Mental Health Recovery Newsletter
Contents
Recovery Topics:
Supporting A Person in Crisis
Post Crisis Planning
A Note from Marty Roberts
Wellness Toolbox:
A Wellness Tool from James Franklin-The Wish
Card
Keeping Control of Your Life
Overview of WRAP: Wellness Recovery Action PlanT
Focus on Home/Respite or Community Care
News from Mary Ellen and Ed including Upcoming
Presentations
New Resource
Free Resources
Introduction
Welcome to Mental Health Recovery Newsletter, begun in March 2000
and published quarterly from the office of Mary Ellen Copeland. This
newsletter is for anyone who wants to learn more about recovering
from uncomfortable, often disabling psychiatric symptoms. If you
would like a copy of previous issues of this newsletter or would
like to enter your subscription, please see the paragraph below.
Subscription is free to individuals, by email or ground mail. Institutional
subscriptions available: 50 copies for $25 plus mailing; 100 copies
for $45 plus mailing. Please contact us and let us know whether
we can send you the email version to save a tree. You may freely
copy and distribute this newsletter, giving credit to Mary Ellen
Copeland.
If you would like a copy of previous issues of this newsletter or
would like to enter your free subscription, please contact the office
of Mary Ellen Copeland by e-mail or click
here.
Recovery Topics
Supporting a Person in Crisis
Anyone can have a crisis, a time when they are so overwhelmed or
scared that they behave in a very unusual or bizarre fashion. They
may be very agitated-rushing aimlessly about, muttering, shouting
or screaming, gesticulating wildly, even making threats against themselves
or others. They may be destroying property. Or they may be very quiet,
refusing to interact in any way. In a crisis, it is usually very
clear that the person is very troubled and upset.
A crisis may be precipitated by an event like an accident, the death
of someone who is close, an upsetting news event, receiving bad news,
being treated badly by another person or people, losing your home
or job or from using alcohol or drugs. It may be caused by unexpected
prescription medication interactions. It may be the result of a bad
dream, a nightmare, intrusive thoughts or flashbacks, or reminders
of something that happened recently or a long time ago. It may come
seemingly "out of the blue", with no known or recognized
precipitating event.
How others handle a crisis can make the difference between a positive
or negative outcome-in some instances even between life and death.
Far too often the tragic result is further traumatizing experiences
or death.
I have learned through my own experience, hearing anecdotes from
others and from reading news stories of people in crisis, that how
others handle the crisis can have a great effect on the outcome.
For instance, suppose a man seems very upset and agitated. He is
in a crowded public space, running around and shouting that people
are chasing him, that they want to kill him. He is shoving people
aside as he moves wildly through the crowd.
Ways this could be handled:
- People shout at him and tell him to quiet down. They call him
a madman and threaten to call the police. Someone grabs him and
wrestles with him to try and subdue him. He breaks away and runs.
People pursue him. They catch him. The police come. He is restrained
in hand and leg cuffs and taken away.
- Someone, perhaps several people, speaks to him softly and with
compassion, asking him what has happened, what he needs, and what
would help. They encourage him to talk and tell them how he feels.
They assure him that they will keep him safe. They give him room
to express his feelings and emotions. They wait patiently, keeping
him and others safe until he quiets down. They hold or hug him
if that is what he wants. When he has quieted, they talk together
about what he needs and what will help him to feel better.
Which of these two ways would be most helpful to you if you were
in crisis? I contend that most crises could be handled the second
way-and that many of the behaviors described in the first scenario
are never necessary.
Post Crisis Planning
"I remember coming home from the hospital feeling great
and as soon as I got there I was bombarded with loneliness, other
people's problems and all the stuff that probably helped put me in
the hospital to begin with, less the drugs and alcohol." - L.
Belcher
Many of us have found that, through developing a Wellness Recovery Action PlanT, and then putting it to good use, we have significantly
improved the quality of our lives. I have certainly found that to
be true. However, I think adding post crisis planning to the Wellness Recovery Action PlanT, as an option for people who care to develop
and use such a plan, is an important next step. Richard Hart who
is a Mental Health Recovery Facilitator from West Virginia brought
this need to my attention. Recovering after a crisis was an issue
in a group he was leading. He felt that it was an issue that deserved
further consideration. I agree.
