WRAP is Born

This article was written in 1997 and continues the story from “Getting Well: the Seeds of WRAP”. It describes the process on how the parts of WRAP were formed.

Read Part 1 of the WRAP Story: “Getting Well: the Seeds of WRAP” for the first part of this story

Now let’s fast forward.  It is 1997.  It is a cold winter day in northern Vermont.  In the past 6 years I have written several books based on my studies, my mother has died at the age of 82, leaving her family and the community adrift in sorrow, and I have been traveling all over the country teaching people the simple, safe self-help skills and strategies that I have learned through my studies.  And I was doing pretty well myself.  Not great but pretty well. I still often had moments of deep despair.  And sometimes I felt so good that I was obnoxious. I thought I had it all figured out.

So on this cold winter day in northern Vermont in 1997, I was finishing up an 8-day training teaching almost 40 people, mostly people who had serious mental health issues, and who had braved the wind-chill and the blowing snow, the skills and strategies I had learned through my studies. I thought I had done a great job.  Then a woman stood up in the back of the room and said, “This is all well and good.  But I have been in state hospitals all over the country and I wouldn’t have any idea how to organize these things to make them work in my life.”  I heard her, and so did all the other people who were there.  We made a commitment that day to keep meeting until we had come up with some kind of a system so that people could organize the skills and strategies I had been sharing with them into their lives.

We spent three full days deliberating.  Trying this idea and that idea.  We worked with sheets of newsprint paper across the wall.  Sharing ideas.  Discussing things.  Crossing things out.  Adding new things.  Until, after 3 days, it felt like we had something. And they decided to call it the Wellness Recovery Action Plan—“it has such a good acronym”–and so WRAP was born.  The structure that they came up with is the same structure that is WRAP today.

I am going to describe for you the process we went through to develop WRAP as I remember it.  First, they decided, you have to have a list of all of the possibilities, all of the things you can use to help yourself feel better and help yourself stay well, all of the resources you have at your fingertips but often neglect when you are having a hard time.  That became the Wellness Toolbox.  It included things like all the skills and strategies I had been teaching them all week–relaxation and stress reduction techniques, diet changes, exercise, focusing, arts, music–and all the things they had discovered in their own lives.  These lists can go on and on and on and often do.  I have over 80 Wellness Tools on my list.  And it keeps growing and growing and growing as I keep growing and my needs change.

Then they said you need a list of those tools you need to use every day.  Call it the Daily Maintenance Plan.  It shouldn’t be too long so you can be sure to get it all done.  And then they said, before that, you need at least a list of words that describe you when you are well.  You need a point of reference.  You could write a paragraph, or a book, or put in a picture, but a simple list of descriptive words would be fine. And then, they said, after that list of things you need to do every day, you need a list of things you might need to do on any given day to avoid stress–things like buy groceries, make an appointment, keep an appointment, call a friend, clean your living space.

Then they said, what about those unexpected things that happen that get us off course— Triggers, they called them.  Things like someone being rude, or a big disappointment like losing a job or seeing an accident, an upsetting news story, or the anniversary date of a great loss.  We need to list them.  And they agreed that probably they would add to this list as they discovered new ones.  Then they said we need an action plan so we don’t get overwhelmed when these things come up.  So, back they went to their Wellness Toolbox and came up with lists of possible things they could do to keep from getting overwhelmed or stressed, or to get back to feeling OK after an unexpected event or Trigger.

They felt that, because these things happen at lots of unanticipated times and in unanticipated places, they would need different options of actions they could take.  As you can see, a new way of proactive thinking is evolving here.  They were coming up with a structure that each person could use to develop their own personal WRAP, their Wellness Recovery Action Plan.

Then they said, “There are times when we just start feeling worse and we don’t know why”.  I could really relate to that.  Sometimes I just feel off.  I don’t feel like buckling my seat belt.  I don’t feel like answering the phone.  I have a slight headache.  I have a negative attitude.  I am self-critical.  They wanted to call this time Early Warning Signs.  This was all sounding so sensible to me. They said we should make a list of these early warning signs, and then develop another action plan of things we must do when these notice these signs.  For me personally these were the kinds of things I always used to ignore.  So taking action at this time was a new concept for me, a new way of thinking.   I put things on my list like getting at least one hour of exercise, working on either a drawing or quilting project, playing the piano for half an hour, and making my favorite Creamed Dried Beef on Toast for lunch.

