Transcript for October 2015 Brown Bag

>> Okay, we're ready to go. I'm Dr. Marge Olney. I know most of you. Hi, everybody. And I wanted to

share with you today some work that I did a couple summer ago, some data collection I did actually

through [inaudible] employment services. [inaudible] helped me identify a group of people who had been

successful on the job and had also taken WRAP, and I'll explain to you what WRAP is. And I was able to

interview those individuals and then analyze that data. So that's what I'm reporting on today. I think

in order for you to be able to see the screen and for people to be able to hear me I have to sit down.

So I apologize.


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So just to explain the title. Self-management, the strategies I'm happy about have to do with WRAP, the

wellness recovery action plan, which is a [inaudible] program that allows people to develop from their

own repertoire of behaviors strategies in order to cope with symptoms, uncomfortable, difficult life

events, etcetera. And it's proven to be really effective, and there's a lot of literature that deals

with activities of daily living and just regular coping kinds of things, but surprising absolutely

nothing on employment.

So I guess I'm the first person to actually take those strategies and say how are these working for you

on the job? Okay, go ahead, next slide. So first of all, I wanted to discuss recovery, and those of you

who have been in my class, if you've had this hit over your head over and over again, but recovery

basically is a process and an outcome with some common things that include development of self-

confidence, a self-concept beyond the illness, and symptom management, a sense of well-being, hope and



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So basically it doesn't mean that symptoms disappear. Recovery doesn't mean the complete absence of

symptoms, it means that people have all kinds of ways of coping with their symptoms and coping with

adversity as it comes up. So that's recovery. And so if you hear of someone talking about the recovery,

the wellness recovery action plan that's what they mean by recovery. They're talking about those kinds

of characteristics, that kind of learning that allows people to go forward and have the life they want

to live. Go ahead, next slide. So recovery includes things like a meaningful life in the community, an

ability to work toward one's potential.

And, of course, that would include employment. So potential for [inaudible] relationships, be they

friendships or intimate relationship, and certainly having a careering, having something that gives

meaning and structure to a person's days. So those are the components as I conceptualize them. You

know, the inner changes that take place with those strategies plus the outcomes that happen in a

person's life. And I'm going to show you and teach you what WRAP is, so that if you're feeling like, ah

I don't know what this is, you'll know. So what is wellness recovery action? What is WRAP? First of

all, it's a peer run program. And that differs from a lot of the programs that you see, which are

professionally constructed and run. This plan was developed by a consumer, a person with a mental

illness, who couldn't find the kind of help that she needed so she decided to develop it herself.

And so it's -- and she's used it all over the world and refined it along the way. So it's very much

kind of a grass roots thing, whereas some of the other ones are, you know, maybe more sophisticated,

but they're professionally administered. So you can imagine that has -- that has -- that makes a

difference to people, whether they're in a program with peers learning a new skill or whether they're

with professionals.


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It's our guide to daily living, and it's a guide for one's self by one's self. So the strategies

involved in developing a WRAP have to do with identifying your own needs, your own strengths, your own

skills, and bringing those into play. So no two WRAPs look alike. They're all completely unique and the

guided process basically helps you think about what are some of the things that I need to do in order

to stay well.

It's nobody else's, it's just yours. It's also an early warning system so that when people start

developing symptoms they're able to catch it early before things get out of control. And one of the

things you'll see as we go through learning what the WRAP is the different components of it, is that it

has a lot to do with preventing crisis, but also provides a plan for if there is a crisis.

There are contingencies in there to help you deal with any level of mental illness so. It's a set of

suggestions for your own wellness. So not just -- you're not just addressing emergencies but also day-

to-day, what do I need to do to stay well, to do the things I want to do day by day by day, again

generated by one's self. And it's also a written plan revised as needed. I have one. Sarah [assumed

spelling] just walked in, she has one, that we keep with us, you don't me saying that do you, Sarah?

>> No, I don't mind. [inaudible].

>> It's a plan that you can -- that would be great, a plan that you can revise as needed but you have

with you and you can make sure that other people know that you have a WRAP. So the WRAP is designed to

allow people to improve their ability to take responsibility in life. A lot of times people are treated

as clients and all the responsibility of being an adult is taken away from them.

They become clients rather than full adults with full responsibilities. So it's an opportunity to start

getting that back again. A way to manage and reduce mental health symptoms, using self-help techniques

which you will see, and then to learn to reach out and use support. So not just -- not just what can I

do for myself but what are the supports out there that can help me.

Is it my therapist? Is it my friend? Is it my spouse? Who are the people who are out there? Where's my

circle of support? So many times when people have been in the system for a period of time, they not

only lose their sense of responsibility and their sense of being able to help themselves, but they lose

that circle of support too. So it's a way to help build that back up. I have a website at the bottom,

and if you go there you actually can find more information about WRAP.

WRAP around the world. So here are the components that go into the WRAP. And I'm going to talk about

each of these six components, the wellness toolbox, daily maintenance plan, triggers, warning signs,

what to do when things are breaking down, and sort of the final step which would be crisis planning,

what to do when things have gotten really bad. Now the wellness toolbox is basically the huge array of

things that keep you well, and all of us have them. We all have things that we do every day. I have to

see an episode of The Big Bang Theory every day to stay well. I have to -- I have to be in touch with

my partner every day.