Back in the late 1980's, I was hospitalized repeatedly for deep
depression and severe mood swings. Those hospitalizations were somewhat
useful. They gave my family and me a much-needed break from each
other. I got some peer support. I was introduced to some wellness
tools, although that is not what they were called at that time, things
like stress reduction and relaxation techniques and journaling. I
was stabilized on a medication regime.
However, any positive effects from these hospitalizations were quickly
negated when I got home. Twice, I returned to the hospital within
two days of my discharge. Why? When I got home all my family and
friends considered that I must be well. I was dropped off at my apartment
and spent the next few very trying hours alone. One time a friend
who had promised to be there decided I must be napping, and didn't
bother to call or come. There was no food. The space was messy and
disorganized. I immediately felt overwhelmed and totally discouraged.
In addition, there was a message that my employer expected me back
at work full time in the next few days.
No matter how you work your way out of a crisis, in a hospital,
in respite, in the community or at home, you may also find that your
healing takes a few steps backwards unless the journey out of this
very hard place is given careful attention. I have come to believe
that, for most of us, it takes as long to recover from a crisis as
it would to recover from any other major illness or surgery. We need
assistance and support that can be gradually reduced, as we feel
better and better. It makes sense that advanced planning for dealing
with that critical time would enhance wellness and more rapid recovery.
Richard Hart of West Virginia says,
"As with all the elements of WRAP, a post crisis plan is very
individualized."
Returning to your everyday, healthy diet may require some assistance.
A trip to the grocery store is often a task that must be undertaken
the first day home. One person told me that after the strict regime
of "hospital food", when they went to the supermarket,
all they could do was fill the cart with "junk". Sugar,
salt, fat, those foods that were restricted when meals were prepared
and snacks were monitored by a nutritionist, became the attractive "forbidden
fruit". The same thing happened with alcohol. This person, a
very moderate social drinker, wound up with a hangover the first
morning they woke up in their own bed. Be certain that good food
is available when you come home.
Folks who are returning to a family have a different set of concerns.
As much as we would and do miss our children, depending on the individual
circumstance, we may need some help initially resuming our parenting
duties. As with those who return to the workplace, a gradual resumption
may be best. Some children may enjoy a visit with another family
member. Older children may enjoy spending some time at a friend's
house. No matter what, the dynamics of returning to family life present
concerns that must be anticipated in order to cope with potential
difficulties.
One of the most important considerations is whether or not to be
alone. Those of us who live alone have very different concerns than
those of us who do not. Making certain that I have a friend stay
with me at least the first night I am back home is most important
to me. In discussing whether or not one might stay with a friend
we felt it was better to be back in one's own space. However, that
first day alone again can be most difficult. After the first day
back, one can make a decision as to whether or not additional companioning
is needed.
Sometimes, you may not be able to make arrangements to have someone
stay with you. Coming home to a comfortable, clean home is in that
case most important. Folks who discussed this all agreed that many
of us have come home to a house that was most unkempt. Exposure to
that can bring on distressing memory of our days when "things
were breaking down". Arrangements to have a friend "straighten
up" can make a big difference.
Who would think that the mail could be traumatizing? It can. Having
a trusted supporter go through one's mail before we do can shield
us from distressing overdue notices and the like. I have found that
making out a check is no problem, but reading those awful "PAY
NOW OR DIE" notes from a creditor is rough.
Spreading the word to friends and associates that one is "back" is
a task that can be a bit daunting to someone in the early stages
of recovery. A buddy can be enlisted to call folks to let them know
how you are and also let them know if you would like them to visit
or call. Some folks may welcome visits, while others would prefer
some time to "decompress" before seeing friends. The same
is true for phone calls.
Along the same line, reentering the workplace should be thought
out carefully. Personally, I have made the mistake of trying to go
back to work too quickly. I have found that for me a gradual reentry
is best. Working a few hours for a few days has been good for me.
Please visit the Post Crisis Planning
pages now available on this web site. When the red Wellness Recovery Action PlanT book is next revised, this section will be
added to the back of the book, without changing the pagination
for the rest of the book so old books can still be used in groups.
People with old books can download the new section from the website.
