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Mental Health Matters – Wellness Recovery Action Planning (WRAP)



hi welcome to mental health matters I'm Shannon Eliot while less recovery action planning or rap is a self-management recovery system that helps people around the world struggling with mental health issues today I'm joined by two individuals who are instrumental to the development and growth of rap dr. Mary Ellen Copeland is the author of the book wellness recovery action plan Rapp has helped her achieve long-term wellness after years of experiencing mental health challenges her work has changed the mental health field as she is advocated that people with mental health issues can have hope and recover Mathew Federici is the executive director of the Copeland Center a Vermont based organization that promotes wellness and empowerment through education training and research he's an advanced level mental health recovery educator and rap facilitator welcome Mary Ellen and welcome Matthew thanks so much for joining me today thanks for having me Mary Ellen can you tell us what rap is and what its purpose is rap is a system that was devised by a group of people of mental health challenges 30 people that I had been working with teaching them recovery skills and strategies it's a very simple system for figuring out what your resources are what are the things that you have that you can use to help yourself feel better and help yourself stay well and then organizing them into a group of plans daily maintenance plan what are the things you need to do every single day to stay as well as possible which of those resources do you need to use what are the triggers that might upset you and then which of those resources could you use to help you feel better if something really upsets you and what are the early warning signs what are the signs that things are not going well and just the beginning signs I used to ignore these signs things like not buckle my seatbelt anymore I don't feel like answering the phone I don't want to go out and want to talk to people I kind of feel crummy what are those early signs that most of us ignore and what are the resources I can use to help myself feel better when those signs come up because ignoring them often leads to feeling much worse and then the next section is when things are breaking down that's when you're really feeling awful and this is a time when in the past people would end up calling the emergency services perhaps going to the hospital for a while and through the development of a wellness recovery action plan they've learned that if they can identify the signs that they're doing having a really difficult time that there are resources that they can use themself or perhaps reaching out to others but that they can use so that they can help themselves just get better without having to do something that's more intrusive in their life and invasive and then it also includes in in the cases that we hope don't happen a crisis plan or advance directive and a plan for helping yourself get better after you've had a very difficult time crisis to get sounds like a very thorough plan to help yourself as opposed to someone else caring for you absolutely on your behalf absolutely so how was wrapped born where did the idea come from well the the originally I did a body of research because I was very concerned that I was losing my life to the mental health issues and challenges in my life I was having repeated hospitalizations I was taking a lot of medications that were making me feel sicker and sicker instead of feeling better and I was very discouraged with that and I wasn't given much hope by the mental health system so I reached out to a vocational rehabilitation counselor and I said I really want to do research and I want to find out how people who have the same kinds of challenges that I do how do they get by day to day that's all I was looking for back then I wasn't thinking about recovery if you mentioned recovery back then people just said recovery is not possible can't get over these things so I set up a research project with the help of my vocational rehabilitation counselor and studied 125 people to find out how they cope and got lots and lots of loss of information and began to put that information together began using it began to get better and better myself and that was that was how I really got involved in that in this work and started writing books and doing trainings and it was actually at one of those trainings where the people the training said you know this is all good and useful information it's really good but we don't know how to organize it into our life so it was interesting it seems like you really had the professional and the personal perspective work together their own personal worker right and so and so that's when we we all sat down together and we worked it out and said this is what we need this is how we need to organize it and after we did that after we came up with this plan I it sounded really good to me and I took it home and wrote one for myself and started using it and it was it was incredible it made a huge difference in my life and it continues to must have been the best feeling when you realize you finally got it and yeah it wasn't medication it wasn't necessarily talking to someone else but it was your wrap plans like that for you they were helping me figure out what do I need to do every day how suppose somebody is rude to me what you know still letting that get worse and worse right what am I going to do to help myself feel better absolutely so it's it's it's worked well for me and now it's worked well for lots and lots of people and we even have some bodies of research that have proved that it works for people great so Matthew how receptive are providers to wrap plans and peer support in general well one of I think my draw towards towards this work really really evolved from my own experience with significant mental health challenges early on and and also having an older brother who has had significant challenges and I from my experience of knowing about pulling from your inner resources and recovering out the potential recovery I went into working as a provider in community mental health and there were a lot of beliefs and practices that seem very inconsistent with what I knew on a practical level and when I discovered rap and in particular the a lot of initiatives that were beginning where people were making a fundamental shift in how mental healthcare and mental support was delivered and that shift was one that Mary Ellen was ahead of the curve on and that is that people are the experts on themselves they know what's working they they're here today because they are doing