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I need to work every day in order to feel well. So these are things that are unique to me, but they're

true throughout my life. So this wellness toolbox is basically a box of ideas that you can draw on for

a lot of different purposes. So some examples from the book are talk to a friend, journal, get a med

checkup, exercise, relax, music. There's an exhaustive list of strategies that you can -- that can be

individualized to the person. Yeah?

[ Inaudible ]

Right, right. And just as a person in our audience was saying, it's a set of strategies, or coping

strategies, but using the word tools is a lot less clinical than saying strategies or coping, and also

it encourages people to really want to use them because who doesn't like a toolbox. I think girls like

them too [laughter]. So that's the toolbox. And next slide. I'm sorry I haven't been telling you. The

next thing is the daily maintenance plan. What am I like when I'm well is the first step?

And you might think, well this might not even be that necessary. But when you think about it, if you

have a handle on who I am when I'm well, what I'm like when I'm well, then you can communicate that to

clinicians down the road. People who are advocating for you can go back and say, look it, this is how

this person really is and this is why the symptoms seem so extreme in this situation.

But to be able to identify who you are and what you're like when you're well. Examples here, talkative,

industrious, serious, any number of things, and again, generated by one's self. So if you're sitting

there learning how to do a WRAP you are generating your own list, and maybe getting some ideas from

each other is one nice thing about working in a group, and getting idea from other people, but at the

same time it's your list.

And then the second thing is, what do I need to do each day to maintain my wellness? And again, so

you're pulling from that toolbox. It could be anything, exercise, talk to a friend, watch a goofy

comedy show, any number of things that someone might need to do each and every day. One of the things

that I noticed, and I won't jump ahead into the study yet but one of the things I did notice in talking

to people during the study was that people made those things nonnegotiable. People who were successful

on the job made those things nonnegotiable.


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Those things were going to happen every day, and it really kept people well. And there are certain

things that we do every day. I mean, just routinely, you get out of bed at a certain bed, you take a

shower, you make sure you return phone calls. There are certain things that everyone has that's a

nonnegotiable, every day, but maybe if you've been living with mental illness you may not have had

those routines, you may not have had those expectations. Yeah?

[ Inaudible ]


[ Inaudible ]

That is -- that is so true. And somebody in the group was just saying that recognizing that -- what --

how someone is when they're well helps them recognize when they're not doing as well. And a lot of

people think that those things, those symptoms, just come out of the air out of nowhere, wherein

reality there are things that lead up to them, and if you're able to catch it early then you can turn

it around. You can see how incredibly simple this is yet powerful.

Triggers, what are the kinds of things that set me off? What events or situations cause symptoms or

behaviors that cause me trouble? And some of the examples, work stress, a relationship ending, guilt,

the anniversary of a trauma, it could be a very long list of things that might cause somebody to have

sudden symptoms. And the question is, okay, not only what causes that, what are my triggers, but what

am I going to do when I'm triggered? So to start really recognizing what I'm going to do it might

include everything on the daily maintenance plan, all those non-negotiables I was talking about, taking

a break, calling a supporting, breathing, contacting a therapist, anything.

It could be almost anything out of your toolbox would be the kind of thing that you might want to do

when you experience a trigger. [inaudible] what a trigger is. [inaudible] comfortable with that idea.

So, you know, something that really kind of clicks in and causes some symptoms. And early warning

signs. What signs tell me I'm starting to have trouble? Did you have something you wanted to add,



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[ Inaudible ]

Right, and just to reiterate what was said, once you recognize your triggers and you have a plan for

dealing with those triggers, you're not avoiding them so much, so you're not tending to isolate or move

away from situations that might be scary otherwise. So again, it frees the person up to do more things

in their life. So yeah, what tells me when I'm starting to have trouble?

It could be anything. And the examples I used here were isolating one's self, being irritable, feeling

needy or worthless, not eating, eating too much, anxiety, weepiness. There are some things that let me

know that I'm having some difficulty now, and those again in the plan written down so you have them

there. And what if I do notice a warning sign? I'm sorry, I'm not telling you when to advance. Is it


[ Inaudible ]

You might contact a supporter, a therapist, get your meds checked, that's often a really early thing to

do. Just go to the psychiatrist and say I don't know why I'm having these symptoms but can you check

and maybe we can do some adjusting. Arrange for someone to stay with you, help you out. You might want

to turn over your keys depending how things are going. And these things are very touchy because you

don't want to just -- one of the reasons that you have a WRAP is that you're not going to just turn

your life over to some professional to run it for you, you're going to plan in advance to know who's

going to do that and what is going to happen.

You're going to have an agreement with that person in terms of what is going to happen if you take my

keys, and I determine when I get them back. But anyways, you might want to turn over keys or credit

cards to a trusted supported.

This would be true in a situation, let's say somebody has bipolar disorder and they're having a manic

episode. If they have somebody to trust that they can turn things over to, they can reduce the amount

of damage they do to their lives and other people's lives. Next one. How about when things are getting



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So you can see that gradually we're going from maybe don't feel like myself to I've been triggered and

I really don't feel good to things are getting worse and now things are getting much worse. How can I

tell when things are really, really bad but not yet in a crisis? You might notice some things about

yourself, increased substance abuse for instance, racing thoughts, risky behaviors.