A Note from Marty Roberts
I agree that crisis and post crisis planning is crucial. However
I don't really see it as the center of Recovery. As I have been growing
in my own recovery, one of the things I have learned is that I don't
have to have a crisis to have growth and learning. My previous life
was built around crisis. My life now is built on learned skills that
means I can catch things long before they reach crisis proportions,
and that the things I thought I could get only if I were in a crisis
- help, attention, respect, etc. - can be had without any crisis.
Of course these are still crises. And I use the skills I have learned
to get myself into a place of centeredness and stability. I learn
from the crises, but I don't require them in order to grow.
WELLNESS TOOLBOX
Personal responsibility is key to using any wellness
tool. It is up to you to notice how this tool is making you feel,
to decide whether or not you want to use it, and how much use of
this tool is best for you.
A Wellness Tool from James Franklin-The Wish
Card
Sometimes our illness becomes so challenging that we forget our
path of recovery. It was just this experience not so long ago. It
was late at night and sleep was not in the cards. Next the racing
thoughts...it was one symptom after another. And my WRAP called for
free writing. Hence the subject of wishes came up. I began to make
a list of wishes that I want to come true.
I choose three wishes:
- Motorcycle
- Dream Cruise
- Girl Friend
Then I wrote them on a card and put them in my wallet. I focus on
one when I am challenged or stressed. The symptoms seem to vanish.
The wish becomes the major thought. It is a pleasant way of dealing
with unpleasant thoughts or symptoms. And it reinforces ALL THINGS
ARE POSSIBLE.
Your wish cards can be simple or elaborate. They can be achievable or something
that might take a miracle. But a "wish card" offers HOPE and recovery
is the next step after HOPE..
Keeping Control of Your Life
At recent training, I realized that many, many people,
who have used or are using mental health services, believe that they
are not in control of their life. They believe that their doctors,
other health care providers and in some cases, family members, have
the right to make key decisions about their lives, including decisions
about treatment, medications, hospitalization, counseling, living
space, employment, education, leisure activities, choosing friends
and even intimate relationships. This is not true. The only circumstance
under which you can lose control of your life is if a court decides
you are a danger to yourself or someone else, or you have committed
a criminal offense. Unless you are in that category, you are the
captain of your own ship. You make decisions about how you will conduct
your own life.
In some cases another person may have been given guardianship over
you at a time when the court decided you needed assistance and protection.
This may have been done many years ago at a particularly trying time-and
never rescinded when you had recovered. You may even have an appointed
guardian or durable power of attorney that you do not even know you
have. In some cases, seemingly "out of the blue", the named
person may decide to exert their rights.
You can find out if you have a "guardian" or if anyone
holds durable power of attorney in your name by contacting your state
agency of Protection and Advocacy. Attorneys and their assistants
can help you determine the procedure you need to use to find out
if you have a guardian or durable power of attorney, and, if you
choose to do so, assist you in the process of removing your guardian
or durable power of attorney. Every state has an agency of protection
and advocacy. Contact the National Association of Protection and
Advocacy Systems (NAPAS), to find out how to reach the agency of
protection and advocacy in your state.
Overview of WRAP: Wellness Recovery Action PlanT
"WRAP works because it puts you in charge of your own wellness
and your own life."
In the first issue of this newsletter, two years ago, I described
how you could develop for yourself a Wellness Recovery Action PlanT.
It is a good time to review this plan, focusing on areas where people
have had difficulties or concerns.
WRAP is a self-management and recovery system designed to maintain
wellness, decrease symptoms, increase personal responsibility and
improve quality of life. This self-designed plan teaches you how
to keep yourself well, to identify and monitor your symptoms and
to use simple, safe, personal skills, supports, and strategies to
relieve these symptoms. WRAP can be used along with any other treatment
scenario that you have chosen for yourself.
The enthusiasm for this program continues to be overwhelmingly positive.
People are reporting that by developing and using this simple planning
process, they are achieving levels of wellness that they had never
dared dream of. In my own life, use of WRAP means that instead of
having weeks or months of severe depression or out of control mania,
I now have an occasional bad afternoon or several bad days. By using
my wellness tools, I can quickly help myself to feel better and get
on with doing the things I want to do.
As you may remember, WRAP was developed in 1997 by a group of people who were
having a hard time with troubling emotional symptoms and behaviors-some of
them so severe that they were spending months in hospital and day treatment
programs, or feeling so badly that they could not do the things they wanted
to do with their lives. Many said that they felt hopeless and worthless. They
were searching for ways to effectively use wellness skills and strategies.