They said that next they need to know “When Things have Gotten Much Worse”. H’mmm.  Isn’t this the time when we should go to the emergency room or call the crisis team?  Or instead, perhaps we could help ourselves around this and get ourselves feeling good again.  They wanted to call this section “When Things are Breaking Down”.  Again, it would start with developing our own individual list for what, personally, for us, indicates that things are breaking down.  Things like crying all the time, not eating at all, being unable to sleep for three nights, yelling at people you love, feeling like drinking alcohol or drinking alcohol, feeling like cutting or even cutting.  They acknowledged that these signs are very idiosyncratic.  What might be an early warning sign for one person might mean things were breaking down for someone else.    And then they said, we need an action plan–something we are committed to do even when we don’t feel like it, something that is very structured with few choices, something like what a good hospital day would look like in a perfect world. It might be 4 relaxation exercises a day, a half hour playing my trumpet, two fifteen minute sessions of being listened to by a friend, one hour of walking or riding my exercise bicycle, and wearing my power outfit.

It took lots of haggling to get this far.  We had been warned that people wouldn’t be able to stay in a session for 15 minutes.  They worked on this from 9-4 for 3 days. They felt exuberant about it.

They said there is one more piece we need.  Given what we have already come up with, we think we can avoid a crisis where other people have to step in and take care of us.  But given the uncertainty of the future, we should include a Crisis Plan or Advance Directive.  Something that tells others what to do for us when we cannot take responsibility for ourselves.   Something we actually give to others.  All had been in agreement that this WRAP needed to be developed by the person who was using it and only they would determine what was in it, and they didn’t have to show it to anyone else unless they wanted to.  But this part of the plan had to be different so others would understand it.  What they came up with has some of the usual boilerplate that is found in all Advance Directive forms, but they also included some innovative sections that they felt were critical to their recovery.  One was a list of signs that indicate someone needs to step in and take over–to prevent well-meaning supporters from stepping in when you are already doing what you need to do to help yourself feel better.  It includes a list of those supporters who should be included in any crisis responses and people who should not.  It includes a plan so that they can stay at home or in the community rather than be hospitalized, it has a list of things that they would like others to do for them that would help them feel better, and a list of things that others should not do, things that would make them feel worse.

So that was WRAP.  And people were really happy about it.  They all left with a strong commitment to try it.  I did too.  I went home and the next afternoon, when my spouse went off to make maple syrup, I decided to write my WRAP. This is now March, 1997.  I wrote my WRAP.  And I started using it.  I was amazed.  My own personal level of wellness moved ahead faster than I could have imagined.  I was thrilled.  I was getting reports from others who helped with the development of WRAP that they were getting the same results.

I decided to share this new idea we were calling “WRAP”, at the next conference I was invited to speak to–the International Conference for Depression and Manic Depression.  When I got to the conference and realized there were lots of workshops on brain anatomy and the chemical formulation of pharmaceuticals, I cringed.  But I decided to go forward with my plan.  I presented WRAP to a full house.  At first people seemed incredulous.   But by the time I finished everyone was with me.  I got a standing ovation.  People said, “Finally something we can do to help ourselves”.

Things happened quickly after that.  Everyone wanted WRAP.  Working with Jane Winterling, who played a key role in this effort, we wrote the red WRAP book that describes the Wellness Recovery Action Plan.  And those books went flying across the country and around the world.  We experimented with various formats for sharing WRAP and found that, while there are various ways people can learn about WRAP and use it in their lives, the one that works best is the WRAP group, facilitated by a trained facilitator.  So, working with a group of people who were committed to recovery, we developed the Mental Health Recovery and WRAP Curriculum and a five-day training protocol for training facilitators.  It continues to be enormously successful.

Richard Hart from West Virginia convinced myself and many others that we needed a Post Crisis plan. It was what people felt like they needed to guide their way back to wellness, to again using their Daily Maintenance Plan, after they had been through the worst of times. We came up with one, checked it out with lots of people, revised it over and over again, and then, added it to WRAP.

WRAP Today

Since its development in 1997, WRAP is now recognized as evidence based system and has been extensively adapted for use with all kinds of life issues.  WRAP is being used world-wide by people who are dealing with mental health challenges as well as medical conditions such as diabetes, weight gain, smoking, and pain management, and life issues like addictions, aging, suicide, and trauma.

WRAP is being used in many different settings such as schools, prisons, hospitals, veterans’ facilities, and with children, transition age youth, seniors; anyone who wants to attain the highest possible level of wellness.

WRAP has become the cornerstone of health programs all over the world. WRAP is for life ― it is for anyone, any time, and for any of life’s challenges.

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