Wellness Recovery Action Plan WRAP Deborah Amesbury LCSW

Wellness Recovery Action Plan (WRAP) Deborah Amesbury, LCSW Deb. BAmesbury@msn. com 9/2007

Having a mental illness does not mean that you can’t be mentally healthy. Amesbury Deborah 2

Key Recovery Concepts HOPE PERSONAL RESPONSIBILITY EDUCATION SELF-ADVOCACY SUPPORT 3

There is lots of hope. Those of us who experience psychiatric symptoms get well and stay well for long periods of time. We work toward and meet our goals. We lead happy and productive lives. 4

We don’t want or need dire predictions about the course of our illness from anyone. We want our supporters and health care professionals to encourage us, help us in alleviating our current symptoms, and assist us in staying well. 5

Hope is the anchor of the soul, the stimulus to action and the incentive to achievement. Unknown 6

Hope is like a bird that senses the dawn and carefully starts to sing while it is still dark. Anonymous 7

Personal Responsibility We need support from others as we take personal responsibility for our own wellness and our own lives. We know we need to rely on ourselves, with help from others, as we work to control our symptoms and our lives. Those of use who take personal responsibility achieve the highest levels of: wellness, happiness and life satisfaction. 8

I am responsible for my own life. I cannot expect or count on anyone else to make my life the way I want it to be. It is finally up to me to make happen what I want to happen – to create whatever it is that I want created. Mental Health Empowerment Project Albany, NY 9

Education We learn all we can about our symptoms so we can make good decisions about our: Øtreatment Ølifestyle Øcareer Ørelationships Øliving space Øleisure time activities Øall aspects of our lives 10

We do this by: Ø attending workshops, lectures and support groups Ø reviewing educational resources (articles, books, newsletters, audio & video tapes) Ø checking out the Internet Ø contacting related organizations Ø talking to health care professionals and others who have similar experiences 11

Self-Advocacy We become effective self-advocates by: Ø Believing in ourselves Ø Knowing our rights and seeing that they are respected Ø Setting personal goals and working toward meeting them by: getting the facts, planning our strategy, gathering support, and targeting our efforts. 12

Self-advocacy means… “Going for it” with courage, persistence and determination, expressing ourselves clearly and calmly until we get what we need. 13

Personal Bill of Rights 1. I have the right to ask for what I want. 2. I have the right to say “no” to requests or demands I can’t meet. 3. I have the right to change my mind. 4. I have the right to make mistakes and not 5. I have the right to follow my own values and standards. 14

6. I have the right to express all of my feelings, both positive & negative. 7. I have the right to say “no” to anything when I feel I am not ready, it is unsafe, or it violates my values. 8. I have the right to determine my own priorities. 9. I have the right not to be responsible for others’ behavior, actions, feelings or problems. 10. I have the right to expect honesty from others. 15

11. I have the right to be angry at someone I love. 12. I have the right to be uniquely myself. 13. I have the right to feel scared and say “I’m afraid. ” 14. I have the right to say “I don’t know. ” 15. I have the right not to give excuses or reasons for my behavior. 16. I have the right to make decisions based on my feelings. 16

17. I have the right to my own needs for personal space and time. 18. I have the right to be playful and frivolous. 19. I have the right to be healthier than those around me. 20. I have the right to be in a nonabusive environment. 21. I have the right to make friends and be comfortable around people. 17

22. I have the right to change and grow. 23. I have the right to have my needs and wants respected by others. 24. I have the right to be treated with dignity and respect. 25. I have the right to be happy. 18

Support from family, friends and health care professionals is essential. Being effectively supported helps relieve symptoms. 19

Everyone needs at least 5 good friends or supporters they can call on when they need: Øsomeone to talk to Øcompanionship Øhelp in figuring things out & decision-making Øsomeone to take over for them & keep them safe when they can’t do it for themselves Øto have a good time 20

Supporters are people who: Ø care about you Ø empathize with you Ø affirm & validate you and your experience Ø accept you as you are Ø listen to you & share with you Ø advocate for you Ø enjoy sharing fun & interesting activities with you 21

