Recovery, Self Management Recovery, Self Management and WRAPand WRAP

Laurie DavidsonLaurie Davidson

RecoveryRecovery

Recovery is a belief system about what is helpful Recovery is a belief system about what is helpful based on experience rather than book knowledge.based on experience rather than book knowledge.

““Hope and restoration of a meaningful life are Hope and restoration of a meaningful life are

possible, despite serious mental illness…instead possible, despite serious mental illness…instead of focussing primarily on symptom relief, recovery of focussing primarily on symptom relief, recovery casts a much wider spotlight on restoration of self casts a much wider spotlight on restoration of self esteem and identity and on attaining meaningful esteem and identity and on attaining meaningful roles in society.”roles in society.”

Self ManagementSelf Management Self management is one of the ways in which people build Self management is one of the ways in which people build

up a range of personal resources and tactics which work up a range of personal resources and tactics which work for them and give them more control over their lives. for them and give them more control over their lives.

““Having agency means believing that one can control, or at Having agency means believing that one can control, or at least influence, the circumstances of one’s life. Even least influence, the circumstances of one’s life. Even though our lives are affected by external circumstances, though our lives are affected by external circumstances, believing one does have some control is important to believing one does have some control is important to mental health. Alternatively, feeling helpless is inimical to mental health. Alternatively, feeling helpless is inimical to mental health. Agency is a key element in narratives of mental health. Agency is a key element in narratives of illness in recovery, because it is integral to the most illness in recovery, because it is integral to the most dramatic moment of narratives, the turning point – when dramatic moment of narratives, the turning point – when participants truly become the heroes of their own lives and participants truly become the heroes of their own lives and cease to be victims of circumstance or controlled by others, cease to be victims of circumstance or controlled by others, including health professionals..” (Lapsley et al 2002) including health professionals..” (Lapsley et al 2002)

Self ManagementSelf Management Self management is one of the ways in which people Self management is one of the ways in which people

build up a range of personal resources and tactics build up a range of personal resources and tactics which work for them and give them more control which work for them and give them more control over their lives. over their lives.

““Agency (taking control) is a key element in Agency (taking control) is a key element in narratives of illness in recovery, because it is narratives of illness in recovery, because it is integral to the most dramatic moment of narratives, integral to the most dramatic moment of narratives, the turning point – when participants truly become the turning point – when participants truly become the heroes of their own lives and cease to be victims the heroes of their own lives and cease to be victims of circumstance or controlled by others, including of circumstance or controlled by others, including health professionals.. it is at the heart of recovery. health professionals.. it is at the heart of recovery. Although support and intervention from others was Although support and intervention from others was crucial too, it was important that support stimulated crucial too, it was important that support stimulated personal initiative, rather than creating dependency” personal initiative, rather than creating dependency” (Lapsley et al 2002)(Lapsley et al 2002)

Wellness Recovery Action Plan Wellness Recovery Action Plan (WRAP)(WRAP)

Developed by Mary Ellen Copeland with other Developed by Mary Ellen Copeland with other people who had experienced serious mental people who had experienced serious mental health problems but who had found that a self health problems but who had found that a self management plan could be effective in avoiding or management plan could be effective in avoiding or moderating the negative effects of their mental moderating the negative effects of their mental health problemshealth problems

Is a framework for self managementIs a framework for self management Is something we can all do Is something we can all do May be solely for our own use or can be shared May be solely for our own use or can be shared

with otherswith others

Why WRAP is specialWhy WRAP is special It is based on common sense and experienceIt is based on common sense and experience It is easy to use for individuals, groups or self help It is easy to use for individuals, groups or self help

settingssettings It stresses how we all go through similar It stresses how we all go through similar

processes - but in very individual waysprocesses - but in very individual ways It moves from being managed to self managementIt moves from being managed to self management You can mix and matchYou can mix and match It can be secret or sharedIt can be secret or shared It could lead to a change in culture through more It could lead to a change in culture through more

clear demands / ideas for change in servicesclear demands / ideas for change in services Staff, service users and carers have seen it as Staff, service users and carers have seen it as

helpfulhelpful Multi person trainingMulti person training

WRAPWRAP 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 PlanWRAP Crisis Plan What you are like What you are like

when you are wellwhen you are well Indicators that others Indicators that others

need to ‘take over’need to ‘take over’ Who takes over and Who takes over and

who doesn’twho doesn’t Information on health Information on health

contacts and contacts and medicationmedication

Acceptable and Acceptable and unacceptable unacceptable treatmentstreatments

Home / community / Home / community / respite plan respite plan

Acceptable and Acceptable and unacceptable hospital unacceptable hospital facilitiesfacilities