things that are working and they know stuff and nobody was really tapping into what they know and helping those people connect together and so this had started to emerge kind of after you began your work on a federal level for community-based mental health services and these initiatives were focusing on peers becoming counselors with each other and a major element to peers being able to coach other peers was learning about what Mariana created with the peers in her area on the wellness recovery action plan there there is often some resistance because I know from my formal academic training this idea that people are experts on themselves that there are simple safe inexpensive things that people can do every day and have significant changes in their life from feeling really isolated alienated having a difficult time going down to the mailbox to turning their life around and establishing significant careers as Mary Ellen's mother did with transforming her life from institutionalization to becoming a well known nutritionist and this is perplexing to many people who are studying behavioral sciences studying the mind how this happens so there are very strong beliefs in the mental health system based on theories that have not really been proven that why people are going through the challenges they're going through what's causing it and how to treat it a lot of expensive and complicated theories and philosophies about this the reality is that what has been created with the group appears starting with Mary Ellen's initial inquiries and research on this is that people who are living with these challenges coming together and coming up with simple common-sense strategy are extremely effective isn't amazing that the common-sense strategy is the radical approach yeah yeah exactly and so this can be very challenging and working with systems that have invested a lot in a lot of expensive a lot of complicated theories and techniques to come in and say really let's come back down to the simple here one of the biggest challenges and I know this from my own training is that some of the beliefs about providing supports to people professionally with significant mental health challenges is the concept of professional distance and and really focusing on that this isn't about me as the professional it's about you what's wrong with you and how I can help you and and the real fallacy about this is that relationships are so critical to healing and recovery and so it's not just about you it's not just about me it's about us in the relationship that we form by and large the system is designed in a way where I'm the next expert I've studied these academic theories and practices and and the science behind what may be wrong with you and you're here to be fixed and a lot of people get this constant type of support the the challenge about that is that people don't really know they don't learn when they're constantly in relationships like that that real support in people's lives is always two ways right you get support when you give support and this is also something that Mary Ellen's work really spoke to when she did her initial inquiry she talked about and got results back from people that one of the key concepts of people who got well and stayed well for longer period of times they had support but that kind of support was one where it was two ways they had people in their lives they were helping and they were helping themselves so it can be difficult bringing these concepts into a system provider system where it's more one-directional I could very easily see how that level of inequality would not only be not only making no effect but actually make things worse because suddenly feels smaller than the person who is supposed to be providing you help and feeding into that own internalized stigma and downward spiral and so forth yeah so Mary Ellen if I was interested in rap if I was going through a hard time and I came to my first rap session what could I expect well if it was the first time this group was meeting you could expect that you would get a really warm welcome that you would be introduced to the people that were leading the group and that the group would would work together at the very beginning to set up some guidelines some group guidelines so you could feel really safe there lots of times when people go to a group for the first time it's hard it's really hard sure anytime you go to anything first time right yeah and and so they set up guidelines so that you can feel safe and comfortable there so that you'll know that people are not going to be doing things that that would make you feel unsafe and and then they will probably first introduce you to the key concepts of recovery which are hope personal responsibility education self-advocacy and support and those came out of my early research and so we would have some discussion around those topics and then people would begin to work together in the group people for those key concepts people would share their own stories I'm not the the group would be facilitated by a person but but that person wouldn't be like a teacher but then it's really based on the premise of people are there to teach and work with each other everyone's on the same level every everyone's on the same level absolutely it's non hierarchical everybody's on the same level and that they would would work together and that everyone would have chance to share their own stories of hope and how they learn to be personally responsible and talk about education and self-advocacy and and and have ongoing probably discussions about support which is huge and and then from there they would start talking about the facilitator would describe the wellness toolbox and then people would start sharing what are the wellness tools that they you have at each person would share the ones that they could think of and you have a long period of time when people just list their wellness tools and usually they have some newsprint pads they jot them all down and hang around on the wall so that everybody can see them and everybody's getting ideas from each other what are some examples of wellness tools um well one of the wells wellness tools I use a lot is listening to music is playing the piano it may be just taking a few deep breaths it may be changing what I'm thinking about to something positive focusing on positive things positive affirmations I have a list of over 80 of these I keep very simple things to do and you're in a moment that you need some positivity right and they can be things like it can be things I need to do every day like drinking eight glasses of water a day avoiding sugar having three meals a day maybe whatever that is for a person whatever they're kind of like