These are some of the things that you might notice about yourself. And if you have them written down

and you start having those you can recognize them and say this is something that I need to address. And

what do you do in that situation? Is a whole array again, a whole toolbox of things to -- get someone

to stay with you, take a walk with a friend, call a therapist. My go to thing would probably be always

get a friend to take me shopping [laughter].


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>> They pay right?

[ Inaudible ]

>> And then the final thing is the crisis plan. What indicates that I'm no longer able to make my own

decisions or take care of myself? And it might be things like not being able to recognize people, some

severe agitation, some confusion, some really severe symptoms are preventing the person from fully

engaging. And so at that point, again, you don't want to hand your life over to some professional, you

want some control of what's going to happen in that situation.

And one of the really powerful things about a WRAP is it allows people to have an advance planner so

that if they're in a situation like that they're preferences are written down and clearly stated for

everyone in their environment. So you might want to adapt a decision maker, somebody you really trust,

maybe your spouse, a close friend who you really do trust.

Always think about what I'm like when I'm well. Articulate medication preferences. This is going to go

in your list. I'm at page, so you're going to appoint somebody and you're going to identify that

person. Write down again what I'm like when I'm well. Specifically talk about which medications that

you do want to try and which ones you absolutely never want to try again.

The same thing with clinicians, clinicians are psychiatrists who you would like to work with or you

never ever want to see again. Those things should be in your plan. And clinicians, you go to the

hospital, people are pretty respectful of the WRAP. All this needs to be in writing and should

accompany the person to the hospital when they go. Go ahead, Sarah.

>> The nice thing about the WRAP is that you have it in written form. You can get it notarized and then

it's a legal document. So it's a legal [inaudible].


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>> I have some -- I have some of the planning books. Here, I'll get closer to the microphone. I've got

some of the planning books for WRAP. One of them is for veterans and people in the military. The red

one is for everybody. And then the WRAP for addictions is here too. And I just brought some with me and

I'm going to hope that I go home with as many as I came with. But let me send them around for you to

look at them. There's also the DVD so.

>> And where can we get them?

>> The information is inside the front cover. Go ahead and send them around.

>> Marge?

>> Yeah.

>> Could you repeat [inaudible].

>> I can't remember it.

[ Inaudible ]

Oh, if you -- Sarah was just saying if you get your WRAP notarized it's an advance directive and so it

has a certain amount of clout when you -- in a hospital situation. So that's a powerful aspect to this

tool. Hopefully people won't just simply ignore it, they'll pay attention. So that is WRAP and I wanted

to give you that introduction before we jump into the study.

[ Inaudible ]

Triggers, yeah. WRAP and employment. As I mentioned, there wasn't really anything in the literature to

talk about WRAP and employment, but some things were mentioned. One of the things being that the

consequences of mental illness include unemployment. So we know that this is an issue, we know that the

incidents of unemployment among this population is very high.


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Also, work should be [inaudible] with a person's personal preferences and satisfying for them. And

these are things as rehab counsellors we know. And this did come from a study, and that is [inaudible]

unemployment though, overall the majority of people interviewed were aware of the pressures of work and

the need for management of their illness; however, those who are more successful at continuous

employment have specific strategies in managing their illness that they have found successful.

So that was one finding from a study. In terms of methodology, I mentioned a little bit earlier that I

was able to work through mental health systems, employment services and [inaudible] helped me locate a

number of -- it turned out to be working age adults who had a mental illness, who had also completed

WRAP and had worked for 90 days. So those were the parameters for the study. They were 60 minute

interviews. By and large some of them were 70 minutes, some of them ran over a little bit. And they are

taped and transcribed. [inaudible] research that you're probably used to reading.


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And then also analyze using saturate app. Saturate is -- you can find it online, it's a free app which

I tried for the first time with this study. It was a little scary because you're data just goes out

there someplace and you don't have any physical way of necessarily getting it back. If the app stops

working everything is gone. So you're able to do all your analysis and it's free and it's a nice,

simple program, but it was nerve-racking. Yeah?

[ Inaudible ]

Well SPS won't do it but some other programs do.

>> Oh okay.

>> And I've used Atlas TI and also one called HyperRESEARCH, so I've tried a number of different

programs. I just thought I'd give this a shot. I wanted to do it because I teach the doctoral program

in qualitative research methods and I was going to get them to use it so I figured I'd better give it a

shot. And actually I liked it, it was really easy to use. And here are the [inaudible] so you

understand basically how qualitative research works.


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You have all this data and you slice and dice it and you figure out what it all means and you put it

back together again into themes that come out. So you might have 200 pages of written documents and you

turn around and you figure out what the themes are. And what I've done here is I've used quotes from

the study to both substantiate and illustrate the points I'm trying to make.

>> And do you have to create like a code for the themes?

>> Yes.

>> You give it like a code right?

>> Yeah, yeah.

>> Yeah.

>> Yeah, you code them and -- Chuck [assumed spelling] and I have done some together, it's pretty fun.

