Sunday, September 16, 2012


The “Wellness Recovery Action Plan” is an idea developed by a woman named Mary Ellen Copeland in 1997. It’s a widely used tool, now, to help patients gain a sense of control over their lives.

You work in groups, or one-on-one with an Occupational Therapist. There is a workbook where you identify things that are triggers for you; signs that you are becoming unwell; actions to take to feel better; and actions to take if you become progressively unwell.

After my most recent flirtation with suicide, I did a WRAP on my own. You can Google it, and many variations of WRAP workbooks appear that you can print off and fill out.

The two most important parts for me are the warning signs and the advance directive.

I’ve given copies of my warning signs to several people who know me. They are my “early detection system.” They quiz me if I come to work unshaven; they ask me how much sleep I’ve had the previous night; they listen to see if I’m talking too quickly; they’ll check in with me if they hear I’m making grandiose or unrealistic plans; and so on. And believe me, they do! (I’ve given myself two days leeway now on the shaving. When you are making lunches, cooking breakfast, helping with homework – sometimes you just can’t shave).

If there are too many warning signs, they make me go to a doctor. I don’t have a choice.

If they see me with cuts on my arms or bruises on my head (easy to notice because of my lack of hair and penchant for short sleeves), they immediately take me to an Emergency Room. I don’t have a choice.

If they hear me talking to myself, or planning to kill myself, they call 911 and sit with me. I don’t have a choice.
See how well that works? It makes me feel really safe.

The second part is the advance directive. It clarifies who gets to make decisions and be my advocate if I’m so incapacitated that I can’t do it for myself.

I recommend finding a good friend – someone who knows you really well, and will respect your wishes. You need to talk this over carefully with them.

Why not parents or other extended family members? Most make poor advocates, because they see you through a certain lens.

Here’s an example:

Doctor: “Has he ever tried hard drugs?”
Parents: “Absolutely not.”
Friend: “About ten years ago he did ecstasy for a while, then he stopped.”

Doctor: “How often does he drink?”
Parents: “He doesn’t drink.”
Friend: “He parties once or twice a month.”

Doctor: “Has he, or is he currently using marijuana?”
Parents: “Never that we know of.”
Friend: “He used it for about six months a year ago, then stopped”

Doctor: “Does he have any allergies, or any medications he prefer not to take?”
Parents: “No allergies, but we don’t know about the medications.”
Friend: “Haldol gives him tardive dyskinesia. He doesn’t like taking Ativan, and would prefer to try Seroquel instead. Two milligrams of Clonazepam puts him right to sleep.”

There are exceptions, but most family members are not good at being advocates. It’s important to make sure that everyone knows who is making the decisions, so when there is a crisis, it’s perfectly clear who talks to the doctor.

What’s important for everyone else is to be great cheerleaders – support the advocate and the patient – it’s a big part of helping someone recover.

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