This page started out life as my traffic lights system, a way for me to notice how I am and when things are slipping. It was helpful in so far as it allowed me to keep check of what’s going on for me, but didn’t take go any further in terms of what to do when things are going south.
As part of the Eden Programme delivered by Suicide or Survive, I was given the opportunity to take part in WRAP. Wellness Recovery Action Planning (WRAP) is a way of monitoring and managing our mental health. It was initially developed by and for people who have experience of significant mental health difficulties. However, WRAP can be useful to anyone in planning and managing their own wellbeing.
- help us to stay as mentally well as possible
- help us to monitor our own feelings and behaviours so that we can recognise when our mental health is taking a dip
- help us to develop action plans for what we will do to manage our own mental wellness when we face challenges in life
- identify the people/services that can support us and the type of support that is useful to us’
I was extremely skeptical initially, primarily down to the wording of the programme (which I realise is a fairly epic example of judging a book by its cover). I’m wary of the word recovery as I feel it’s very loaded, and I just plain don’t like the word wellness. That said, over the course of the two days I was well and truly proven wrong, and would recommend WRAP to anyone, not just those experiencing mental health difficulties.
The ultimate goal of WRAP is to develop action plans, ie, what we need to do to keep ourselves well, and how to help ourselves when we start to dip. Everyone’s WRAP is different and unique to them. I want to share mine for a couple of reasons. First and foremost, these plans are for me. I have a tendency to find something that works and then promptly dismiss it. I could write all this on a sheet of paper, but chances are it would be lost within a week, and when I really need it, I wouldn’t be able to find it. If it’s here, it’s accessible all the time. I’m also hopeful it might be of help to some of you, even if just to see that someone as skeptical as me can get something from it!
At the core of WRAP are the wellness toolbox and 5 key recovery concepts.
This is a list of things I can to to keep myself well, and things I can do to make myself feel better when I start to take a dip. They form the basis of my WRAP.
- headspace/soothing rhythm breathing
- being in nature, preferably near water
- hugs – with Hubby, with my kids, with my dogs
- tea and cake
- talking – therapy, with friends, family etc
- emergency meds
- wine (occasionally of course)
- housework (a strange one I know but sometimes bringing order from chaos really help)
The other core element is the 5 key recovery concepts – hope, personal responsibility, education, self advocacy and support.On the first day of the programme we explored these in more detail, looking at what the those words mean for us as individuals. Again, it will probably be different for everyone, but this is what I get from them.
This is a word I’ve had a set against for a very long time, most of my life to be honest, and particularly over the last 8 years since things got really bad, primarily because for much of that time, I had none. I lurched from crisis to crisis with many and varying interventions along the way. It is only in the last few months since starting with Therapist 2.0 that I’m starting to be able to see a future, and one that holds the possibility of (relative!) peace and stability.
This is the big one for me, and something I’ve struggled with forever – taking responsibility for our own actions, our own wellbeing. I just did not want to do that, and couldn’t see how to. It was too big. Where could I possibly start? The entire time I was working with Therapist 1.0 I wanted her to save me, and I put that responsibility solely on her. I could not see, never mind accept, how much of it would come back to me and what I do or don’t do. I’ve been exploring it with Therapist 2.0 in terms of compassion and self compassion, and it’s all coming back to the same thing – we are ultimately responsible for our wellbeing. It sounds so obvious, and so simple, but it really isn’t, especially when things are bad. It’s far from easy either – it means acknowledging when something isn’t working for us, and both committing to and following through on doing something to change it.
Another big one. Knowing what I’m up against has made such a difference for me. Knowing the why behind my behaviour has started to give me the power to do something about it. I’m learning more and more about my triggers, how I react to them, and how to handle those reactions. Instead of getting caught up in my emotions, I’m learning how to take a step back from them. Finding out about bpd and all it entails, while not exactly pleasant reading, has helped so much in understanding myself and how I relate to the world, and has had a hugely positive impact on my ability to cope. It’s also been incredibly helpful for my family, particularly my husband, to try to understand all of this.
I understand this as being able to ask for what I need, or in some cases, recognise what I don’t, what isn’t working. Over the last few years this has taken many forms – accessing therapy, accessing and dealing with psychiatric services, the blog and crowdfunding for treatment being among them.
Possibly an obvious one, but something I know I struggle with and I doubt I’m the only one – being able to ask for help from those around us, and knowing what it is we need of them and what we can reasonably expect from them.