working on I need to be sure that every day I have plenty of vegetables so I have okay on my daily maintenance at seven servings of vegetables a day and it might be different on somebody else's it might be be all together a plans are like thing they're customized to the individual they are absolutely you you write it for yourself some people might write in there so that they need to take a shower every day I don't have to write that because I've been taking a shower every day for you it's not something it you know we're taking I don't have to put in brushing my teeth but somebody you know somebody who has not done anything to help themselves for a long time they're their wellness tool box could be very simple it could just be every day I'm going to pull the coverlet up on my bed and I'm going to brush my hair for one minute or their wellness tool might be I'm going to smile at one person and that might be it and that's a starting place it's a starting place for them to take back their life so after they've smiled at one person for a while then they can talk about and think about what else could I put on my list you know in Jesus evolving yeah that of tools yeah great so Matthew Kay tell us about your first rap group and what that experience was like well as I was saying earlier about kind of my migrating interest into peer support one of the initiatives going on in my local area where I was working was bringing this concept of peer counseling and paying peer counsellors and making peer people who have had this lived experience a complement to the array of services within the state that I was at the time in Pennsylvania and in enjoying an initiative where we were going to develop this as a formal part of the system where people could talk to somebody at services that have been through mental health system themselves when I was going through that we were designing what kinds of training peers should have with each other I was introduced to the wellness recovery action plan and went through a workshop with it and found myself at a place where there were values and practices that were completely consistent what I had always believed where the the mentality of the workshop in the group from the group leaders was this concept that we were all peers and then we all had an equal stake and wellness that you know I remember looking at the terms wellness recovery action plan and I've been familiar with other approaches that were similar but they were often designed from theoretical stands but this was designed from practical experiences of people that were talking about what it was they were already doing they were the things that we were doing that worked and it really hit me that this was quite different because this was about recovering your wellness it wasn't about focusing on people its illnesses and deficits and the focus was one in which where anyone in the room had a stake and had an ability to write a plan for themselves and this was very helpful for me because I realized that although I done a lot of these things already in my recovery and had really moved away from a very destructive point in my life I there were still a lot I need to do to have a healthier quality of life and and so I began to to really think about where I was in my life and what I really wanted to go after what wellness really looked like for me the mentality was that that there were no limits to what people could could achieve in their wellness there are no limits to recovery that it was voluntary that the people who you know do this that it was in your power to do it and you did as much or as little as you chose to do these are fundamentally different ways of relating and engaging people about their mental health and it was a huge shift and so it was a no-brainer for me that this was the ideal curriculum to impart for this initiative with peers and in peer counseling and it really helped me roll out a rather challenging initiative because you know one of the key concepts of hope Mary Ellen has written that you will not benefit from dire predictions about your future this is not only so important to people who are going through a difficult time but even in the workplace even at the home front just to know that when you're getting these dire predictions about the future which nobody knows that you're not going to benefit from this kind of behavior and that you need hope did you find that once you had your own personal wrap plan that you had a certain day-to-day peace because you knew you had something waiting for you in case you fell on a tough time if you know for me you know writing it down was very helpful and then and then revising and I really found that I did you know come up with additional strategies that were not in the wrap plan itself so for example you know you can list what you look like when you're well and things you need to do every day then you go into the things that challenge your wellness and in how you respond to those action plans but I I was finding so many areas of my life that this was applying that I would create little triangles and asterisks next to things to indicate this was from my marriage this was for my you know my own personal record this was for work and I've stopped doing that since I found that just that's perfect that it works yeah just accepting that it really is going to cover a lot of areas of my life but it was that kind of engagement right it was it became not just using a written plan looking at it and following every day but it's just a way of processing every challenge that I encountered in life in a way that was a out taking action about that there were things I can do so every challenge that from that point on every challenge that came into my world I had a simple structure to take it on it was actually made it more exciting when challenges came into my life gotta tackle him I had a strategy it was easy to follow that I could at least try and if it didn't work I could try again something else so around the world thousands maybe tens of thousands of people use rap and it has helped them immeasurably recover from challenges what are some of the most moving or memorable stories that you have both heard from people who have used rap to recover well does it put one particular story that I like to share is about somebody who is in that original group where we worked together to develop rap he had been in the whole eight days we gotten together to talk about skills and strategies and he was um he couldn't stay in the room very long he had to leave often because he got far too agitated and he had to come with a care provider and he dressed in very somber clothes and he pulled his hat down over his face so they couldn't really see him