The Development of Recovery and WRAP in the UK

Britain – Piers Allott

Background

I have been working in and around services for people diagnosed with mental illness since 1966. I have never been comfortable with many of the approaches to people’s distress that I witnessed and for many years searched for better approaches. Eventually I found WRAP.
It was my contact with the Centre for Community Change through Housing and Supports and Dr. Paul Carling in the mid 1990’s that led me to WRAP. However, it was a number of years after first hearing about it that I became fully aware of the Recovery and WRAP facilitators training and trainers manual.
Recovery as a concept in the United Kingdom was difficult to promote but it was the West Midlands Regional Health Authority that enabled the introduction of the concept through the publication of a series of five Directional Papers. These papers had recovery at their heart though they did not directly promote WRAP. They did raise awareness within a very traditional English establishment that recovery is possible and it was this that enabled the funding of a Recovery Research Project in September 2000 that had three strands 1) Training as a Recovery and WRAP Facilitator with Mary Ellen Copeland in Vermont 2) The development of a recovery literature review and 3) a small pilot recovery narrative research project. Of these it was the Recovery and WRAP Facilitators training and Literature Review that have contributed most greatly to the implementation of WRAP in England and the UK.

Recovery and WRAP Facilitators Training

In order to join this training it was a prerequisite that I complete Mary Ellen’s correspondence course within a short space of time. That required my having copies of her books and I was only able to access those in time through a person in recovery in Manchester, England – identified by Mary Ellen. Completing the correspondence course was a challenge for me but one that I took very seriously, spending a lot of time exploring Wellness Tools that would work for me. However, I was able to use my learning from the work at Anam Cara, a peer operated crisis alternative to hospital admission, to supplement my learning from Mary Ellen’s books.
I joined the training in November 2000 along with about 12 people from across the US with some from as far away as Texas and Ohio and others from more local States such as Vermont and Massachusetts. It became clear to me that many of these ‘consumers’ were also mental health professionals and those who were not appeared to have the support of their local groups or of their service with expectations that they would put their learning into practice once the training was complete.

I found the training challenging but stimulating and benefited enormously from the experience. I learned a lot about recovery and WRAP and experienced considerable anxiety about having to deliver a presentation on a topic of my choice to the rest of the participants. However, the experience was essential to my development as a Recovery and WRAP Educator.

Literature Review

The literature review was completed in January 2002 and its intention was to promote recovery across the country. It was not published in the normal manner but was published on the web and through the West Midlands Recovery Network that was established to disseminate information on mental health recovery as a result of the first Recovery and WRAP training in January 2001. The paper states:
The principal author trained as a mental health recovery educator with Mary Ellen Copeland in the US in November 2000 and delivered the first two-day Wellness Recovery Action Plan (WRAP) training in January 2001. This training was so successful that it led to calls for ways of disseminating the information particularly from service users and family members and led to the establishment of the Recovery Network within the West Midlands.

This paper summarized WRAP under the heading of ‘Implementing Recovery Oriented Practice’ and was the first wide dissemination of Recovery and Wellness Recovery Action Planning knowledge in England.

Delivering WRAP Training in England

Before I left for the Recovery and WRAP Facilitators training in November I had advertised a two-day training in January 2001. At the time I had no idea if there would be any response but had not expected the overwhelming response we received. I had also arranged for the person who lent me the books from Manchester to co-facilitate the training with me – and was very glad that I had done so. We had 37 people on that first training and it was one of the most tiring trainings I have ever delivered. However, it was also the most extraordinary and rewarding.
An African Caribbean mother and her daughter attended the training and at the end of the first day said that this knowledge had to be disseminated because it is so important and more or less demanded that I find a way of doing this. Overnight I came to the conclusion that we had to establish a network of people in recovery in the West Midlands and I put this to the participants on the second day and twenty two signed up for the Mental Health Recovery Network – West Midlands.

The networks aims were to:

  • Promote the recovery vision locally & regionally
  • Facilitate the development & strengthen locally based recovery cells and groups
  • Promote examples of best practice from regional work
  • Increase awareness of ‘expert patient’ self-management and access to training, including WRAP

The Network was formally launched at a conference entitled ‘Focus on Recovery’ in Birmingham in May 2001. At this time the Centre was joined by a new administrator, Claire Craven, without whom much of the work of the Network could not have been supported and the development and dissemination of recovery knowledge and practice would have been curtailed. Claire organized many of the Network events including conferences and newsletters as well as the first UK based Recovery and WRAP Facilitators training delivered in Birmingham in October 2001. She was always at the end of the telephone and enabled networking in the West Midlands and much further a field – as knowledge of recovery and the Network spread. Claire is now studying to be a doctor with a view to eventually becoming a psychiatrist.