Following on from these key concepts are the action plans. The daily maintenance plan has 3 components:
- a description of how I am when I’m well
- what I look like physically
- what I do
- how I think
- what emotions I feel
- how others would know I’m well
- a list of things I need to do every day to keep myself well
- a list of optional extras – things I might do on a weekly/fortnightly/monthly basis to keep myself well
Then there are triggers, and the actions required to deal with them. Next is planning around recognising my early warning signs, ie, what are the indicators that things are not all as they should be, and what I can do when these start to happen. This leads into recognising signs that things are getting worse, with very clearly defined steps that must be taken to try and prevent a crisis from happening. Sometimes it won’t be possible to stop the crisis occurring so there’s a plan around that too, which can include indicators for others that I need them to ‘take over’, details of treatment/meds, who I’m comfortable supporting me, things others can do that will help etc. Finally there’s the post crisis plan, which will help me to get back on track with life.
Daily Maintenance Plan
When I’m doing well, all of the following (in no particular order) are part of my life:
- I’m calm, mindful, controlled – at peace with myself
- I’m able to focus and feel motivated
- I’m able to multitask without feeling pressured or frantic
- I have the energy to do both what I need and want to do
- I have a clear head, thoughts aren’t racing
- I feel optimistic about the future and trust myself to make decisions
- I want to look after myself – eat well, exercise, wash! Cooking isn’t a chore
- I look forward to family time instead of panicking about how I’ll fill the weekend, I enjoy hanging out with the kids
- I’m more available to other people, more able to handle their emotion without being overwhelmed by it
- I’m softer – Hubby finds me easy to be around, I handle the kids much better
- I want to see my friends
- I recognise that I need medication and therapy, that neither is causing a problem
- I’m able to keep things in perspective
- I’m more resilient
- I have faith in myself
In order to try and keep myself in this space there are certain things that I know I need to do. I don’t always do them – sometimes I choose not to, and sometimes life gets in the way. I need to try and remember that while if I don’t do these things for a couple of days it likely won’t have much impact, if it becomes a pattern it will lead to a dip.
Again in no particular order, this is what I ideally do every day:
- take medication
- eat well, drink enough water
- get enough sleep
- keep track of what I need to do with lists so I don’t get overwhelmed trying to remember everything
- minimum of 5 minutes of yoga
- headspace/soothing rhythm breathing
- walk (for the sake of the dogs as well as my own!)
- have compassion for myself – not beat myself up if all of these things don’t happen
Optional extras on a weekly/monthly/fortnightly basis could include:
- catching up with mail/blog related bits
- a photo expedition
- trip to the cinema
- family day trip
- date night with Hubby
- a night out with the girls
- keeping on top of household stuff – banking etc
I have so many it’s almost funny. Some of them will take me to stratospheric levels of rage in a nanosecond, others will make me incredibly anxious, others will scare the shit out of me, others will send me on a guilt/shame spiral……. Again, in no particular order:
- too much noise (eg dishwasher/washing machine/cooker hood/stereo all going at the same time)
- being in town for too long when it’s busy, or some days just being in town full stop
- managing finances
- bumping into Therapist 1.0 in town, or seeing/hearing something that reminds me of her
- the sound of people chewing/swallowing
- doors banging/taps dripping
- having too much to do in one day, feeling under pressure for time
- the school runs (on a bad day negotiating that many people feels impossible)
- having to repeat myself over and over again (put your shoes on put your shoes on put your shoes on put your shoes on…………)
- feeling like I’ve let someone down
- believing I’ve pissed someone off
- realising I’ve made a mistake
- letting blog related bits build up – replying to comments, mail etc
It’s been a really interesting exercise to list them all like this, because I can see a pattern emerging in how I might cope with them. In almost every case, allowing myself space to take a step back before I react will be absolutely huge (with the possible exception of spiders. Those I run screaming from before I’ve even registered that I’ve seen them). Taking a step back will (ideally) allow me to notice whatever emotion is coming up, and in theory at least, being aware of what that emotion is might help me to manage it a bit better. It might be an easy fix, like turning off one of the noisy machines, stopping the door from banging, moving something from the to do list to another day, or simply recognising that I need to breathe. It might take a bit more work, such as taking some time out alone or writing to try and figure out why I’m reacting as I am. Above all recognising when I’m triggered rather than pushing it away or trying to ignore it will make it more likely that I’ll be able to cope with whatever is bothering me and hopefully avoid going off the deep end.