Supporters: Ø can make decisions & take action on your behalf when you can’t do this for yourself Ø are willing to follow your predetermined plans 22

WRAP is something that I can hold around me to make me feel safe, comfortable and warm. Margo

Recovery isn’t the end of the rainbow; It’s the beginning. Evy Jarman

Mental illness is not for wimps! Judy Lucero Denver 1991

WRAP is a gift you give yourself! Deborah Amesbury

WRAP Daily Maintenance List Additional things I might need to do that would be good to do (continued) Take a class Ride the bus around town Get dressed up and go shopping without any money Cook and invite someone for dinner Get a new haircut Work in the yard Do some volunteer work 27

If you have much, give of your wealth; if you have little, give of your heart. Arab Proverb 28

WRAP Triggers Things that, if they happen, might interfere with my wellness/recovery Anniversary dates Excessive work stress Guilt about past actions Fear of failure Holidays Being criticized and feeling like a failure Remembering being sexually assaulted Drinking alcohol or using street drugs 29

WRAP Triggers Things that, if they happen, might interfere with my wellness/recovery (continued) Financial problems Sleep disruption Not being able to say “no” Letter from SSA or IRS Rent increase Violent movies Argument with family member or co-worker 30

WRAP Triggers Things that, if they happen, might interfere with my wellness/recovery (continued) Cruelty to people or animals Crowded places Legal problems Over-extending myself Not feeling heard/validated Condescending providers Physical illness 31

WRAP Triggers Action Plan – Things that I can do if my triggers come up to keep them from interfering with my wellness/recovery Take the day off from work Get validation from a friend / supporter Go swimming Focus on something else (diversionary activity) Do some deep breathing exercises Take a hot bath and use aromatherapy Meditate and/or pray 32

WRAP Triggers Action Plan – Things that I can do if my triggers come up to keep them from interfering with my wellness/recovery (continued) Go to church Do something artistic Take an inventory of all the “gifts” I have in my life Journal Listen to relaxing music Go to a support meeting 33

Wherever there is a human being there is an opportunity for a kindness. Seneca 34

WRAP Early Warning Signs Some early warning signs that others have reported and/or I have observed that may indicate that I have to take better care of myself Inability to experience pleasure Forgetfulness Increased smoking Lack of motivation Muscle cramping Avoiding doing things on my Daily Maintenance List Failing to buckle my seat belt 35

WRAP Early Warning Signs Some early warning signs that others have reported and/or I have observed that may indicate that I have to take better care of myself (continued) Inattention to personal grooming Recycling bin is overflowing House get more cluttered Can’t find things / forgetting where I put things Plants are dying from neglect Less concern / caring for pets 36

WRAP Early Warning Signs Some early warning signs that others have reported and/or I have observed that may indicate that I have to take better care of myself (continued) Wearing more makeup than usual Dressing in dark colors “Overacting” to small annoyances Forgetting where I’m driving to Forgetting to take my meds Eating more sugar than usual 37

WRAP Early Warning Signs Things I must do if I experience early warning signs Do things on my Daily Maintenance List whether or not I feel like it Tell my therapist how I am feeling and ask for their advice Do at least one focusing exercise a day Do at least 3, 10 -minute relaxation exercises each day Write in my journal at least 15 minutes each day Spend at least 1 hour involved in an activity I enjoy 38

WRAP Early Warning Signs Things I must do if I experience early warning signs (continued) Turn off the TV Go to ___ 12 -step meetings each week Go to ___ support meetings each week Call one supporter to let them know that something is not working Stay off the couch Exercise 39

WRAP Early Warning Signs Things I must do if I experience early warning signs (continued) Do affirmations Think about RECOVERY and WELLNESS Ask others to take over my household responsibilities for a day Put a sign up in my bedroom that indicates that I may be experiencing a mood change Stay away from any place where there is alcohol 40

WRAP Early Warning Signs Things that I can do if they feel right to me Check in with my psychiatrist Surround myself with loving, affirming people Go see a funny movie Dance, sing, listen to good music, play a musical instrument Take 3 days off from work (without feeling guilty) Ask someone to stay with me or go to stay with someone Go fishing 41

