Bipolar articles

Planning Ahead For Your Next Episode

I just finished filling out a WRAP plan with the help of my therapist. WRAP stands for Wellness Recovery Action Plan. The plan can be found at mentalhealthrecovery.com and is free to print out.

This isn’t the first time I’ve filled out the plan. Years ago while I was in an acute treatment unit for severe depression (before my bipolar I diagnosis) I half-heartedly filled one out as part of a recovery exercise. The plan has you list things to do that will help you maintain your wellness and what happens if things start breaking down.

In addition, WRAP can be used as part of your toolbox to list coping skills and wellness tips. It keeps everything in one complete package to help you remember.

I have no idea what happened to my WRAP plan from many years ago. I don’t even think I filled it out completely. There were sections of the plan that I didn’t think were important at the time.

My life today looks very different from when I first filled out the WRAP. Mania changes everything.

During my last manic episode six months ago, I almost got arrested, people had to watch me swallow my medication to be sure I took it, I was having visual and auditory hallucinations and I insisted I could walk to another town 50 miles away.

I barely avoided being hospitalized because my family, therapist and psychiatrist scrambled to help. I was lucky. My therapist later told me that one unfortunate move on my part and it would have been a completely different story. She said I was very unpredictable.

Mania is very unpredictable. I’m glad this past episode ended as well as it did and I’ve been compliant with my medication ever since, but both my therapist and I agreed that a plan needed to be in place for possible future episodes.

So, with more seriousness than the last time, I once again filled out the WRAP, paying special attention to the Crisis Plan part of it. It included listing my symptoms and people who I would like to take over when the symptoms become unmanageable and I can’t make decisions for myself. It had me list people I don’t want involved (there’s a certain doctor at the mental health center I go to that I don’t get along with), and medications and treatments I want to avoid if possible. There is a plan for staying home to get the care I need to reduce the chances of hospitalization, and what treatment facilities I would prefer if necessary.

There was one part that was especially difficult to fill out. I had to list what I needed my supporters to do if my behavior endangered myself or others. When I’m well and rational I could never imagine doing anything to harm anyone else. When I’m manic, rational thinking and self control is virtually gone and I find myself driving down the highway at 100 mph. It was hard to insist in the plan that my supporters call the police or drive me to the ER for a mental health evaluation if things break down to that point. (Although these steps may seem obvious to some, others may need specific instructions to realize the seriousness of the situation.)

At the end, the WRAP can be signed by you and by witnesses. If you appoint and name an agent to act on your behalf it can even be a durable power of attorney.

It wasn’t easy to fill out, but the WRAP is now in the hands of all my family and friends who are supporters, along with my therapist and doctor. I hope the crisis part of the plan sits there in my drawer without ever being used, but if it has to be, at least I have some control over this unpredictable illness.

By Paula Bostrom