Wellness Recovery Action Planning (WRAP)
Key Takeaways
- Developed by Mary Ellen Copeland, WRAP is a self-directed, evidence-based system designed to help individuals monitor, manage, and decrease distressing symptoms.
- The core structure of WRAP consists of six distinct sections: Daily Maintenance Plan, Triggers & Action Plan, Early Warning Signs, When Things Are Breaking Down, Crisis Plan, and Post-Crisis Plan.
- The Crisis Plan is created by the peer while well, granting legal authority to designated supporters and providing explicit instructions for care during acute psychiatric or health emergencies.
- Psychiatric Advance Directives (PADs) are legally binding legal instruments that complement WRAP by documenting medical treatment preferences, facility choices, and surrogate decision-makers.
Wellness Recovery Action Planning (WRAP)
Wellness Recovery Action Planning (WRAP) is an evidence-based, self-directed wellness system created in 1997 by Mary Ellen Copeland alongside a group of individuals seeking recovery from mental health challenges. WRAP is designed to help individuals decrease distressing symptoms, increase personal empowerment, improve quality of life, and achieve self-directed wellness goals.
A fundamental tenet of WRAP is that there are no limits to recovery. WRAP is completely voluntary, individualized, and non-clinical. Rather than being prescribed by a clinician, WRAP is authored entirely by the individual (referred to as the "author" or peer). Certified Recovery Support Specialists (CRSS) often facilitate WRAP workshops or assist peers one-on-one in building their WRAP, acting as supportive sounding boards while ensuring the peer retains absolute ownership of their plan.
Mary Ellen Copeland's WRAP Framework & Core Principles
The WRAP framework is built upon five Key Concepts of Recovery:
- Hope: Believing that recovery is possible and that people can regain control over their lives.
- Personal Responsibility: Taking charge of one's own wellness and life decisions.
- Education: Learning about one's conditions, options, resources, and rights.
- Self-Advocacy: Reaching out for what one needs and effectively communicating personal rights.
- Support: Receiving assistance from and offering support to loved ones, peers, and professionals.
The Six Structural Components of WRAP
A comprehensive WRAP document consists of six sequential, highly structured sections:
1. Daily Maintenance Plan (Wellness Toolbox & Daily Routine)
The plan begins with the creation of a Wellness Toolbox—a comprehensive list of tools, strategies, and activities that keep the author feeling well. Examples include walking the dog, listening to music, taking medication as prescribed, eating balanced meals, calling a friend, or spending time in nature.
Using the Wellness Toolbox, the author constructs three distinct parts of the Daily Maintenance Plan:
- What I am like when I am well: A description of the peer's healthy baseline (e.g., energetic, talkative, organized, patient).
- Daily List: Non-negotiable daily activities required to maintain wellness (e.g., getting 8 hours of sleep, drinking water, taking medications, practicing meditation).
- Additional List: Wellness activities to consider doing periodically (e.g., attending a weekly support group, getting a haircut, scheduling a dental check-up).
2. Triggers & Action Plan
Triggers are external events, circumstances, or occurrences that produce emotional distress, anxiety, or discomfort. Unlike internal symptoms, triggers originate outside the individual. Examples include financial stress, anniversary dates of trauma, interpersonal conflict, unexpected major changes, or physical illness.
The author identifies their specific triggers and writes a detailed Triggers Action Plan outlining immediate coping strategies from their Wellness Toolbox to prevent triggers from escalating into a crisis.
3. Early Warning Signs & Action Plan
Early Warning Signs are subtle internal signals that indicate a person's wellness is beginning to slip or that distress is increasing. Unlike external triggers, early warning signs are internal reactions, behavioral changes, or physiological shifts. Examples include subtle changes in sleep patterns, feeling unusually irritable, withdrawing slightly from social activities, experiencing heightened anxiety, or persistent physical fatigue.
The author drafts an Early Warning Signs Action Plan containing simple, direct steps to address these signs immediately before symptoms become more severe.
4. When Things Are Breaking Down (Signs of Impending Crisis)
This section addresses situations where symptoms have progressed significantly and are becoming severe, dangerous, or overwhelming, but the peer can still take self-directed action. Examples of signs that things are breaking down include severe insomnia, intense feelings of paranoia, inability to perform basic hygiene, thoughts of self-harm, or substance use relapse.
The When Things Are Breaking Down Action Plan requires a clear, explicit, and directive plan of action that involves immediate assistance from designated support individuals or professionals to avert a full-scale emergency.
5. Crisis Plan (Advance Directive for Crisis)
The Crisis Plan is authored by the peer while feeling well to dictate how they wish to be treated if they experience an acute psychiatric or health crisis where they temporarily lose the capacity to make informed decisions or keep themselves safe.
Unlike previous sections, the Crisis Plan is written to be executed by others (family, peers, doctors, emergency responders). It contains nine vital sections:
- What I am like when I am well.
- Signs that indicate supporters must take over decision-making.
- Names and roles of designated supporters (and who should not be involved).
- Names of preferred healthcare providers and medications.
- Names of unacceptable treatments or medications (and reasons why).
- Preferred treatment facilities (and facilities to avoid).
- Strategies supporters can use to help at home or in the hospital.
- Tasks supporters must manage on the peer's behalf (e.g., childcare, pet care, bill payment).
- Clear indicators that signal the peer is ready to resume self-care and deactivate the Crisis Plan.
6. Post-Crisis Plan
The Post-Crisis Plan guides the transition from acute crisis back to daily life. It helps the peer process what happened, resolve consequences of the crisis (such as financial or relationship strain), revise their WRAP to prevent future crises, and gradually resume independent responsibilities at their own pace.
Psychiatric Advance Directives (PADs)
A Psychiatric Advance Directive (PAD) is a legally binding legal document executed under state law that allows an individual to declare their preferences for mental health treatment before a crisis occurs. While a WRAP Crisis Plan is a personal recovery tool, a PAD is a formal legal instrument.
Legal & Peer Support Considerations in PAD Facilitation
PADs typically include two primary mechanisms:
- Instructive PAD: Specifies explicit instructions regarding preferred and refused medications, emergency interventions, electroconvulsive therapy (ECT), and hospital choices.
- Proxy PAD (Health Care Power of Attorney for Mental Health): Names a designated agent or surrogate decision-maker authorized to make mental health treatment decisions if the individual becomes incapacitated.
CRSS professionals educate peers about PADs, assist them in filling out official state forms, and encourage them to share completed PADs with their healthcare team and legal proxies.
Comparison Table: Crisis Plan vs. Psychiatric Advance Directive
| Feature / Dimension | WRAP Crisis Plan | Psychiatric Advance Directive (PAD) |
|---|---|---|
| Legal Status | Informal, personal recovery plan; non-legally binding | Formal legal document governed by state advance directive laws |
| Primary Audience | Self, family members, peer supporters, trusted friends | Medical providers, hospital staff, courts, designated legal proxies |
| Enforceability | Relies on voluntary agreement and trust of supporters | Legally binding on medical providers under state law (with narrow emergency exceptions) |
| Creation Process | Authored as part of Mary Ellen Copeland's WRAP framework | Executed with formal legal formalities (notarization or witness signatures) |
| Scope of Directives | Covers clinical care, daily living, pet care, bills, and supporters | Focuses primarily on clinical treatments, medications, facility preferences, and legal proxy |
According to Mary Ellen Copeland's WRAP framework, how do external triggers differ from early warning signs?
Who is responsible for authoring and maintaining a peer's Wellness Recovery Action Plan (WRAP)?
Which distinction accurately describes the difference between a WRAP Crisis Plan and a Psychiatric Advance Directive (PAD)?