They spent several days working together to develop WRAP, which is now touted
as an "evidence based best practice" and widely used around the world.
I developed a simple book that describes WRAP-now known as the "little
red book". I also wrote "Winning Against Relapse' which describes
how you can use the WRAP process to address any life issue, such as weight
loss, substance abuse, smoking or grief. The "little red book" is
now available in Spanish and in a special edition for people who are dealing
with both addictions and other troubling mental health symptoms. It is also
available on an audio cassette and is part of the Mental Health Recovery Facilitator
Curriculum.
WRAP must be developed by the person who will be using it as their
guide to living. No one else can do that for them. The person who
is developing the plan can ask a family member, friend or care provider
for assistance and support. Most people choose to develop the plan
in a ring binder, 1" thick will do. In addition it helps to
have five tabbed separators and a supply of binder paper.
In developing your own Wellness Recovery Action PlanT, you will first
want to spend some time developing your Wellness Toolbox - making
a list of things you have done in the past that have helped you to
feel better, and responses that others have used to help themselves
feel better that you think may be helpful to you in developing your
plan. They include things like reaching out for support, peer counseling,
focusing, relaxation and stress reduction exercises, journaling,
fun and affirming activity, exercise, diet priorities and restrictions,
light exposure, and bed times.
In Section 1, list daily maintenance activities - those activities
you know you must do every day to maintain your wellness. There is
also a listing of how you define your own wellness as well as things
you don't need to do every day but may need to do on certain days.
In Section 2 list your personal triggers - those events that might
make you feel worse. Then, using the strategies learned previously,
develop and write a plan that lists those wellness tools that you
think will help you to get through this difficult time.
In Section 3 list your early warning signs - those subtle signs
that warn of a possible worsening of symptoms. Then develop a more
intensive plan for responding to these symptoms, again using wellness
tools, to keep these feelings from worsening.
In Section 4 list those signs that would indicate that things have
gotten much worse, but you can still take action to help yourself.
When you have been in this place in the past, you may not have felt
you could help yourself, but now, using your wellness tools, you
may find, as many of us have, that we can be much more self-reliant,
helping ourselves to get through the worst of times without needing
to reach out for intensive treatment and crisis interventions. Again,
develop a plan, but now a very intense and specific plan that may
include using some wellness tools several times each day that you
feel will help you get through these very hard times. You can always
revise your plan if it doesn't work as well as you would have liked.
Section 5 is an intensive crisis plan. This is the time when your
life is literally "out of your control", when you can't
take care of yourself. When you are developing your crisis plan,
you identify those signs that let others know they need to take over
responsibility for your care, list who you want to take responsibility
for your care, and describe acceptable and unacceptable actions to
take on your behalf. There are forms for developing this plan in
all of my books.
Focus on Home/Respite or Community Care
One section of the WRAP Crisis Plan is called Home/Respite or Community
Care. Typically, when a person's symptoms fell into the crisis category,
when they could no longer take care of themselves, they were hospitalized.
In fact, for many of us, this may not have been the best option.
In the hospital you are taken away from all the comforts of your
home, away from your space that is set up to best meet your needs,
away from the things you may need for your wellness tools and away
from your supporters. In these days with shortened hospital stays
and lack of availability of hospitalization as an option, it is even
more important that each of us have a plan so that we could stay
at home or in the community when we are going through the most difficult
times.
I suggest you assess what options you have available in your community.
Is there any kind of program that you could attend during the day
that would give you care and safety, staying in your home or with
your family at night? Is there a respite center-a place where you
can stay and be supported by your peers? Do you have friends and/or
family members who could take turns staying with you around the clock,
keeping you safe and doing things for you that would help you to
feel better (you could write these things in your crisis plan)? If
you want to involve others in this plan, it is best to discuss it
with them in advance.
A number of years ago, my counselor realized that I was in a deep
suicidal depression. As we had previously agreed, she contacted one
of the women in my weekly women's group. This woman contacted other
women in the group and members of my family. They took turns staying
with me, cooking for me, listening to me, taking me to health care
appointments, taking care of household task, engaging me in agreed
upon activities, and giving me space to relax until the depression
lifted and I was able to resume my daily activities. It was much
more effective than my prior hospitalizations. It felt like a gift
to be with people who I know well and trust, to be in my own space
where I can do my own thing.