So this is a -- this is the first thing, then and now is what I called it and it had to do with people

talking about before WRAP and after WRAP, that's what then and now means. And the first thing was that

realization was a turning point for them and this person said, it was like my eyes were just popped

open at the first meeting I went to when they said there's recovery because I was told that I have a

chronic depression for the rest of your life and just live with it.


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Here are your drugs, live with it. So this is the impression that people had from dealing with

clinicians and psychiatrists, and all of a sudden it's like this realization, there is recovery, there

is a life for me. The second part of that, the then and now theme, reclaiming one's life.

And this is an interesting quote because it was -- the man who was talking about this had been homeless

and had really got his life back together, had a great career, and he said, I have a car, I have a

house, I mean that's not a problem. Now it's a matter of a happiness and wanting to fulfill. So much of

my life was empty because of the mental illness that I wasn't able to be happy. Today I know what

happiness is to a degree.

I've got a taste of it and I like it. And these are kind of consistent. As I examine the data over the

10 participants these are the kinds of comments that came up over and over, and this why I identify

them as themes. So you can kind of trust -- you're going to have to trust me that this was consistently

happening. The second one is strategies for wellness, and the first component of that I call self-



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This person said, I think I have an advantage over other people. I think that WRAP and learning how to

empower yourself and that accountability for yourself puts us far beyond people that don't. So this

person was recognizing the fact that they had accrued a set of skills that maybe other people don't

have. Not even necessarily other people with mental illness, but other people in general.

If you think about what you gain by going through a rigorous eight week process of writing down lists

of what you're like and lists of things that you need to do and then using it, that's a powerful thing.

And I always think to myself that probably all my students could use a WRAP. I've attempted -- some

years in psych rehab classes I've attempted to get people to write their own WRAP, but it doesn't -- it

doesn't necessarily fly, but we all need it, we all need to have that kind of [inaudible]. And here's

one, strategies for wellness. This one is about supports and significant relationship.


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I really, really like this one because the woman I was talking to at the time had developed a circle of

friends from WRAP. So she had met this circle of people and she was saying yeah, I'm not going to allow

myself to get sick without letting my girlfriends know. We text every day, several times a day, every

day. You know, if one of us isn't doing that we're at their door, we're at their door.

So pretty powerful there that not only did WRAP provide the skills to do that but also the supports and

relationships to make sure that that happened. And the last thing, and this study just ended up with

three major themes, the last one was toward employment success. And you're probably wondering, when is

she going to talk about employment, and then finally I'm about to do it. But all these things that I've

talked about so far, the then and now and the strategies, all have to do with people's ability to

maintain and succeed at their jobs.


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And these are -- these are the things that people said specifically about their job situations, they

use the WRAP tools for job retention was one. In the work life, if I get -- if I start getting stressed

it's like okay, what's stressing me? Is it something I can change? Is it something I can control? And

that's another thing that's talked about in WRAP, is that we can't control the world but we can control

ourselves, and that's a big thing. So, I mean, the level of sophistication in terms of people's

thinking about themselves and the rest of the world, it's pretty strong, it's pretty powerful.

Here's another one, choice of employment, and this was a powerful theme. A number of the people in the

study had work that was related to mental health or related to human services, and people found that

having those jobs really -- having a job where you're lived experience is not just tolerated but really

honored and drawn on as a point of strength was a real help to people, and people seemed to be happy in

those job.


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So choice of employment. In my work as a nurse I've always seen a patient not just as a body but as a

being, and in the past I've been able to share my story in order to be able to hopefully empower

someone to, you know, accept some assistance or help with their issues. So the choice of employment was

a -- was a very powerful subtheme in the employment area.

So, basically one of the things that came out of this, this is -- this is a qualitative study so it's

very exploratory and we can't say anything for absolute true and we can't necessarily generalize our

findings to other things. But it really appears that WRAP -- that work is therapy for people, that the

activity of getting up out of bed, getting showered, getting to work, having something meaningful to do

every day, it's just providing that structure and meaning to a person's life that just is lacking

without work.


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And I've always maintained that work is really important, even the literature to [inaudible] that

employment is actually better at alleviating mental health symptoms than medication, and you've

probably heard me say that before. So that's in the literature and that's been proven to be so. But

work is therapy. Work is something that really helps somebody to get better and stay better. It's

something that I don't know if people really started exploring that yet. Yes, go ahead.

[ Inaudible ]

No, and one of the -- one of the things that I was going to talk about at the end of this list was

recommendations for clinicians and psychiatrists, one of the things that I didn't report on in this

study was that people never got the right kind of help from clinicians when it came to self-help.

They seem to not be aware of WRAP or, if they're aware of it, they kind of minimize its importance. So

people were finding out through other ways about WRAP. They would find out through mental health

systems. They would find out through some of the other programs in town, maybe the clubhouses, about

WRAP, but necessarily, uh-huh?

[ Inaudible ]


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The question was, does [inaudible] provide the information? I, no, not that I know of. And, you know,

it's something that I will happily share with them. I've done a lot of travel around the state doing

training and psych rehab because rehab counsellors really need to understand their clients who have

mental illnesses. And I -- and I'm hoping that they'll understand them through the lens of psych rehab

and through the lens of recovery.

