Recovery, Self Management and WRAP

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Recovery, Self Management and WRAP

• Laurie Davidson

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Recovery

• Recovery is a belief system about what is helpful
  based on experience rather than book knowledge.
• Hope and restoration of a meaningful life are
  possible, despite serious mental illnessinstead
  of focussing primarily on symptom relief,
  recovery casts a much wider spotlight on
  restoration of self esteem and identity and on
  attaining meaningful roles in society.

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Self Management

• Self management is one of the ways in which
  people build up a range of personal resources and
  tactics which work for them and give them more
  control over their lives.
• Having agency means believing that one can
  control, or at least influence, the circumstances
  of ones life. Even though our lives are affected
  by external circumstances, believing one does
  have some control is important to mental health.
  Alternatively, feeling helpless is inimical to
  mental health. Agency is a key element in
  narratives of illness in recovery, because it is
  integral to the most dramatic moment of
  narratives, the turning point when participants
  truly become the heroes of their own lives and
  cease to be victims of circumstance or controlled
  by others, including health professionals..
  (Lapsley et al 2002)

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Self Management

• Self management is one of the ways in which
  people build up a range of personal resources and
  tactics which work for them and give them more
  control over their lives.
• Agency (taking control) is a key element in
  narratives of illness in recovery, because it is
  integral to the most dramatic moment of
  narratives, the turning point when participants
  truly become the heroes of their own lives and
  cease to be victims of circumstance or controlled
  by others, including health professionals.. it is
  at the heart of recovery. Although support and
  intervention from others was crucial too, it was
  important that support stimulated personal
  initiative, rather than creating dependency
  (Lapsley et al 2002)

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Wellness Recovery Action Plan (WRAP)

• Developed by Mary Ellen Copeland with other
  people who had experienced serious mental health
  problems but who had found that a self management
  plan could be effective in avoiding or moderating
  the negative effects of their mental health
  problems
• Is a framework for self management
• Is something we can all do
• May be solely for our own use or can be shared
  with others

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Why WRAP is special

• It is based on common sense and experience
• It is easy to use for individuals, groups or self
  help settings
• It stresses how we all go through similar
  processes - but in very individual ways
• It moves from being managed to self management
• You can mix and match
• It can be secret or shared
• It could lead to a change in culture through more
  clear demands / ideas for change in services
• Staff, service users and carers have seen it as
  helpful
• Multi person training

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WRAP

• Wellness Tools
• Daily Maintenance Plan
• Identifying Triggers and an Action Plan
• Identifying Early WarningSigns and an Action
  Plan
• Signs that Things Are Breaking Down and an
  Action Plan
• Crisis Planning
• Post Crisis Planning

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WRAP Crisis Plan

• What you are like when you are well
• Indicators that others need to take over
• Who takes over and who doesnt
• Information on health contacts and medication
• Acceptable and unacceptable treatments

• Home / community / respite plan
• Acceptable and unacceptable hospital facilities
• Things others can do that would help
• A list of tasks for others
• Indicators that the plan is no longer needed
• Signatures of key people

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Relevance for all

• It is a common sense approach which all can
  benefit from - whether we have never had
  noticeable mental health problems or if we have
  had several admissions to hospital or have severe
  mental health problems. The process is the same,
  but the more serious the consequences of ill
  health, the more the need there will be for
  robust self management plans or WRAP

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WRAP Developments

• Recovery and Self Management Conference
• Recovery and Self Management Action Group
  focussing on WRAP
• First WRAP course in East Devon
• Next in North, Exeter and South Devon
• Expert Patient Programme
• Particularly relevant to Crisis Resolution, Early
  Intervention, Assertive Outreach and Rehab and
  Recovery service
• Could be used in primary care or as part of CPA
• Regional group (NIMHE) being set up

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Narrative Research

• The scientific study of human behaviour has been
  characterised by an emphasis on objectivity, a
  distrust of experiential knowledge and the
  application of quantitative and observational
  methodshowever, some social scientists have
  been concerned that the emphasis on empirical and
  objective methods seems to strip human behaviour
  of its meaning, agency, purpose and social
  contextbecause they ignore narratives and their
  central importance in creating meaning and
  conveying experience
• Kia Mauri Tau Narratives of Recovery from
  Disabling Mental Health Problems. New Zealand
  Mental health Commission. 2002

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WRAP Crisis Plan

• What you are like when you are well
• Indicators that others need to take over
• Who takes over and who doesnt
• Information on health contacts and medication
• Acceptable and unacceptable treatments

• Home / community / respite plan
• Acceptable and unacceptable hospital facilities
• Things others can do that would help
• A list of tasks for others
• Indicators that the plan is no longer needed
• Signatures of key people

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Narrative Research

• The scientific study of human behaviour has been
  characterised by an emphasis on objectivity, a
  distrust of experiential knowledge and the
  application of quantitative and observational
  methodshowever, some social scientists have
  been concerned that the emphasis on empirical and
  objective methods seems to strip human behaviour
  of its meaning, agency, purpose and social
  contextbecause they ignore narratives and their
  central importance in creating meaning and
  conveying experience
• Kia Mauri Tau Narratives of Recovery from
  Disabling Mental Health Problems. New Zealand
  Mental health Commission. 2002

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Aspects of Recovery