Mental Health Recovery including Wellness Recovery Action Planning Program Description

By Mary Ellen Copeland, PhD author of:
The Depression Workbook: A Guide to Living with Depression and Manic Depression, Living Without Depression and Manic Depression: A Guide to Maintaining Mood Stability, Wellness Recovery Action Plan™., Winning Against Relapse, The Adolescent Depression Workbook, The Worry Control Workbook, The Loneliness Workbook, Healing the Trauma of Abuse: A Women's Workbook, and more.

PROGRAM OVERVIEW

About the Presenter
Mary Ellen Copeland is an author, educator and mental health recovery advocate. She specializes in the successful self-management of psychiatric symptoms. Her work is based on her intensive nationwide studies of thousands of people who have psychiatric symptoms and on her own personal struggle with manic depression - rising from total incapacitation to enjoying a rich and rewarding life.

Abstract
People who experience psychiatric symptoms no longer feel that they are sentenced to a life of chronic illness that interferes with their ability to work toward and reach their goals. Instead, by using self-help skills and strategies that complement other treatment scenarios, they are achieving levels of wellness, stability and recovery they always hoped were possible. This recovery information is being networked across the country by Mary Ellen and an ever-growing number of recovery educators, through self-help publications, seminars, workshops, presentations, support groups and the internet.

Goals
To teach participants recovery and self-management skills and strategies for dealing with psychiatric symptoms so as to:

• promote higher levels of wellness, stability and quality of life
• decrease the need for costly, invasive therapies
• decrease the incidence of severe symptoms
• decrease traumatic life events caused by severe symptoms
• increase understanding of these illnesses and decrease stigma
• raise participants' level of hope and encourage their actively working toward wellness, as outlined in the model developed by Mary Ellen Copeland in coordination with other people who have experienced psychiatric symptoms, health care professionals and several related organizations.
• increase participants' sense of personal responsibility and empowerment

Objectives
The following topics will be covered using a workshop style, including presentations, demonstrations, interactive discussion and related activities:

• Hope, Personal Responsibility, Self-Advocacy, Education, Support
• Accessing good health care and managing medications
• Self-monitoring using WRAP: A Wellness Recovery Action Plan™ (an individualized system for monitoring and responding to symptoms to achieve the highest possible levels of wellness)
• Symptom responses: finding and keeping a strong support system, peer counseling, focusing, relaxation exercises, diet, light, exercise, sleep, journaling, music, etc.
• Ongoing work:
  Dealing With Trauma
  Suicide Prevention
  Building Self-Esteem
  Changing Negative Thought Patterns To Positive
  Building A Lifestyle That Promotes Wellness

Expected Long Term Outcomes From a Recovery/Self-Management Focus

• A shift of focus in mental health care from symptom control to prevention and recovery.
• Significant reduction in the need for costly mental health and emergency services as people who experience psychiatric symptoms effectively take responsibility for their own wellness and stability, manage and reduce their symptoms using a variety of self-help techniques, and effectively reach out for and use the support of a network of family members, friends and health care professionals.
• Increased ability to meet life and vocational goals, significant life enhancement, and gains in self-esteem and self-confidence as people become contributing members of the community.

New Hampshire Program
The eight-day recovery program, based on the above outline, has been presented in each of the ten regions of New Hampshire. The seminar included lectures, interactive discussions, reinforcement activities and hands-on development of personal recovery resources. Each seminar was attended by a mixed audience of people who experience psychiatric symptoms, family members and mental health professionals. Following the seminar, the presenter returned to each region for four days to work with the group on skills and strategies that have been difficult to implement.

 

After work was completed in five regions, forty people with interest in teaching recovery skills attended five day "training of trainers" program. These people are now being paid through the Division of Mental Health to lead similar seminars in their region, effectively networking this information throughout the community. They are supported by the Office of Consumer Affairs, a committee of their peers and by ongoing consultation with the presenter. They use the leader's training manual Dealing with Psychiatric Symptoms as a guide.

Vermont Program
The Vermont Recovery Program is modeled after the New Hampshire Program. Eight-day recovery programs were held in three areas of the state. Following the seminar, the presenter has gone back to each region for two full days to problem solve with the group. Two Training of Trainers Programs have been held in New Hampshire and they have over 30 trainers currently teaching recovery skills and strategies.

Through Vermont Psychiatric Survivors, the program received funding through the Van Ameringen Foundation to provide for on-going networking of this information. They have hired a coordinator, and trainers are being paid to lead seminar series throughout the state.

Other Training Programs
The Vermont and New Hampshire programs have now been replicated in Kentucky, Oklahoma, Kansas, and in many regional centers. Several other states are working on developing similar plans. In addition, fifty trainers from across the country have attended Training of Trainers programs and are teaching in hospitals, mental health centers, community support programs, peer support centers, support groups and at public forums.

Mental Health Recovery Seminars
Intensive five-day seminars led by Mary Ellen Copeland and her staff are being held several times each year in the Brattleboro, VT area. There are two sessions: Mental Health Recovery Seminar I: Learning Mental Health Recovery including Wellness Recovery Action Planning, and Mental Health Recovery Seminar II: Facilitator Training. The first session is open to people who experience psychiatric symptoms, to family members and supporters, and to health care providers. The second session is open to people who have completed the first session or have taken the four-week Correspondence Course. The seminars make this information available to people from across the country and from diverse backgrounds in an intensive, supportive environment that encourages networking. The diversity enriches this program as participants learn from and support each other.