So I've done quite a bit of that. And they -- when I'm done talking to them they know about WRAP and

they know about some of the other methods that can be used, but before-hand, no, I think throughout the

state I haven't encountered anybody who really understood WRAP or knew how to use it, knew how to refer

people to use it. It's not something we would use ourselves. Ma'am?

[ Inaudible ]


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[ Inaudible ]

To work in the --

[ Inaudible ]

I will be -- I will be happy to do that. The question was, wouldn't it make sense to work with our own

inner work institute that just got a giant grant to do training to institute a component on WRAP so

that rehab counsellors in our region get trained. And I was going to say, yeah, it really makes a lot

of sense, as long as I don't have to travel all over kingdom come [laughter]. Do some webinars and

things so yeah, it would make sense. Yeah.


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[ Inaudible ]


>> So the question was when was WRAP introduced as recovery strategy?

>> Twenty years ago. If you -- if you turn the -- people here are looking at these booklets, I think

1992. Was that -- is that correct? It's been about 20 years. And it's just gaining traction now. So the

potential is really great. And I think it kind of went along and there were just [inaudible] groups of

people who knew about it but I think it's getting to be more and more something that people are

recognizing as a very powerful tool.

And I believe strongly, and this is the second time I've said this that's how strongly I believe in it,

I believe strongly that one of the reasons that it's so effective is that's peer run. It's not done by

us professionals. That's not what it's for. One of the things I have for you before you go is a list of

all the places that are providing WRAP training around the county -- around [inaudible]. One sec, I'll

get it right now, hold on.


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[ Inaudible ]

>> So it's not something that was developed in a university, it's not something that initially was

well-researched, and it's only as peers have been putting it into place in their lives that they have

-- that practitioners have begun to recognize well this is something that changes lives, maybe we

should look into doing the research behind it. And so, you know, if you're interested in doing the

[inaudible] there's always a need to demonstrate how [inaudible] people's lives doing that research.

>> The suggestion was to encourage as much research as we can into how it is that WRAP works. Is there

another question?


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[ Inaudible ]

>> I did not hear and know about WRAP until I have already lived with my diagnosis for 12 years. And

once I learned about it, I learned about it through the [inaudible] peer class through the National

[inaudible]. They just kept mentioning to me you need WRAP plan, you need WRAP plan, and by the end of

the class I was like what is this WRAP plan. And so then they pointed me to [inaudible] oh okay. And

previously I had created kind of a WRAP plan that I had developed with a counsellor. It wasn't

something I developed with peers.

And so that counsellor had kind of [inaudible] tools, well this is what works and this is what works

and you should try this, but it wasn't something I really had help [inaudible] because that counsellor

had never [inaudible] and she probably never had suicidal thoughts, she had never been in [inaudible].

You know, there are just things that I looked at her life going, yeah, these things work for you but

I'm a completely different person.


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And so sitting down with someone who had my experience and was able to say, you know, this is something

that does work for me rather than having someone telling well if you're tired then you need to sleep,

you should just turn your brain off. It was a completely different context, these brainstorming

strategies. And then I felt [inaudible] because I would say well, you know, my counsellor told me these

are some strategies that help her, they haven't worked for me.

And then someone would write that down and come back the next week, you know, those didn't work for you

but they totally worked for me. And it was like oh, then I kind of felt a little empowered like well

maybe I can help someone because I was able to share with someone something and then they came back and

gave me feedback that yeah, something I shared with them actually worked so.

>> Can you check with the people online and see if they heard that?


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[ Inaudible ]

Oh, you are. Oh okay, okay. It's really handy. But it is true that most clinicians, most counsellors

either aren't aware of it or don't understand the importance of it, and now you have a list and I

encourage you to reproduce it and share it freely with people. The more we can get people to do on

their own as a self-help thing, the more empowering it is. I think that as professionals we have a

really important role in people's lives, but the roles should not be everything.

The role really should be circumscribed and our goals should be to get ourselves out of that person's

life as quickly as possible. So to draw on things that are in the community that we know are effective,

that's really the thing we want to do. As professionals we don't want to install ourselves permanently

in somebody's life. Is there a question?

>> Yeah.

[ Inaudible ]

Okay, these services are free anybody. All we have to do is show up and [inaudible] here's my name and


>> You probably should have a psychiatric diagnosis to go to these things.

>> They don't even ask.

>> But you should.

>> Well you should but I mean they don't ask.

>> No.

>> And so I mean we've all had problems in our lives where we have felt stress or we have felt anxious,

and so that's the beauty of these classes, is that you can take your own experience of having felt

overwhelmed or having felt stressed or having felt grief, and you can take that into a class and you

can -- you can share what you've learned and take from what other people have learned as well. So you

don't -- if you go to a class you don't need to have like this is my letter from my doctor, this is my

diagnosis and here. It's really --


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>> Yeah, that's true.

>> You know, it's more -- in my eyes it's more respectful. They just take you for your word. Oh you

understand what it's like to feel grief, or you understand what it's like to feel stress, come on in.

Not, prove it.

>> It's true, it really is powerful. Yes?

>> [inaudible] question. The question is, what do you hear from critics or non-supporters of WRAP?

