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by Mary Ellen Copeland, MA, MS
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, and Healing the Trauma of Abuse: A Gentle Woman's Guide.
PROGRAM OVERVIEW
About the Presenter
Mary Ellen Copeland is an author, educator and mental health 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
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| decrease the need for costly, invasive
therapies
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| decrease the incidence of severe symptoms
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| decrease traumatic life events caused by
severe symptoms
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| increase understanding of these illnesses
and decrease stigma
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| 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.
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| increase participants' sense of personal
responsibility and empowerment
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Objectives
The following topics will be covered using a workshop style, including
presentations, demonstrations, interactive discussion and related activities:
| Hope, empowerment, personal
responsibility, self-advocacy and education
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| Accessing good health care and managing
medications
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| 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)
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| Symptom responses: finding and keeping a
strong support system, peer counseling, focusing, relaxation exercises,
diet, light, exercise, sleep, journaling, music, etc.
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| Ongoing work:
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 | dealing
with trauma
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| suicide
prevention
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| building
self-esteem
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| changing
negative thought patterns to positive
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| building
a lifestyle that promotes wellness
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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.
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| 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.
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| 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.
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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.
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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 Skills 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 Skills Seminar I: Learning How to Self-Manage
Psychiatric Symptoms, and Mental Health Recovery Skills Seminar II: Teaching
Self-Management of Psychiatric Symptoms. The first session is open to people who
experience psychiatric symptoms, family members and supporters, and health care
providers. The second session is open to people who have completed the first
session or have taken a 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.
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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.
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| 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.
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| 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.
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| Education. Learning all you can about
depression and manic depression allows you to make good decisions about all
aspects of your treatment and life.
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| 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.
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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.
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Take them
only as prescribed.
o
Use a
daily reminder/pill saver system to insure regular use.
o
Get rid of
medications you are no longer using - flush them down the toilet so that they
cannot be used.
o
Don't
expect medications to fix a bad diet, lack of exercise or an abusive or chaotic
lifestyle
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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
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| 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
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| early warning signs - such as irritability
or anxiety - that indicate your symptoms may be worsening, and a response
plan
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| symptoms that indicate the situation is
getting much worse, such as reckless behavior or isolation, and an action
plan to stabilize the situation
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Wellness Toolbox
Use the following tools as part of your symptoms monitoring and response system
to reduce symptoms and maintain wellness.
1.
talk to a supportive person
2.
attend a support group
3.
talk to your counselor, doctor or other health care professional
4.
peer counsel - share talking and listening time with a friend
5.
structured focusing exercises
6.
relaxation and stress reduction exercises
7.
fun, affirming, creative activities
8.
journaling
9.
daily planning
10.
exercise
11.
light exposure
12.
dietary improvement - avoiding caffeine, sugar and heavily salted foods
13.
increasing or decreasing the stimulation in your environment
14.
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
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| a list of all medications you are using
and information on why they are being used
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| symptoms that indicate you need your
supporters to make decisions for you and take over responsibility for your
care
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| 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.
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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
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| empowers you to take positive action in your own
behalf
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| helps you establish connection with other people
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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
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| setting up a system with others so you are
never alone when you are deeply depressed or out of control
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| having regularly scheduled health care
appointments and keeping them
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| throwing away all old medications and
having firearms locked away where you do not have access to them
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| keeping pictures of your favorite people
in clear view at all times
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| instructing a close supporter to take away
your credit cards, check books and car keys when you are suicidal
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| always having something planned to look
forward to
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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.
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| enhancing your life with pets, music, and
activities that make you feel good
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| having a comfortable living space where
you feel safe and happy
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| establishing a career or avocation that
you enjoy
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| keeping your life calm and peaceful
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| taking good care of yourself
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| managing your time and energy well
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| spending time with people who are
positive, affirming and fun
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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.
Guide
to Developing
a WRAP-
Wellness
Recovery
Action
Plan
The following handout
will serve as a guide to developing Wellness Recovery Action Plans. It can be
used by people who are experiencing psychiatric symptoms to develop their own
guide, or by health care professionals who are helping others to develop
Wellness Recovery Action Plans.
This handout, or any
part of this handout, may be copied for use in working with individuals or
groups.
Getting Started
The following
supplies will be needed to develop a Wellness Recovery Action Plan:
1.
a three ring binder, one inch thick
2.
a set of five dividers or tabs
3.
a package of three ring filler paper, most people preferred lined
4.
a writing instrument of some kind
5.
(optional) a friend or other supporter to give you assistance and
feedback
Section
1-Daily Maintenance List
On the first tab write Daily Maintenance List. Insert
it in the binder followed by several sheets of filler paper.
On the first page, describe, in list form, yourself
when you are feeling all right.
On the next page make a list of things you need to do
for yourself every day to keep yourself feeling alright.
On the next page, make a reminder list for things you
might need to do. Reading through this list daily helps keep us on track.
Section
2-Triggers
External events or circumstances that, if they
happen, may produce serious symptoms that make you feel like you are getting
ill. These are normal reactions to events in our lives, but if we don't respond
to them and deal with them in some way, they may actually cause a worsening in
our symptoms.
On the next tab write "Triggers" and put in
several sheets of binder paper.
On the first page, write down those things that, if
they happened, might cause an increase in your symptoms. They may have triggered
or increased symptoms in the past.
On the next page, write an action plan to use if
triggers come up, using the Wellness Toolbox at the end of this handout as a
guide.
Section
3-Early Warning Signs
Early warning signs are internal and may be unrelated
to reactions to stressful situations. In spite of our best efforts at reducing
symptoms, we may begin to experience early warning signs, subtle signs of change
that indicate we may need to take some further action.
On the next tab write "Early Warning
Signs". On the first page of this section, make a list of early warning
signs you have noticed.
On the next page, write an action plan to use if
early warning signs come up, using the Wellness Toolbox at the end of this
handout as a guide.
Section
4-Things are Breaking Down or Getting Worse
In spite of our best efforts, our symptoms may
progress to the point where they are very uncomfortable, serious and even
dangerous, but we are still able to take some action on our own behalf. This is
a very important time. It is necessary to take immediate action to prevent a
crisis.
On the next tab write, "When Things are Breaking
Down". Then make a list of the symptoms which, for you, mean that things
have worsened and are close to the crisis stage.
On the next page, write an action plan to use
"When Things are Breaking Down" using the Wellness Toolbox at the end
of this handout as a guide.
Section
5-Crisis Planning
In spite of our best planning and assertive action,
we may find ourselves in a crisis situation where others will need to take over
responsibility for our care. We may feel like we are totally out of control.
Writing a crisis plan when you are well to instruct
others about how to care for you when you are not well, keeps you in control
even when it seems like things are out of control. Others will know what to do,
saving everyone time and frustration, while insuring that your needs will be
met. Develop this plan slowly when you are feeling well. The crisis planning
form includes space to write:
| those symptoms that would indicate to
others they need to take action in your behalf
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| who you would want to take this action
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| medications you are currently taking,
those that might help in a crisis, and those that should be avoided
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| treatments that you prefer and those that
should be avoided
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| a workable plan for at home care
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| acceptable and unacceptable treatment
facilities
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| actions that others can take that would be
helpful
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| actions that should be avoided
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| instructions on when the plan no longer
needs to be used
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