Things others can do that Things others can do that would helpwould help

A list of tasks for others A list of tasks for others Indicators that the plan is Indicators that the plan is

no longer neededno longer needed Signatures of key peopleSignatures of key people

Relevance for all Relevance for all

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

WRAP DevelopmentsWRAP Developments Recovery and Self Management ConferenceRecovery and Self Management Conference Recovery and Self Management Action Group Recovery and Self Management Action Group

focussing on WRAPfocussing on WRAP First WRAP course in East DevonFirst WRAP course in East Devon Next in North, Exeter and South DevonNext in North, Exeter and South Devon Expert Patient ProgrammeExpert Patient Programme Particularly relevant to Crisis Resolution, Early Particularly relevant to Crisis Resolution, Early

Intervention, Assertive Outreach and Rehab and Intervention, Assertive Outreach and Rehab and Recovery service Recovery service

Could be used in primary care or as part of CPA Could be used in primary care or as part of CPA Regional group (NIMHE) being set upRegional group (NIMHE) being set up

Narrative ResearchNarrative Research ““The scientific study of human behaviour has been The scientific study of human behaviour has been

characterised by an emphasis on objectivity, a characterised by an emphasis on objectivity, a distrust of experiential knowledge and the distrust of experiential knowledge and the application of quantitative and observational application of quantitative and observational methods……however, some social scientists have methods……however, some social scientists have been concerned that the emphasis on empirical been concerned that the emphasis on empirical and objective methods seems to strip human and objective methods seems to strip human behaviour of its meaning, agency, purpose and behaviour of its meaning, agency, purpose and social context…because they ignore narratives social context…because they ignore narratives and their central importance in creating meaning and their central importance in creating meaning and conveying experience” and conveying experience”

‘‘Kia Mauri Tau – Narratives of Recovery from Disabling Mental Health Problems. New Kia Mauri Tau – Narratives of Recovery from Disabling Mental Health Problems. New Zealand Mental health Commission. 2002Zealand Mental health Commission. 2002

WRAP Crisis PlanWRAP Crisis Plan What you are like What you are like

when you are wellwhen you are well Indicators that others Indicators that others

need to ‘take over’need to ‘take over’ Who takes over and Who takes over and

who doesn’twho doesn’t Information on health Information on health

contacts and contacts and medicationmedication

Acceptable and Acceptable and unacceptable unacceptable treatmentstreatments

Home / community / Home / community / respite plan respite plan

Acceptable and Acceptable and unacceptable hospital unacceptable hospital facilitiesfacilities

Things others can do that Things others can do that would helpwould help

A list of tasks for others A list of tasks for others Indicators that the plan is Indicators that the plan is

no longer neededno longer needed Signatures of key peopleSignatures of key people

Narrative ResearchNarrative Research ““The scientific study of human behaviour has been The scientific study of human behaviour has been

characterised by an emphasis on objectivity, a characterised by an emphasis on objectivity, a distrust of experiential knowledge and the distrust of experiential knowledge and the application of quantitative and observational application of quantitative and observational methods……however, some social scientists have methods……however, some social scientists have been concerned that the emphasis on empirical been concerned that the emphasis on empirical and objective methods seems to strip human and objective methods seems to strip human behaviour of its meaning, agency, purpose and behaviour of its meaning, agency, purpose and social context…because they ignore narratives social context…because they ignore narratives and their central importance in creating meaning and their central importance in creating meaning and conveying experience” and conveying experience”

‘‘Kia Mauri Tau – Narratives of Recovery from Disabling Mental Health Problems. New Kia Mauri Tau – Narratives of Recovery from Disabling Mental Health Problems. New Zealand Mental health Commission. 2002Zealand Mental health Commission. 2002

Aspects of RecoveryAspects of Recovery

Service redesign

NarrativeResearch

Social inclusion

Shiftingpower

SelfManage-

ment

Recovery