Man has never made any material as resilient as the human spirit. philosopher Bernard Williams English 42

WRAP When Things are Breaking Down Signs/symptoms that indicate that I am feeling much worse Unable to sleep for more than 3 days Sleeping all the time Not eating Thoughts of self-harm Wanting to be totally alone Racing thoughts Risk-taking behaviors, e. g. , gambling, driving fast, promiscuity 43

WRAP When Things are Breaking Down Signs/symptoms that indicate that I am feeling much worse (continued) Substance abuse Wanting to be hospitalized Paranoia Hearing voices Bizarre behaviors Spending excessive amounts of money Inability to problem solve 44

WRAP When Things are Breaking Down Signs/symptoms that indicate that I am feeling much worse (continued) Can’t begin / complete projects Feeling like crawling out of my skin Crying all day Feeling overwhelmed Sitting and staring Don’t care anymore Stopping meds 45

WRAP When Things are Breaking Down Action Plan – Things that can help me feel better when I am feel much worse Do everything on my Daily Maintenance List whether I want to or not Call my psychiatrist, ask for and follow her instructions Have my meds checked Call and talk as long as I need to my supporters Arrange for someone to stay with me around the clock until my symptoms subside 46

WRAP When Things are Breaking Down Action Plan – Things that can help me feel better when I am feeling much worse (continued) Write a contract with my therapist Call the warm line Arrange to take at least 3 days off from all responsibilities Have someone call me to check in 3 times daily 47

WRAP When Things are Breaking Down Action Plan – Things that can help me feel better when I am feeling much worse (continued) Take actions so I cannot hurt myself if my symptoms get worse, such as give my meds, checkbook, credit cards and car keys to a previously designated supporter for safekeeping Discuss my community plan (from Crisis Plan) with appropriate people to determine if it should be implemented 48

Don’t let what you cannot do interfere with what you can do. John Wooden 49

WRAP Crisis Plan Written when the individual is well. Purpose is to instruct others about how to care for the person when they are not well. Can be used as a psychiatric advance directive – identify the AGENT. Part 1 – What I’m like when I’m feeling well (reference Daily Maintenance List) 50

WRAP Crisis Plan Part 1 – What I’m like when I’m feeling well 51

WRAP Crisis Plan Part 2 – I need help when I (symptoms that indicate that others need to take over full responsibility for my care and make decisions on my behalf) 52

WRAP Crisis Plan Part 2 – I need help when I am: Not sleeping at all Not getting out of bed Not taking care of my pet Destroying property Talking continuously and not making sense Engaging in self-destructive behaviors Having uncontrollable thoughts about hurting myself 53

WRAP Crisis Plan Part 2 – I need help when I am: (continued) Not leaving my house Refusing to take my medications Sending e-mails and letters that make no sense to others Not showing up for work and not calling anyone Screaming at voices Thinking that someone is trying to hurt me 54

WRAP Crisis Plan Part 2 – I need help when I am: (continued) Unable to stop compulsive behaviors like constantly counting things Giving things away Not answering the phone / isolating Neglecting my personal hygiene 55

WRAP Crisis Plan Part 3 – These are my SUPPORTERS, the people who I want to take over for me when the symptoms I listed in Part 2 come up Name Relation to me Phone number Role I want this person to play and/or task(s) I need him / her to do 56

WRAP Crisis Plan Part 3 Supporters Barbara Markum Friend/Guide 303 -123 -4567 Advise me, talk to me about recovery. Let me call her in the middle of the night when I feel out of control. Paul Mc. Nulty Friend 720 -123 -4567 Check to see that I am in a safe place/facility. Make sure that my WRAP has been evaluated by staff. Talk to Barbara Markum about how to be helpful. 57

WRAP Crisis Plan Part 3 Supporters (continued) Sara Tilson Therapist 303 -911 -9876 Explain the reason for hospitalization. Make sure that my WRAP is followed as much as possible. Consult with my psychiatrist and facility treating staff. Carol Hannock, MD Psychiatrist 720 -911 -0000 Work with facility treating staff regarding any changes in meds and following my WRAP. 58

