process. It contains enough information so that you can develop your own Wellness Recovery Action Plan. You can refer to the books for more information if you need help. You can also check out my Web site at www.mentalhealthrecovery.com for further assistance.

That’s a WRAP

WRAP is a self-designed plan that teaches you how to keep yourself well, to identify and monitor your symptoms and to use simple, safe, personal skills, supports, and strategies to reduce or eliminate symptoms. It is not meant to replace, but to complement, professional health support and medications, though in more and more cases people are able to shift the balance of care to this self-management approach over time.

The only materials you will need to create a WRAP are a 1” thick three-ring binder, five tabbed separators, and plenty of three-holed paper.

In developing your own WRAP, you will first want to spend some time developing your “Wellness Toolbox.” The Wellness Toolbox is a listing of those things you may already know and do to take good care of yourself and things you think would be helpful. You will use these “tools” to develop your own plan. Wellness tools include things like developing a strong support system; peer counseling; focusing; relaxation and stress reduction exercises; journaling; creative, fun and affirming activity; exercise; diet; light; and getting a good night's sleep. Include this list in the front of your notebook. Add new ideas to the list as you think of them.

Now, set up your notebook using the tabs. Insert each tab followed by several sheets of lined paper.

  • In Section 1, list your daily maintenance activities – those activities you know you must do every day to maintain your wellness. Things like getting a half-hour of exercise, drinking eight glasses of water, doing relaxation exercises and spending time doing things you like to do.

  • In Section 2, list your personal triggers – those events that might cause an increase in symptoms like getting a big bill, having an argument with a family member or having car trouble. Then, using the previously learned strategies in your Wellness Toolbox, develop and write a plan to get through this difficult time. Strategies may include calling a supporter, taking extra time to do something fun and doing a deep breathing exercise.

  • In Section 3, list early warning signs – those subtle signs that warn of a possible worsening of symptoms like nervousness, sleeplessness or fatigue. Then develop a plan, more intensive than the last one, which will help you to avoid further difficulties. This plan might include getting extra exercise, seeing your counselor, avoiding caffeine and doing some peer counseling with a friend.

  • In Section 4, list those symptoms that indicate that the situation is worsening, also known as when things are breaking down. These may include crying all the time, sleeping all day, being very irritable and shouting at family members and co-workers. Then write a very intensive plan that would help relieve these symptoms, like taking three days off from work, asking a family member to take over your household responsibilities and spending two to three hours doing something you enjoy, like woodworking.

  • Section 5 is an intensive crisis plan. This part of the plan may be hard for you to write and may take much more time than the other parts of the plan. You may want to set it aside and leave it for another time when you feel more ready to do this work. In this plan, write: 1) those symptoms that indicate that you would want others to take over responsibility for care, like being deeply depressed, very agitated or out of touch with reality; 2) who you want to take responsibility for your care and make decisions for you; and 3) acceptable and unacceptable actions to take on your behalf. Give copies of this part of the plan to the people you want to take over for you so they will know what to do if you are having a crisis.

After you have written your WRAP, review it daily. Do the things on your daily maintenance plan every day. If you are triggered, have early warning signs, or know that things are getting much worse, do the things you have listed in your response. Revise the plan as needed. After a while, using the plan will become second nature to you and you will not have to refer to it as often.

The WRAP approach empowers you to take control of your own health and wellness, while reducing symptoms and improving your quality of life. Since its development, the system has been shared with thousands of people through the books mentioned above, the “Winning Against Relapse” Audio Cassette, through numerous support groups, workshops and seminars, and through the www.mentalhealthrecovery.com Web site.

Resources:

Copeland, M. (1997). Wellness recovery action plan. Brattleboro, VT: Peach Press.

Copeland, M. (1999). Winning against relapse: A workbook of action plans for recurring health and emotional problems. Oakland, CA: New Harbinger Publications. [Available both in paperback and audio cassette versions] Date published: 8/24/00

Last reviewed: By John M. Grohol, Psy.D. on 9 Oct 2013
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