but he came to every session even though it was in winter and it was cold and it was snowy and it was an a drafty building he came every time and after we talked about rap and figured it out I would get calls from the mental health agency that he used and they would say we're trying to find another rap group for David David wants to go to another rap group and so I would do a little research and we'd find another rap group and then I didn't hear anything for a while and I was asked to go to a graduation for a rap group and when they're in my area I like to go really fun because people have finished their whole rap plan and I went and this was in the summertime this time and this man met me at the door and he was wearing a Hawaiian shirt and shorts and he was grinning broadly and he looked him in the eyes and he said hi Mary Ellen and I knew it was somebody I knew but I didn't lately yeah he said you don't know who I am do you and I said Wow this is David and he had been going to rap groups he got there on his own he's sitting all the way through it he was he was living it he was living rap he got his life back from this and it was really incredible and I will never forget it was just really that's really inspiring so recently the first annual rap for health conference was held in Oakland could you tell us a little bit about that what the goals were and what some of the highlights were in your opinion that was just you know we just just had that and I think that the goal was to look at rap as a tool not just for mental wellness but for total wellness for overall health and I know that that people are thinking about how we can have primary care doctors and other kinds of health care providers know about rap so that they can be referring people to rap programs and so it's it's really the focus was to move rap out of the mental health arena where it started and to really cover the whole person which is what it is anyway which is if you can't separate mental health from physical health from emotional and and in spiritual well-being you can't take all of those things and push them apart just as no way to do that and so that's what we talked about at the conference and and that's the thing going to be a big focus at Pierce moving forward and across the country is about using rap on a more general way to promote health but one of the things that the people in the who have mental health issues their mortality there is is 10 years less their level of mortality is ten years less than people in the general population so we know that this is really an issue that we need to work about Whole Health with people who have had ongoing mental health challenges so that's what we're trying to really reduce that to so that people have long lifespans just as long lifespans as they one quality like spins – yes yes yes so Matthew what's the Copeland's that our offer and why is it important to society and what do you envision for the future well I think the most important thing is that when when Marielle began this work with a group appears that it was constantly being revised and getting input from from others that were sharing their collective wisdom I think essentially that is the challenge of the Copeland Center is to carry on that tradition particularly around this structure of the wellness recovery action plan one of the things that again evolved out of the the initiative that Mary Ellen began was that there were there were effective ways that they looked at in terms of why was this work so important why was it really catching for people and and moving them and they developed the core set of values and ethics you heard me talk about beliefs and practices that people have had in the field it's what really drew me to rap and the Copeland Center were there were these core values and ethics that they had developed that must be upheld when introducing wrapping is really what makes it distinct from a lot of the other things that are out there that are being offered to people what's really important for the Copeland Center is to carry on the mentorian and Mary Allen began in her workshops what she has learned what groups appears that have worked with her over the years have learned that have created these values and ethics we have close to 200 advanced level facilitators so through this whole process of dissemination and creating a peer based environment where people exchange these strategies together we developed the training model that training model went under rigorous research to be proven now on the National Registry of evidence-based practices judith cook was one of the primary lead researchers out of the university of illinois in chicago that looked at this training model the people who took the trainings that the Copeland Center has developed to disseminate and replicate the group's the early groups that Mary Allen began and they showed significant evidence that people had increased quality of life increased sense of hope now there are even seeing that people are becoming stronger self-advocates in the doctor's office which is resulting in better care and outcomes for them our role is to really maintain those practices of dissemination and facilitating groups that are working okay well thank you so much Matthew and Mary Ellen for being here today it's been an absolute treat and I cannot wait to see Rapp take off even more throughout the country thank you thank you for more information on Rapp please visit the Copeland center website at www.clemson.edu/peach Allender on the piers web site at piers net org slash calendar to view videos of the recent rap for Health Conference visit the piers website at www.engvid.com you

Glenn Chapman

8 Comments

  1. Self directed recovery means I choose and take responsibility for my mental health = I'll probably do it because it's my choice and I don't have someone pushing me or forcing me – I love this and it is "common sense".

  2. I am a survivor of long term domestic violence and a recovering addict and the WRAP plan has been essential in my healing process and recovery……loved the videos and was full of information about the beginning of this plan that in my experience helped to save my life!!!!! Would recommend WRAP plan to anyone who is struggling with anything in their life that is affecting them mentally and emotionally!!!

  3. Good informative tools that can be applied to real life situations.

  4. 'How do they get by day to day?' quoting Mary Ellen Copeland.
    'Common sense strategies are often considered the radical approach!' quoting Shannon Eliot
    Sharing wellness tools – peer based, no teacher – no hierarchy of skills based approach to wellness. Love this!

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