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Wellness Action Recovery Plan (WRAP plan) Wellness
Recovery Action Plan Overview Wellness Action Recovery Plan (WRAP) is a wellness and relapse prevention program for people who experience symptoms of mental illness. The WRAP program teaches people how to set up a daily maintenance plan, how to recognize the triggers that cause symptoms to develop, and how to build an action plan for when things are breaking down and they face a mental health crisis. The program was developed by Mary Ellen Copeland, M.A. and has had national success. Clinicians can also help consumers use the program as part of their service plan. Those who have used the program report that they feel a sense of mastery over their symptoms and have more confidence in their ability to stay out of the hospital, rebuild relationships with family members, and return to work or school. You can learn about the WRAP program and get a copy of an actual WRAP plan by going to: If you are interested in putting together a WRAP plan, you can use the following outline: WRAP
-Wellness Recovery Action Plan Overview This handout is a guide to developing a Wellness Recovery Action Plan. This plan can be used by people who are experiencing psychiatric symptoms to develop their own plan, or by health care professionals who are helping others to develop Wellness Recovery Action Plans. For further information on developing a WRAP, see Wellness Recovery Action Plan (Peach Press revised 2000), Wellness Recovery Action Plan for Dual Diagnosis (Peach Press, 2001) and Winning Against Relapse (New Harbinger Publications, 1999) available from the office of Mary Ellen Copeland. The Plan must be developed by the person who will be using it, when they decide the time is right to develop one. A Wellness Recovery Action Plan must never be required. A care provider or supporter can assist and support a person in this process if the person developing the plan wants their help. The person who develops the plan can choose to share it with the people of their choice, but again, this is never required. Getting Started The following supplies will be needed to develop a Wellness Recovery Action Plan: 1. A three ring binder, one inch thick, 2. A set of five dividers or tabs, 3. A package of three ring filler paper, most people preferred lined 4. A writing instrument of some kind, and, 5. (Optional) a friend or other supporter to give you assistance and feedback. Wellness Toolbox Begin developing the plan by identifying and listing all the tools and strategies you have found to be effective in helping you to stay way and in relieving symptoms when they come up. In addition, write possible new skills and strategies you have l earned through this workshop, from supporters and care providers, or through books like The Depression Workbook (New Harbinger Publications, 1992), Living without Depression and Manic Depression (New Harbinger Publications, 1994). Wellness Recovery Action Plan (Peach Press 1997) and Winning Against Relapse (New Harbinger Publications, 1999). Some of these tools include addressing things like dietary needs, exercise, relaxation exercises, journaling, doing something fun or creative, getting outdoor light, medications, getting support, peer counseling and using spiritual resources. Put this list in the front of your binder. You can also include a list of your supporters along with their phone numbers. Section 1-Daily Maintenance List On the first tab write Daily Maintenance List. Insert it in the binder followed by several sheets of filler paper. On the first page, describe, in list form, yourself when you are feeling all right using words like happy, energetic, competent, capable, introverted, quiet, resourceful etc. On the next page make a list of things you need to do for yourself every day to keep yourself feeling all right like eating three healthy meals, drinking plenty of water, getting outside exercise, and doing relaxation exercises. By doing these things every day you can often prevent the onset of troubling symptoms. On the next page, make a reminder list for things you might need to do like buy some groceries, call your doctor, pay some bills, contact a friend or do something fun. Reading through this list daily helps keep us on track. Section 2-Triggers External events or circumstances that, if they happen, may produce serious symptoms that make you feel like you are getting ill. These are normal reactions to events in our lives, but if we don’t respond to them and deal with them in some way, they may actually cause a worsening in our symptoms. On the next tab write, "Triggers" and put in several sheets of binder paper. On the first page, write down those things that, if they happened, might cause an increase in your symptoms. They may have triggered or increased symptoms in the past--things like someone being rude to you, the anniversary dates of trauma or loss, not getting enough rest, stress, moving, and illness. On the next page, write an action plan to use if triggers come up, using the Wellness Toolbox as a guide so that your symptoms don’t worse--things like deep breathing exercises, taking a walk, doing some peer counseling and watching a funny video. Section 3-Early Warning Signs Early