Early warning signs/signs that things are getting worse
These are internal – things I notice about myself that let me know all is not well, that I don’t feel the way I want to, and/or that things are not as I would like them to be.
- I feel the need to contact Therapist 1.0 which will become a compulsion if things get worse
- thoughts of self harm and suicide come to mind too easily
- I think about stopping my medication
- my breathing is very shallow and I find it hard to take a deep breath
- there’s a lump in my throat
- I find it hard to make eye contact
- I avoid people, and if I can’t, will make excuses to get away as quickly as possible
- my mind is very busy, thoughts are racing
- I want to be left alone
- I’m easily overwhelmed
- I’m irritable, snappy, prone to catastrophising
- I can’t stay in the moment – I’m panicking about the future or dwelling on the past
- I don’t want to do yoga
- I drink too much, eat rubbish
When I get to this point there are certain things that must happen. I have got to talk to Hubby and let him know what’s going on. I absolutely must not make any major decisions!!!! I need to get out to the sea or the lake, somewhere that I can be completely alone, preferably with the camera. There’s something about water that I find incredibly soothing, and if I’m taking photos, I’m concentrating on what I’m seeing rather than what I’m feeling. It won’t necessarily make everything better, but for the length of time that I’m there it will give me breathing room. I need to keep things simple, go right back to basics – don’t expect too much of myself, don’t line up a long to do list. I need to do my soothing rhythm breathing. I’ll need to know my friends are available, even a text every now and then. They don’t need to try and fix me, or feel obliged to come and see me. Chances are I wouldn’t answer the door anyway! But knowing they’re there is huge. Sleep. Above all else I need sleep, because when I’m tired my ability to keep things in perspective and do what I know I have to do goes right out the window.
Sometimes despite my best efforts, the crisis can’t be avoided and this is when other people, Hubby in particular, need to take over. He’s already far too well versed in recognising when this has happened, but’s it’s useful for me to think about this on a good day, so I might be better equipped to know when I’m in the bad place.
- Bitchface is in control
- I’m overwhelmed by everyday tasks
- I want to run away, I feel trapped, but at the same time I’m paralysed because I don’t know where I would go
- I’m incredibly impatient. Everything needs to happen now, right now, this very minute!
- My mood can be anything from numb to angry to extremely low
- I cry, shout, am quick to anger, I pick fights with Hubby
- Perspective is gone
- Motivation is gone
- I blame Hubby for perceived problems and decide our marriage is doomed
- Black and white thinking – I’m always like this, it’s never going to go away, we’re always fighting etc etc
- I self harm, and think more realistically about suicide
- I’m completely withdrawn from everyone – Hubby, kids, family, friends. I just want to be left alone.
- I’m impossibly hard on myself, nothing I do is good enough
- If left alone, I’ll sit and stare at nothing for hours
- I’ll stop taking meds
This is where Hubby steps in, and there are certain things that have to happen.
- I’ll need to check in with my GP, and ideally my psychiatrist. Hubby will have to come to these appointments because when things get this bad, I’m not really able to articulate myself, and I certainly don’t remember what’s been said to me
- I’ll need help with the kids – afterschool care if I’m not able to cope, or else for one or both of my parents to come and stay to help out
- I need Hubby to take over household stuff – shopping, cooking, bills etc
- Much and all as I resent it and hate to put it on him, I’ll also need Hubby to ensure I’m taking meds correctly, and question me as to whether I’ve hurt myself or am contemplating suicide
- If necessary, inpatient treatment, particularly if I can’t be trusted to keep myself safe.
This is the absolute worst case scenario, and if I’m really lucky, I’ll never hit this point again. But, we have no way of knowing what life will throw at us, so we have to be prepared.
Last but not least, what happens when the crisis has passed? If I was recovering from a serious physical illness or had had surgery, I wouldn’t be expected and nor would I expect myself to be back on my feet straight away. It would take time, and I have to allow for that if things reach crisis point with my mental health. I’ll continue to need help with the kids and the household bits till I feel more stable. While I won’t necessarily need my parents to stay with me, it would help to know that they’re available and can come over if I start getting overwhelmed again. I’ll need space to write, walk and do my yoga to try and start breathing properly again. I’ll need my friends to feel able to ask me how I’m doing and hear a genuine answer, not one that brushes everything under the carpet again, and for them to try and understand that if I’m not able to see them, it’s nothing personal. Mostly I’ll just need time, patience and love. If I have those, the rest will follow.