Crisis Plan Part 3 Supporters (continued) Hannah Stephens Sister 303 -234 -5678 Bring me things I need. Take care of my valuables, home, plants. Kay Warner Co-worker 720 -987 -6543 Support me in my recovery at work. 59

WRAP Crisis Plan Part 3 Supporters – People to Notify. (List those people you want your supporters to notify if you are in crisis along with what to tell each of them. ) 60

WRAP Crisis Plan Part 3 Supporters – People to Notify Please notify Lauren Sanchez, my supervisor. Tell her that my psychiatrist wants me to take a week off from work. Please notify my sister, Bailey. Tell her that I’m not doing well and to pray for me every day. Please notify my friends Marcella and Bill, Janice and Hal, Evadne, Susan. Tell them that I will not be in contact with them for awhile. Tell them that prayers, emails (including inspiring quotes and jokes) and cards are appreciated. 61

WRAP Crisis Plan Part 3 Supporters – People to Notify Please notify Reverend Kenyon, my minister. Tell him to pray for me and Please contact Tessa Constance, my support group facilitator, and ask her to let group members know that I am struggling and need their thoughts and prayers. Tell Tessa that I will try to get to meetings as soon as possible. 62

WRAP Crisis Plan Part 3 Supporters – People I don’t want involved in any way in my care and treatment (Include name and why you don’t want them involved. ) 63

WRAP Crisis Plan Part 3 Supporters – People I don’t want involved in any way in my care and treatment: My mother because she is critical and doesn’t understand my illness. 64

WRAP Crisis Plan Part 3 Supporters – How I want disputes between my supporters settled 65

WRAP Crisis Plan Part 3 Supporters – How I want disputes between my supporters settled I want my sister and my therapist to take the lead in making decisions and organizing all the support and services I need. 66

The words that enlighten the soul are more precious than jewels. Khan Hazrat Inayat 67

WRAP Crisis Plan Part 4 – Medical Information/Medications/Supplements/ Health Care Preparations 68

WRAP Crisis Plan Part 4 – Medical Information/Medications/Supplements/ Health Care Preparations PCP – Cindy Lin, 303 -757 -1234 Psychiatrist – Carol Hannock, 720 -911 -0000 Massage therapist – Marian Willis, 303 -998 -7766 Chiropractor – Mark Ray, 720 -432 -526 Pharmacy – Walgreens, 303 -722 -4545 Allergies – None 69

WRAP Crisis Plan Part 4 – Medical Information/Medications/Supplements/ Health Care Preparations (ATTACH PHOTCOPY OF CURRENT INSURANCE CARD/INFORMATION) 70

WRAP Crisis Plan Part 4 – Medical Information/Medications/Supplements/ Health Care Preparations ü Medications/supplements I am currently taking and why I am taking them ü Medications/supplements to be used if needed, when to use them and why I choose them ü Medications/supplements/health care preparations to avoid and why 71

WRAP Crisis Plan Part 4 – Medications/Supplements I am currently taking and why I am taking them Depakote XXXmg Risperdal XXXmg features Klonopin XXXmg help me sleep Glucophage XXXmg Chromium picolinate loss and help Centrum vitamins Melatonin Mood stabilizer To control psychotic For anxiety and to For diabetes For possible weight with diabetes For good physical health For sleep 72

WRAP Crisis Plan Part 4 – Medications/Supplements I prefer to take if medications or additional medications become necessary, and why I choose them Topomax Should not cause weight gain Zyprexa Has worked for my brother who has similar symptoms IM med for heavy sedation if I have not had any sleep for 3 or more days – to help me sleep for at least 24 hours Zoloft Has worked to treat my depression in the past 73

WRAP Crisis Plan Part 4 – Medications/Supplements that are acceptable to me if medications become necessary and why I choose them Any mood stabilizer or combination of mood stabilizers if my mania is difficult to get under control Any SSRI because I have not had any negative side effects from Zoloft Meds that my supporters feel are OK as long as they are not on my “must be avoided” list 74