>> Oh, I was a conference last summer and I saw a poster and it was basically rating all the self-

management programs, of which there are five or so that are in play. Right now there's a whole bunch of

them. And it rated WRAP really low on a number of dimensions in comparison to some other plans.

And yet at the same time what we're seeing is people are excited about using it and willing to use it,

whereas if it's a professionalized thing it might be a really cool plan, you're not going to get the

buy in. So I didn't really understand his parameters, because my experience with WRAP is that it's

really effective. And the literature shows that too, but this particular study did not.


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I guess one of the things that I've learned from here -- from the study is that people use their

toolboxes, they use their daily maintenance plans, and these were the people who were also successful

and were maintaining their employment. They had a set of skills, that they use a set of tools that they

use, and they use them routinely. They were able to articulate what they were doing, they knew each and

every strategy, and they knew what to do when, which is a lot different from, let's face it, most of



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You know, to actually have that level of insight into your own behaviors and your own emotions is

pretty powerful. I guess the next thing is that recovery and WRAP are really complimentary. You

probably remember at the beginning of the presentation I was talking about recovery and how recovery

had to do with not just the process of getting better but the outcome of becoming better.

So you've got this notion of recovery, not necessarily meaning lack of symptoms, and WRAP and how well

those fit together. And it should because it's wellness recovery action plan, so it makes sense that it

would, but it really is a very, very good fit. And so if you're talking recovery with somebody you're

working with then WRAP is kind of a next logical place to go. Yes?

[ Inaudible ]

Oh great.

[ Inaudible ]


[ Inaudible ]


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Yeah, yeah, and I agree with you. I think that if it's not a professionalized service that people kind

of look at it sort of, you know, not very favorably. For some reason we feel like we do it better. So

and another thing I wanted to say is that the next study that I'd like to do is interviewing therapists

about how they direct people in terms of self-help.

And I'm not sure if and when I'm going to get a chance to do that. But I agree with you, there's so

many that just simply don't know, they don't have -- they don't have a clue. And they're missing such a

huge component of what it means to be a helping professional. Yes?

>> You mentioned that there's not a lot of research on WRAP right now, right?

>> There's -- no, there's no research on WRAP and work, there's research on WRAP.

>> There is?

>> Yeah, yeah. There's a -- yeah, I think -- I think I'm the first person to actually do something that

looks into the world of work.

[ Inaudible ]

I bet you it won't, and I think it's because it's peer run.

[ Inaudible ]

>> Actually I'm surprised because just recently I [inaudible] educational groups that are taught by

family members of loved ones living with [inaudible] and that class has been in existence for more than

15 years and they said [inaudible]. So I think it is just finally getting professionals onboard who are

willing to do the research.


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[ Inaudible ]

>> It's a little slippery to study, because so much of it is self-report and you can't get away from

the fact that people are saying yeah, these are -- this is my daily maintenance plan. These are the

things that I do. But how do you judge how often a person does it, how well a person does it, how --

it's really -- and the variables are really, really a little slippery. And I think that's one of the

reasons that you get results that are all over the place. It just depends on who is doing the asking

and what they're asking. What else? Oh, oh, oh.


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I guess this is the main point. Since I care deeply about rehab and rehab counsellors and rehab

counselling clients, I think that this -- that WRAP, even if -- even if we don't make really good

inroads with the rest of the psychologists and the clinicians in town and in the world, but if we can

-- if we can introduce it into rehab, into what rehab counsellors are doing day by day by day I think

it could make a huge difference and work outcomes. Another area that would require some really good

study would be how people are using WRAP on the job. Yes?

[ Inaudible ]

Wow, I do not know. And it really is important. You know, I really hadn't thought that through. That's

really important. Maybe with some pressure.

>> Or even weekends.

>> Not even weekends. There is one?

[ Inaudible ]

Which one?

[ Inaudible ]

Oh, that's Saturdays?

>> Yeah.

[ Inaudible ]


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Yeah, maybe the, you know, maybe with some pressure though, because as more people are working it's

going to make it very difficult.

>> Well the problem is all of these clubhouses, because they teach at primarily clubhouses, they're all

open Monday through Friday.

>> Right.

>> So there's only, I think there's only two clubhouses in San Diego that are open -- even open on


>> Right.

>> So that makes it more difficult when you're a provider looking for a place to hold something.

>> Yeah.

>> And you want to hold it in a [inaudible] if your organization is always closed on the weekends

you're not going to be able to hold it there.


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>> Yeah, yeah. Yeah.

>> I have one question. Do you know if WRAP is primarily for people over age 18 or if you?

>> I can't see that there's any -- there's no age limit. There's -- I don't think it was designed with

one population or a different one in mind. In fact, [inaudible] has been really good about flexing it

and making sure it fits every group. And I wouldn't be surprised at all if she had a WRAP that was

designed for transition age youth.

For people who wrote down the information inside the cover of those booklets, I think when you go on

the website you'll see that there are -- there's more than what I've handed out to you. She's tried to

keep it very flexible. Yes?

[ Inaudible ]


[ Inaudible ]

Yeah there is.

>> It's really cool.

>> How do you get -- you just go on the app store and type in WRAP?

>> Just type in WRAP w r a p, but it's hard because it's -- the only thing about the WRAP app is that

it is [inaudible] and the other thing is that some of the [inaudible] they don't have enough space or

enough characters. I'd like to see kind of future editions of it.

