Wellness Recovery Action Plan WRAP

7/29/2019 Wellness Recovery Action Plan WRAP

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WELLNESS RECOVERY

ACTION PLAN

A system for monitoring, reducing and eliminatinguncomfortable or dangerous physical symptoms

and emotional feelings

developed by

Mary Ellen Copeland, MS, MA

Author of

The Depression Workbook:A Guide to Living with Depression and Manic Depression

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Living Without Depression and Manic Depression:A Guide to Maintaining Mood Stability

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Winning Against Relapse:A Workbook of Action Plans for Reoccurring Health and Emotional Problems

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The Adolescent Depression Workbook~~~~~~~~~

The Worry Control WorkbookRevised 7/3/02


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DAILY MAINTENANCE LIST

What Im like when I am feeling all right:

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Things I need to do for myself every day to keep myselffeeling all right:

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Additional things I might need to do (or that would begood to do):

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TRIGGERS

Things that, if they happen, might cause an increase inmy symptoms:

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TRIGGER RESPONSE


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TRIGGERS

Action Plan -- Things that I can do if my triggers come upto keep them from becoming more serious symptoms:

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EARLY WARNING SIGNS

Some early warning signs that others have reportedand/or I have observed:

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EARLY WARNING SIGNS

Things I must do if I experience early warning signs:

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EARLY WARNING SIGNS

Things I can do if they feel right to me:

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WHEN THINGS ARE BREAKING DOWN

Signs/symptoms that indicate that things are gettingworse:

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WHEN THINGS ARE BREAKING DOWN

Action Plan Things that can help reduce my symptomswhen they have progressed to this point:

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CRISIS PLAN

This crisis plan is written when I am well. The purpose is to instruct

others about how to care for me when I am not well. This keeps mein control even when it seems like things are out of control.

Part 1 What Im like when Im feeling well:(reference Daily Maintenance List)

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CRISIS PLAN

Part 2 SYMPTOMS that indicate that others need to takeover full responsibility for my care and make decisionson my behalf:

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CRISIS PLAN

Part 3 These are my SUPPORTERS, the people who Iwant to take over for me when the symptoms I listed inPart 2 come up:

Name __________________________________________________________

Relation to me ___________________________________________________

Phone number ___________________________________________________

Role I want this person to play and/or task(s) I need him/her todo_______________________________________________________________

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Name __________________________________________________________

Relation to me ___________________________________________________

Phone number ___________________________________________________

Role I want this person to play and/or task(s) I need him/her to do

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Name __________________________________________________________

Relation to me ___________________________________________________

Phone number ___________________________________________________


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CRISIS PLAN

Part 3 (continued)

Name __________________________________________________________

Relation to me ___________________________________________________

Phone number ___________________________________________________


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Name __________________________________________________________

Relation to me ___________________________________________________

Phone number ___________________________________________________


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The people I do not want involved in any way and why:


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CRISIS PLAN

Part 4 Medications/Supplements

Medications/supplements I am currently taking and why I amtaking them:

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Medications/supplements I prefer to take if medications oradditional medications become necessary, and why I choosethem:

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CRISIS PLAN

Part 4 continued

Medications/supplements that are acceptable to me ifmedications become necessary and why I choose them:

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Medications/supplements that must be avoided and reasonswhy:

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CRISIS PLAN

Part 5 Treatments

Treatments that help reduce my symptoms and when theyshould be used:

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Treatments I want to avoid and why:

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CRISIS PLAN

Part 6 Community Plan

What can be put into place in order for me to stay at home orin my community and still get the care I need:

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CRISIS PLAN

Part 7 Treatment Facilities

Treatment facilities where I prefer to be treated or hospitalizedif that becomes necessary:

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Treatment facilities I want to avoid and why:

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CRISIS PLAN

Part 8 Help From Others

Things that others can do for me that would help reduce mysymptoms or make me more comfortable:

What I need/would like done Who Id like to do it

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CRISIS PLAN

Part 8 continued

Things others might do, or did in the past, that would not/didnot help and/or might make symptoms worse:

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CRISIS PLAN

Part 9 Inactivating the Crisis Plan

Symptoms, lack of symptoms or actions that indicate that mysupporters no longer need to use this Crisis Plan:

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I ______________________________________ consider this document to be part of my treatment,

and therefore authorize my treatment provider _________________________________________

to share information contained in this Wellness Recovery Action Plan with the following hospitals,

agencies and/or individuals in the event of an emergency and/or hospitalization:

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Signature _________________________________ Date ____________

Witness/Supporter ______________________________ Date ____________





Notary


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Documents

Wellness Recovery Action Plan WRAP