1st UK WRAP Facilitators Training – October 2001

The Network was established as a result of participant requests during the 2-day WRAP Training delivered in January 2001 and the newly established Adult Learning, Education and Development Centre (LED) decided to support the training of 13 people as Recovery & WRAP Educators, one from each of the Local Implementation Teams in the West Midlands. It was hoped that many of these places would be allocated to people who had their own ‘lived experience’ of recovery from mental distress and possibly be ‘service user’ representatives on their local LIT’s.

The training was delivered by Mary Ellen Copeland and her spouse Ed Anthes and was also promoted through the Network as an opportunity for members of the Network (and others) to become Mental Health Recovery Educators.
In the end some 21 people attended this training although most of these were not nominated, as intended, by the LIT’s. Of those it is estimated that six are still active as trainers.

2nd UK WRAP Facilitators Training – October 2003

In April 2003, I took up a post as Senior Service Development Fellow at the University of Wolverhampton and was seconded two days per week to NIMHE (National Institute for Mental Health in England). As the Fellow for Recovery, I had a national remit to enable the concept and practice of recovery to begin to become a part of the services being delivered within the National Service Framework for Mental Health (NSF) and as part of the National Health Service Plan for England. Informed by the experience of WRAP within the West Midlands one of the first tasks was to arrange a further Recovery and WRAP Educators training by Mary Ellen in order to build more training capacity across England.

In a similar way to the previous training, it was intended to engage NIMHE as an organization in taking this work forward but that proved more difficult since, at that time, the majority of directors and staff were unfamiliar with recovery as a concept and even less familiar with WRAP. It was hoped that each of the NIMHE Development Centers would nominate and fund the training of at least one member of staff and one person with a lived experience of mental illness and/or family members/significant others. In the event the two DC’s in London and Eastern regions did not nominate anyone and two nominated four or more people. Interestingly, it was the southwest and northeast of England that nominated the most participants and it has been in these areas that WRAP has moved forward significantly but particularly in Devon in the southwest where a psychiatrist participated in the training.

The Development of Training Trainers in the UK

Following the 2003 training, Mary Ellen indicated that it was unlikely that she would manage to deliver further Recovery and WRAP Educators trainings in the UK. She told me that as I had completed my own personal training and assisted in the delivery of two further trainings, that I should consider training others.

I continued to deliver many 2-day trainings and initially felt unsure of delivering trainings for trainers. In addition, there still was very little support from organizations and funders although where trainings had been delivered and some understanding of the work begun, interest grew. From April 2004 hosting arrangements for the Recovery Fellow transferred from the National Office to NIMHE East Midlands and the Director there supported the development of recovery and WRAP across the region. She worked to engage the Chief Executives of the five mental health provider organizations and this eventually led to the funding of a training for trainers in February/March 2005.

This five day residential training was held at the Losehill Hotel on the Losehill side of the Valley of Hope overlooking Winhill on the opposite side of the Valley and in the Village of Hope, Derbyshire. The group took up all the rooms in the hotel and the training was attended by eighteen people of whom eight identified as people who had a lived experience, two as family members and eight as staff.  I led the training  and was supported by two co-facilitators from the 2003 training.  It was a special experience for all participants.  However it is estimated that only half of the group are currently active as trainers though many of the others now promote recovery and WRAP.  Often trained people in England have difficulty getting the funding or support to deliver further trainings and for staff members that may mean not being allowed the time from their ordinary positions to deliver trainings.  This is not simply true of WRAP but other approaches and interventions.

Since March 2005, two more Recovery and WRAP Facilitators trainings have been delivered in October 2005 in Bedford and in June 2006 in Sleaford,Lincolnshire. The latter training is part of a now more integrated plan to take recovery forward in the East Midlands region and two further trainings are planned. The training to be delivered in September/October 2006 is an ‘Open’ training for which people from outside the East Midlands will pay and the income from that will support the trainings in the East Midlands. The final training currently planned will be delivered in Loughborough, Leicestershire in November/December 2006.