Outline of a Typical Recovery Scenario
The following scenario can be modified as necessary to meet individual needs and preferences. It is used as the basis for the eight-day recovery education programs in Vermont and New Hampshire, and has been shared nationally at numerous conferences and seminars.

Key Recovery Concepts
There are five key recovery concepts that provide the foundation of effective recovery work. They are:

• Hope. With good symptom management, you will experience long periods of wellness.
• Personal Responsibility. It's up to you, with the assistance of others, to take action and do what needs to be done to keep your moods stabilized.
• Self Advocacy. Become an effective advocate for yourself so you can get the services and treatment you need, and to make your life the way you want it to be.
• Education. Learning all you can about depression and manic depression allows you to make good decisions about all aspects of your treatment and life.
• Support. While working toward your wellness is up to you, receiving support from others - and giving support to others - is essential to maintaining your stability and enhancing the quality of your life.

Beginning the Journey
As you begin your recovery journey, there are two important things you need to do for yourself:

1. Get good medical care. At least once a year, and whenever your symptoms change or worsen, have a complete physical examination to determine if a there is a medical problem which is causing or increasing your symptoms.

   When you go to see your doctor take a complete listing of:
   a) all medications and health care preparations you are using
   b) any new, unusual, uncomfortable or painful symptoms.

2. Manage your medications carefully. Learn about your medications, how they work, what to expect, possible side effects, and dietary/lifestyle restrictions.
   • Take them only as prescribed.
   • Use a daily reminder/pill saver system to insure regular use.
   • Get rid of medications you are no longer using - flush them down the toilet so that they cannot be used.
   • Don't expect medications to fix a bad diet, lack of exercise or an abusive or chaotic lifestyle.

Symptoms Monitoring and Response System
Through careful observation you will learn: the things you need to do every day to keep yourself well, external events that may trigger an increase in symptoms, early warning signs of an impending episode, and symptoms that indicate you are in trouble. With this knowledge, and by using the tools listed here, and others you have discovered for yourself, you will be able to develop a symptoms monitoring and response system (Wellness Recovery Action Plan™) that will help you keep your moods stabilized. This system would include listings of:

• those things you need to do every day to keep yourself well, such as eating three healthy meals and getting a half-hour of exercise
• external events that could trigger symptoms, such as an argument with a friend or getting a big bill, and responses that might keep this event from causing or worsening symptoms
• early warning signs - such as irritability or anxiety - that indicate your symptoms may be worsening, and a response plan
• symptoms that indicate the situation is getting much worse, such as reckless behavior or isolation, and an action plan to stabilize the situation

Wellness Toolbox
Use the following tools as part of your symptoms monitoring and response system to reduce symptoms and maintain wellness.

• talk to a supportive person
• attend a support group
• talk to your counselor, doctor or other health care professional
• peer counsel - share talking and listening time with a friend
• structured focusing exercises
• relaxation and stress reduction exercises
• fun, affirming, creative activities
• journaling
• daily planning
• exercise
• light exposure
• dietary improvement - avoiding caffeine, sugar and heavily salted foods
• increasing or decreasing the stimulation in your environment
• stop, analyze the situation and make a thoughtful decision on how to proceed

Crisis Planning
Write a personal crisis plan to be used when your symptoms have become so severe and/or dangerous that you need others to take over responsibility for your care. Your crisis plan includes:

• a list of your supporters, their roles in your life, and their phone numbers
• a list of all medications you are using and information on why they are being used
• symptoms that indicate you need your supporters to make decisions for you and take over responsibility for your care
• instructions that tell your supporters what you want them to do

Give completed copies of your plan to your supporters so they have easy access to it when necessary. Update your plan as necessary.

Addressing Traumatic Issues
If you feel your symptoms are caused or worsened by traumatic events in your past, seek out a treatment program that:

• validates your experiences
• empowers you to take positive action in your own behalf
• helps you establish connection with other people

Suicide Prevention
Up to 15% of people diagnosed with depression or manic depression end their lives by suicide. Make sure that doesn't happen to you by:

• treating symptoms early
• setting up a system with others so you are never alone when you are deeply depressed or out of control
• having regularly scheduled health care appointments and keeping them
• throwing away all old medications and having firearms locked away where you do not have access to them
• keeping pictures of your favorite people in clear view at all times
• instructing a close supporter to take away your credit cards, check books and car keys when you are suicidal
• always having something planned to look forward to

Developing a Wellness Lifestyle
Develop a lifestyle that supports your wellness by:

• using self-help books to improve your self-esteem and change negative thoughts into positive ones.
• enhancing your life with pets, music, and activities that make you feel good
• having a comfortable living space where you feel safe and happy
• establishing a career or avocation that you enjoy
• keeping your life calm and peaceful
• taking good care of yourself
• managing your time and energy well
• spending time with people who are positive, affirming and fun

Conclusion
Because of the discouraging nature of these illnesses, and because it may take a long time before we realize the results of our efforts, many of us find it very difficult to motivate ourselves to work on our recovery. Learning and sharing information in a workshop has the substantial benefit of increasing participants' sense of belonging and hope and gives them the support they need to work on their own recovery and/or assist others as they move through the recovery process.

 

See other articles by Mary Ellen Copeland