I'd like to see it have alarms and stuff so that, you know, you can set alarms [inaudible], alarms to,

you know, whatever it is, you know, go for a walk or take a break in the middle of the day and, you

know, [inaudible] through our work day and we don't take our own personal breaks and just to have a

WRAP app say, ding, don't forget, go stand up, stretch, you know, get your back straightened

[inaudible] hunch over or whatever, just having those alarms I think will be able to cue people in

remembering to take care of themselves.


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>> Have you been in touch with Mary Ellen [assumed spelling]?

>> I haven't.

>> Well, we should do that.

>> We should.

>> The comment was --

[ Inaudible ]

Yes. The --

[ Inaudible ]

Sorry, I won't be able to tell you what was said.

[ Inaudible ]

It's Lisa [assumed spelling], I'm sure it was Lisa. Lisa, was that you?

[ Inaudible ]

Yeah, that was -- that was a project that was done for [inaudible]

>> Okay.


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>> Yeah, sometimes it's hard for people to know how to -- you know, people who are really focused on

psych rehab sometimes are at a loss in terms of what to do in the [inaudible] class, but people have

done some pretty cool projects. And I think the idea of the app would be a good one.

>> In terms of technology there's also two apps that are available in the app store, there's

[inaudible]. And both of those let the person set down wellness goals and then like -- I like the

[inaudible] one because you kind of create your seed and then as you do your tools, you know, you're

building your plans, it becomes a tree and, yeah, so you get the whole gaming aspect, especially for

the younger people who are just starting to put their wellness goals in place.

>> That's great. You got to head out? Yes?

[ Inaudible ]

Okay. Thanks [inaudible].


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>> And now Lisa also confirmed that her and Tanya [assumed spelling] did a presentation [inaudible] for

WRAP [inaudible].

>> Yeah, that's great. I guess just to finish out the items that I came up with in response to this

study was the satisfactoriness of a job really matters. Just to get people in any old job ain't going

to cut it. It really, really matters. And these, you know, nine out of 10 people were working and they

were doing things that they found really meaningful and engaging, and we're being very successful doing

those things. So, you know, sometimes the [inaudible] jobs is not the way to go. Yes?

>> Do you think they would be interested, well actually never mind. You might talk about that



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>> No, because it's my last slide.

[ Inaudible ]

Yeah, they -- yeah.

[ Inaudible ]

Yeah, and it's good to build [inaudible] that sometimes people might want to do a wide variety of

things. They might say that they will do any kind of job. In my experience those are the hardest people

to place because they fall out of jobs all the time, because they really don't want any job. They are

just getting a hard time sort of narrowing down what kinds of things they like so they're hard. Kendra

[assumed spelling]?

[ Inaudible ]

The comment was that this approach has a lot of applicability to people with physical illness, as far

as learning how to self-manage symptoms, pain, whatever, because none of that is taught, again, by your

typical doctor clinician. They're not going to be really understanding that 24 seven you're living with

yourself and you need to figure out a way to get a handle on these things that are going on. It's a

good point. Any other?


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[ Inaudible ]

Good, good. You know, one of the things that I can do for you, and I'd be glad to do it, is to send you

the PowerPoint, because that way you'll have the step by step by step. So if -- I don't know if anyone

has a piece of paper to send around.

[ Inaudible ]

Sign up sheet.

[ Inaudible ]


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Yeah, if anyone hasn't signed up and I'd be glad to -- I'd be glad to send you that, the PowerPoint,

does that sound good?

>> Yeah.

>> Anything else [inaudible]?

[ Inaudible ]

It's in review now. Once it gets published. I don't usually share things that are drafts. Yes?

[ Inaudible ]


>> Okay.

>> Yeah, Debbie should be here. I was kind of bugging her to come and present with me but she decided

-- she's very modest [laughter]. But yes, she did a lot.

[ Inaudible ]

What's that?

[ Inaudible ]

Oh, yeah, and that's not like [inaudible] Sarah was -- Sarah was my grad assistant before Debbie.

[ Inaudible ]

So if I have everybody's email addresses I'd be glad to send that. Huh?

>> I pulled this [inaudible].

>> Okay, okay, perfect. Then I'd be glad to send that. But don't expect it this week, it'll be next

week. Anything else?

[ Inaudible ]

Well, you know, I'm so torn [inaudible] because I think -- I think on one hand I'd love to do that

because I've got a lot interesting data on this study about clinicians and basically people saying, how

come I never heard about this? But the other thing I'd really like to do is a survey and looking

specifically at employment and WRAP. So I'm kind of torn between those two. I don't -- I'm not sure

which way I'll go. [inaudible]

[ Inaudible ]


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So data collection didn't take long. It took the summer. You know, one a week or one every two weeks

over a summer. What took a really long time with the study was that the county, anytime you're dealing

with a county funded program, the county has its own IRB, so you have to go through the IRB process

here at state and then you have to go through a much more rigorous, difficult process with the county.

The county process took like a semester and a half, so that was very time consuming. And it makes me

not want to do it again, but I might do it again.

