Recovery, Self Management and WRAP Laurie Davidson

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 illness…instead 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.”

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 one’s 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)

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)

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

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

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

WRAP Crisis Plan  What you are like when you are well  Indicators that others need to ‘take over’  Who takes over and who doesn’t  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

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

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

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 methods……however, 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 context…because 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

WRAP Crisis Plan  What you are like when you are well  Indicators that others need to ‘take over’  Who takes over and who doesn’t  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

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 methods……however, 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 context…because 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

Aspects of Recovery Recovery Self Manage- ment Shifting power Social inclusion Narrative Research Service redesign