Outcomes and Evaluations

There can be no better way to begin this section but with a quote from the newsletter that was produced following the Celebration of Recovery, Self Management and WRAP event held in Devon in February 2005 and organized by Partnerships for Mental Health Recovery, a collective of like minded people in Devon. The Newsletter opens with:

“Since Mary Ellen Copeland came to Devon in October 2003, WRAP (Wellness Recovery Action Plan) has had a life of its own. As a framework or tool to help people stay well and plan their recovery, WRAP has taken the local mental health community by storm. Some ideas need cultivating and nurturing, but WRAP has just taken off and spread all over the county. This is because it is common sense, reflects the way most of us manage our lives and provides a way of taking more active control of our lives.

The last year has seen an incredible cascading of training in WRAP and spreading of recovery ideas across the local mental health community. This day was a celebration of that fact, a chance to take stock and a chance to look forward. A really good day was had by all.”
Of particular interest to me at this meeting was a statement from a senior member of staff from a PCT (Primary Care Trust) that she had used WRAP to reduce her absence from work due to being ill from three times a year to once a year. She also highlighted that other senior managers wanted to attend WRAP trainings for their own personal benefit. This was a shift that caused me most surprise, given the continuing resistances elsewhere in the country – but was not unexpected since students on the University of Wolverhampton Recovery Module reported that ‘This is an approach we can use for ourselves, not just one that will be helpful for the people with whom we work’.

That work has continued in Devon and they are now at the forefront of services in implementing the national STR (Support Time and Recovery) workers all of whom have had the same training that includes recovery and WRAP and to quote their most recent newsletter:
“STR has developed from being a job description into a way of working. They have in common a shared value system and approach to people based around WRAP and self-management. They focus on social inclusion and recovery through supporting people to find what keeps them well, what wellness tools they may need to develop to sustain wellness and practical support during times of distress.”

South Tyneside Evaluation

Two of the participants on the 2003 training delivered by Mary Ellen secured funding from their NIMHE Development Centre to deliver a training that had the benefit of being evaluated although the report of that evaluation has yet to be published. There is not space within this chapter to provide a full summary of that evaluation but some of the comments made by participants included:

  • “the description seemed to be very much in line with a model we would use rather then a purely medical model”
  • “I think it’s important because it instills hope”
  • “The whole top and bottom of it was to help people to help themselves”
  • “If this had been in place years ago when I got taken in to the inpatient unit and sectioned because I was sitting in the car down at the beach… if I had a wrap plan then they would have realized well **** does this, this is her safe place”
  • “the WRAP tool itself is an absolutely brilliant, brilliant thing”

Stoke on Trent Evaluation

There had been one two-day WRAP training delivered in Stoke on Trent in 2002 and whilst many of the managers in the area supported and explored the concept of recovery, little appeared to happen. However, one of the STR workers, a person in recovery, who became familiar with WRAP developed a locally adapted version of WRAP, together with a number of colleagues, particularly one from a local peer support organization CHANGES 12 Steps to Mental Health (the final step ‘take action’ has now been amended to ‘write a WRAP’) and this was used in local services and an evaluation completed. An excerpt from the evaluation report follows:

Further comments taken directly from the questionnaires demonstrate the positive impact and benefits felt from using the WRAP plan.

“I am so glad I was given the chance to use one”.
“Its been brilliant for me”.

Other comments recognized and acknowledged the changes, improvements and advances in mental health care provision over the last few years and with the availability of the WRAP plan for themselves.

“Wish I had one of these a few years ago”.
“How have I got better without one”.
“It’s a very useful tool”.

Unfortunately, some respondents were questioning whether health service providers still have a preference for the traditional methods of health service provision, commenting that:

“It would be interesting to find out what a key worker/CPN had to say about it”.

With another respondent obviously assuming that the WRAP would not be sufficiently acknowledged by health care professionals.

“They should be taken seriously by health careprofessionals”.

Evidently questioning whether or not mental health professionals commitment and belief in the recovery ethos, service user involvement and changes in service delivery patterns is genuine.

Conclusion

It is clear that where there has been a commitment to training and supporting people to learn about mental health recovery and WRAP that significant change and personal transformations have occurred. However, we still do not have sufficient commitment for a widespread adoption of WRAP in England and further robust evaluations are needed to convince our still skeptical traditional mental health professionals.
Perhaps the publication of the two-day recovery training program by the NIMHE National Changing Workforce Programme (due summer 2006) as part of the 10 Essential Shared Capabilities training program identified as necessary for the whole of the mental health workforce will finally bring about this change.
Even without this people who use mental health services are finding their own way and, quietly, there is a revolution taking place that is a revolution for the people who matter – those who experience mental distress and their families. WRAP works!

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