WRAP Crisis Plan Part 4 – Medications/Supplements that must be avoided and reasons why Lithium because I became toxic easily in the past Haldol, except for initial sedation, because I don’t like the long-lasting “drugged up” feeling – The same goes for Prolixin, Mellaril, Thorazine and Stellazine Effexor because it gave me migraine headaches SSRIs because they make me manic 75

WRAP Crisis Plan Part 5 – Treatments and Complementary Therapies ü Treatments/complementary therapies that help reduce my symptoms and when they should be used ü Treatments/therapies I want to avoid and why 76

WRAP Crisis Plan Part 5 – Treatments/Complementary Therapies Treatments/complementary therapies that help reduce my symptoms and when they should be used Hospital should allow me full privileges as soon as possible if I am admitted voluntarily so I don’t feel cut off from the outside Let my supporters visit as soon as I am admitted to a facility because they are helpful to me Make sure that my symptoms are not due to my medical problems – diabetes, hypertension 77

WRAP Crisis Plan Part 5 – Treatments/Complementary Therapies Treatments that help reduce my symptoms and when they should be used (continued) One to one therapy to help me explain my situation Group therapy to support my coping skills Review my WRAP to see what went wrong and if I need to make any changes Art therapy and music therapy to help me relax Let me get outside for 30 minutes a day to feel better 78

WRAP Crisis Plan Part 5 – Treatments/Complementary Therapies Treatments that help reduce my symptoms and when they should be used (continued) Let me sleep off my mania rather than force me to be involved in activities – otherwise I will be agitated and may become verbally abusive Let me have my own CD player and my relaxation CDs because that works to help me relax Let me have my own journal so I can write in it as soon as I begin to feel better 79

WRAP Crisis Plan Part 5 – Treatments/Complementary Therapies Treatments that help reduce my symptoms and when they should be used (continued) Let my friend come and give me a massage which puts me in a good mood and helps me feel better physically Let me practice my meditation in a quiet place to feel grounded When someone sits and talks with me in a calming way I feel safer 80

WRAP Crisis Plan Part 5 – Treatments/Complementary Therapies Treatments/therapies I want to avoid and why Shock treatment because I don’t want to lose my memory Restraints because it causes me to remember being raped and I get flashbacks and panic Don’t approach me from behind or come within 3 feet of me without my permission because I may be fearful of being raped Isolation because I get scared anxious Forced meds unless nothing on my WRAP has worked and at least 3 of my supporters agree 81

WRAP Crisis Plan Part 6 – Home/Community Care/Respite Plan ü If possible, help me use the following care plan to stay in my community and still get the care I need 82

WRAP Crisis Plan Part 6 – Home/Community Care/Respite Plan If possible, help me use the following care plan to stay in the community and still get the care I need Make sure that my schedule is clear Have someone stay with me Support me in following a daily schedule of exercise, meals, journaling and meditation Bring together my WRAP supporters to problem solve and coordinate 83

WRAP Crisis Plan Part 6 – Home/Community Care/Respite Plan If possible, help me use the following care plan to stay in the community and still get the care I need (continued) Have my supporters check in with me at least 3 times a day Have someone take me out on an errand, walk and/or for coffee daily Have daily contact with my psychiatrist and/or therapist. See my psychiatrist at least weekly Have someone take over all my household responsibilities 84

WRAP Crisis Plan Part 6 – Home/Community Care/Respite Plan If possible, help me use the following care plan to stay in the community and still get the care I need (continued) Have someone make sure that I am eating at least 2 meals a day Have someone bring me cooked meals and do my laundry Have someone make sure that I am caring for my dog Have someone make sure that I am caring for my child Spend time with healthy people Have someone make sure that I am taking my meds 85

WRAP Crisis Plan Part 7 – Hospital or Other Treatment Facilities ü Hospitals/treatment facilities where I prefer to be treated or hospitalized if that becomes necessary ü Hospitals/treatment facilities I want to avoid and why 86

WRAP Crisis 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 Boulder Community Hospital because it’s close to home Longmont Memorial Hospital because my friend was treated well when she was there Cedar House because I know the staff there Fort Logan because they won’t discharge me too soon 87