NEWS from Mary Ellen and Ed
Ed and I spent much of the last three months at our
home in Vermont. This was most welcome after a very hectic fall.
Ed worked with my son Jerry making the special Vermont treat, maple
syrup.
Upcoming Presentations
- May 20-24 and September 9-13. Five day Mental Health Recovery
and Wellness Recovery Action Planning Facilitator Trainings in
Brattleboro, VT.
-
May 31 1:30-4:30 PM Chicago, IL Self Management of Psychiatric
Symptoms: Taking Action to Recovery Presented by the Self-Determination
Workshop Training Program, The National Research and Training
Center on Psychiatric Disability
For information 312-422-8180
-
June 8 10:15-11:15 Washington DC National Mental Health Association
Conference - WRAP: An Innovative Self management System for Recovery.
Information (703) 838-7504 or dlooney@nmha.org
-
June 12 Toronto IAPSRS Annual Conference -Using WRAP with Adolescents.
Information (410) 789-7682
Educational Opportunities
Mental Health Recovery Correspondence Course
The four-part Mental Health Recovery Correspondence Course will teach you mental
health recovery concepts and skills as well as how to develop a Wellness Recovery Action PlanT for yourself and/or to share with others. It meets the prerequisites
for attending Mental Health Recovery Seminar II: Facilitator Training. If you
want to attend the Facilitator Training in the fall, this is a good time to
begin the Correspondence Course.
In some areas where several people are taking the correspondence
course, participants are gathering, usually once a week, to discuss
and work on the assignments together. I have found that this works
very well. If several people in your area are taking, or considering
taking the Correspondence Course, you might consider this option.
The course includes reading and written assignments, projects, activities and
phone discussion with the instructor. The three texts for the course are: The
Depression Workbook, Living Without Depression and Manic Depression, and Wellness Recovery Action PlanT. The cost is $200 per participant, plus the cost of any
needed textbooks.
Mental Health Recovery Seminar II: Facilitator Training
September 9-13, 2002 Brattleboro, VT
It's time now to begin making your plans to attend the 2002 fall
facilitator training. Over 300 people have attended this training
in the last several years. It has given them the skills and strategies
they need to teach mental health recovery skills and strategies including
Wellness Recovery Action Planning to individuals and groups.
Anyone who has met the requirements for the training is welcome.
You can meet the prerequisite for this training if you have taken
a basic Mental Health Recovery including WRAP training-perhaps it
was offered in your area by someone who came to a previous training-or
have completed the Correspondence Course described above. Contact
my office to see if you qualify or have questions about your qualifications.
The cost of this seminar is $900, including the Facilitator Training
Manual. Add your travel and personal expenses
New Resource
Recovering from Depression: A Workbook for Teens
The Adolescent Depression workbook is now available in a second
edition with a new title and new publisher. It is now called Recovering
from Depression: A Workbook for Teens and is published by Paul H.
Brookes Publishing Co. In this workbook, teens will have the opportunity
to explore ways to deal with suicidal thoughts and feelings, change
negative thoughts to positive ones, reach out to friends and supporters,
reduce stress, avoid substance abuse, stay healthy, solve problems,
focus on dreams and goals and learn how to recognize and avoid depression
'triggers". Parents, friends and care providers will also find
this interactive workbook to be a very useful resource in helping
teens to get well and stay well.
Free Resources
The booklet, Recovering Your Mental Health: A Self-Help Guide,
is available free from the Center for Mental Health Services. We
developed this booklet with the assistance of a focus group of ten
people from around the country--people who are working on their own
recovery. The first 18,000 copies have been distributed and the second
printing of 35,000 copies is now available. People are really hungry
for mental health recovery education. You can get free copies from
the Knowledge Exchange Network (KEN) by calling 1-800-789-2647 or
through www.mentalhealth.org. Refer to booklet SMA# 3504.
Join the egroup "mentalhealthrecovery" . Share your experiences
and get ideas, advice and support from others with similar problems
and issues. Go to www.yahoogroups.com. Then do a search for mentalhealthrecovery.
It will pull up two sites--one that is the Mary Ellen Copeland group
and one that is in the UK. You may want to join both. Then follow
the instructions to register and participate in the group. There
have been many lively discussions over the last few years.
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