warning signs are internal and may be unrelated to reactions to stressful situations. In spite of our best efforts at reducing symptoms, we may begin to experience early warning signs, subtle signs of change that indicate we may need to take some further action. On the next tab write "Early Warning Signs". On the first page of this section, make a list of early warning signs you have noticed like increased anxiety, headache, aches and pains, negative thoughts and trouble sleeping. On the next page, write an action plan to use if early warning signs come up, using the Wellness Toolbox as a guide--things like getting more exercise, talking to your health car provider, doing extra relaxation exercises, working on a fun project and writing in your journal. Section 4-Things are Breaking Down or Getting Worse In spite of our best efforts, our symptoms may progress to the point where they are very uncomfortable, serious and even dangerous, but we are still able to take some action on our own behalf. This is a very important time. It is necessary to take immediate action to prevent a crisis. On the next tab write, "When Things are Breaking Down". Then make a list of the symptoms which, for you, mean that things have worsened and are close to the crisis stage--like agitation, having a hard time making decisions, crying a lot, wanting to sleep all the time and thinking about using substances. On the next page, write an action plan to use "When Things are Breaking Down" using the Wellness Toolbox as a guide like calling your health care provider and following their instructions, asking someone to take over your responsibilities for several days, doing several peer counseling exercises each day and asking for around the clock support. Section 5-Crisis Planning In spite of our best planning and assertive action, we may find ourselves in a crisis situation where others will need to take over responsibility for our care. We may feel like we are totally out of control. Writing a crisis plan when you are well to instruct others about how to care for you when you are not well, keeps you in control even when it seems like things are out of control. Others will know what to do, saving everyone time and frustration, while insuring that your needs will be met. Develop this plan slowly when you are feeling well. You could use the following form. Name ___________________________________ Date ____________
Part 1 What I’m like when I’m feeling well.
Part 2: Symptoms. If I have several of the following signs and/or symptoms, my supporters, named on the next page, need to take over responsibility for my care and make decisions in my behalf based on the information in this plan.
Part 3: Supporters. If this plan needs to be activated, I want the following people to take over for me. Name Connection/role Phone number I do not want the following people involved in any way in my care or treatment: Name I don’t want them involved because: (optional) Settling Disputes Between Supporters If my supporters disagree on a course of action to be followed, I would like the dispute to be settled in the following way:
Part 4: Medication. Physician ____________________ Psychiatrist ______________________ Other Health Care Providers Pharmacy ___________________ Pharmacist ________________________ Allergies ______________________________________________________________ Medications and health care preparations I am using Medications to be used if necessary **Medications and health care preparations to avoid Why? **take special note
Part 5: Treatments Treatments that help Treatments to avoid
Part 6: Home/Community Care/Respite Center. If possible, follow the following home and community care plan:
Part 7: Hospital or other Treatment Facilities. If I need hospitalization or treatment in a treatment facility, I prefer the following facilities in order of preference Name Contact Person Phone Number Avoid using the following hospital or treatment facilities Name Reason to avoid using
Part 8: Help from others. Please do the following things that would help reduce my symptoms, make me more comfortable and keep me safe. I need (name the person) __________________ to (task) _____________________ ________________________________________________________________________ I need (name the person) __________________ to (task) _____________________ ________________________________________________________________________ I need (name the person) __________________ to (task) _____________________ ________________________________________________________________________ Do not do the following. It won’t help and it may even make things worse.
Part 9 Inactivating the Plan. The following signs, lack of symptoms or actions indicate that my supporters no longer need to use this plan.
I developed this plan on (date) _______________ with the help of ___________________ Any plan with a more recent date supersedes this one. Signed ______________________________ Date __________________ Witness _____________________________ Date __________________ Durable Power of Attorney ____________________________________
Other Publications by Mary Ellen Copeland: The Adolescent
Depression Workbook Video and
audio tapes: To order: |
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