WRAP Crisis Plan Part 7 – Hospital or Other Treatment Facilities Hospital/treatment facilities I want to avoid and why Xavier Hospital because they put me into restraints before trying other things Franklin Memorial Hospital because they “drugged me” Roosevelt Psych Unit because the staff were not respectful to patients 88

WRAP Crisis Plan Part 8 – Help From Others ü Things that others can do for me that would help reduce my symptoms, make me more comfortable and keep me safe ü Things that won’t help me and may make things worse 89

WRAP Crisis Plan 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 my daughter to bring me all my things I need my supporters to call or visit every day I need my supporters to make sure my WRAP is being followed I need my supporters, family and friends to pray for me 90

WRAP Crisis Plan Part 8 – Help From Others Please do the following things that would help reduce my symptoms, make me more comfortable and keep me safe (continued) I need anyone who visits me to bring me chocolate and/or cigarettes I need my supporters, family and friends to listen to me without giving me advice, judging me or criticizing me 91

WRAP Crisis Plan Part 8 – Help From Others Do not do the following. It won’t help me and it may even make things worse. Get angry with me Be impatient Force me to do things I don’t want to do Make me feel guilty or blame me Put me in the hospital without any explanation Call the police 92

WRAP Crisis Plan Part 9 – When My Supporters No Longer Need to Use This Plan (inactivating the Crisis Plan) ü Symptoms, lack of symptoms or actions that indicate that my supporters no longer need to use this Crisis Plan 93

WRAP Crisis Plan Part 9 – When My Supporters No Longer Need to Use This Plan The following signs, lack of symptoms or actions indicate that my supporters no longer need to use this plan Sleeping through the night for 2 nights Being able to carry on a conversation Being rational Eating at least 2 meals a day for 3 days Being able to take care of my pet Returning phone calls and answering the phone 94

WRAP Crisis Plan Part 9 – When My Supporters No Longer Need to Use This Plan The following symptoms, lack of symptoms or actions indicate that my supporters no longer need to use this plan (continued) Getting my sense of humor back Driving again Feeling good enough to go back to work, at least parttime Following my Daily Maintenance Plan 95

Don’t look where you fell, but where you slipped. proverb Liberian 96

The future belongs to those who believe in the beauty of their dreams. Roosevelt Eleanor 97

WRAP Ø Focus is on wellness and recovery Ø The use of complementary/supplemental alternatives in addition to medications, is STRONGLY ENCOURAGED! Ø It is the INDIVIDUAL’S plan and their decision regarding Ø Who they want to have a copy ØHow they want it used in treatment ØHow often they want to revise/update it ØHow much of it they want in their clinical record 98

WRAP To receive any WRAP workbooks, example packets or wellness information via email, contact: Deb. BAmesbury@msn. com 99

If you don’t work your WRAP, it won’t work! 100

WRAP Post Crisis Plan Different from other parts of WRAP in that it is constantly changing as you heal. It is anticipated that 2 weeks after a crisis you will be feeling much better than you did after 1 week and therefore your daily activities will be different. Best to develop when you are feeling quite well. You may want to develop one with your care providers before discharged – a kind of comprehensive discharge plan 101

WRAP Post Crisis Plan includes: Post Crisis Planning Worksheet üTask or responsibility üSteps üWhen you would like to take this step How I would like to feel when I have recovered from this crisis Post Recovery Supporters List 102

WRAP Post Crisis Plan includes: Arriving at Home (if you were hospitalized or away from home) üSafety issues üThings to take care of üThings to ask someone to do for you üThings that can wait until I feel better üThings I need to do for myself every day while recovering 103

WRAP Post Crisis Plan includes: Arriving at Home (if you were hospitalized or away from home) üThings I might need to do every day while recovering üThings and people I need to avoid while recovering üSigns that I may be beginning to feel worse üWellness tools I will use if I start to feel 104

WRAP Post Crisis Plan includes: Issues to Consider üWhat I need to do to prevent further repercussions from this crisis…and when I will do these things üPeople I need to thank üPeople I need to apologize to üMedical, legal or financial issues that need to be resolved 105

WRAP Post Crisis Plan includes: Timetable for Resuming Responsibilities Other issues I may want to consider 106