[ Inaudible ]


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Oh, to analyze the data takes forever, it takes a really long time. So once the -- once the interviews

are done and they're transcribed, which isn't -- doesn't take long either, but then you really start

working with like 200 pages of print and categorizing it and coding it and then recoding it and moving

it around. That is a rigorous process.

>> And that -- so the whole summer or longer than the whole summer?

>> Oh, it was after the summer. That took -- that took two semesters.

>> Okay.

>> Yeah.


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>> Because what I'm wondering is, I'm interested in this kind of stuff, I'm wondering --

>> Everything was done -- I don't know [inaudible] remember, I think it -- everything was done in

April. I had -- I had said it would happen in December but it was April, and then we had a draft very

soon after. It wasn't hard to write it up so. Yeah, it's -- qualitative research is time consuming, but

I keep going back to it because I just love it. I love the results. I think it's so -- it's so


[ Inaudible ]

Yeah, yeah, it is -- it is easier to read. It's fun to read. Anything else you guys? I don't want to,

Chuck [assumed spelling]?

>> No questions right now.

>> No?

>> When you've got a little bit of time.

>> Okay.

[ Inaudible ]

Yeah, yeah. I'll talk on any topic [laughter].

>> Well I have a question on mental health in general, I have a very close person in my life who has a

[inaudible] and she already had [inaudible] about 10 years ago, now she just refuses to take her

medicine. She doesn't want to take the meds so she says as long as she stays away from her triggers,

which could be alcohol or drugs then she says she thinks she doesn't need her meds. And I am kind of

worried about her.


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>> Well, you know, two things in response to that, and Sarah might have something too, I think that

taking meds is a learned skilled and it takes a while for people to figure out whether it works for

them or not. The second thing is that people should be self-determining and I would never try to force

somebody onto meds. You know, that's a very personal choice about what she wants to do with her body. I

do think meds are very helpful. And you'll be seeing over and over again that they're extremely

helpful, but maybe not for everybody.

>> I know for me, I mean, finding the right medication, it took me 12 years to find the right

medications. That's -- during that 12 years I [inaudible] different combinations of medications. And

that's [inaudible] include all the side effects of those medications and the things that happened in my

life because I was on medication, so medications are just one of the wellness tools [inaudible].

>> And the reason why she doesn't want to take it is because she's had so many different cocktails of

all these different, and she doesn't like the side effects.


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>> You know, it took me 12 years to find the right meds. I was on the right meds for about five years

and then those meds stopped working because that's another thing with [inaudible] stopped working. And

so I didn't want to go through the process of finding the right med again either. But my friends told

me about [inaudible] combination of vitamins and minerals.

And so I've been using [inaudible] -- initially I started using them with my medication, but as my

brain began to absorb the nutrition my brain was better able to regulate the brain process. And so now

I'm actually off the medication, and I've been off medication since July and I'm living a life that I

didn't think was possible. But it's, you know, it's something that's very unique for everyone. It's not

-- it's not, well this is the only answer, there are so many answers out there, so many ways that

people can live well.


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It's just the difficulty arises when you can see that their life is completely out of kilter and

[inaudible] good decisions. But if the person is, you know, I have a friend who [inaudible] and she has

been hospitalized in the early '90s and [inaudible] in the late '90s and I became bipolar and she's

actually the person who got me help when I very first had my first psychotic break. For 15 years she

lived a life without medication. She did it very well. She's a mother, she has four children, she lived

a very successful life in my eyes, and it's only been the past three months that she has been like

[inaudible] and lost her job.

There are a lot of stressors involved and suddenly she's like I need to go back on meds. And I said,

maybe try micronutrients because meds take six to eight weeks to even start working if it's the right

combination. And so she actually started that and she's chosen to go with that instead. So every person

is going to be completely different because everyone's body chemistry is completely different.

>> Thanks, thank you.

>> Yeah.

>> And meds can be -- meds can be a powerful, powerful tool but they aren't the only solution. And I

think one of the frustrating things about the mental health systems, serving people with severe mental

illness right now, is that that's the go to solution, and no one is looking at anything else, just

meds, meds, meds, meds, meds, it's all very medically driven. And not to say that they're not useful.

>> They're very useful.


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>> Yeah. They're very useful. Leanne [assumed spelling]?

>> My question is not related to meds, so you have a list of the classes, WRAP classes, do you know if

they offer the classes [inaudible]?

>> They do.

>> There's some Spanish.

>> It's English and Spanish.

>> Yeah.

>> English Spanish?

>> Yeah, it [inaudible].

>> They also teach it at the [inaudible].

>> Yeah.

[ Inaudible ]

I don't think so.


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>> I think they might teach them at the East [inaudible] Clubhouse in [inaudible] the East [inaudible]

Clubhouse [inaudible] and so I don't know which languages they teach them, but I'm not sure. I know

that they're trying to get at least the [inaudible] languages in San Diego country, or ideally

[inaudible] more people that we can reach out to in their own language the more people can embrace


>> The question was around whether any of the WRAP classes were offered in other languages, and we

noticed that there are some in Spanish, possibly one in ASL, and maybe some other Asian languages too?

>> Yes.

>> But we're not -- yeah, they're not listed on here.

[ Inaudible ]

>> These are the classes that are offered free through Recovery Innovations, but there are other

private, like for example, if you want to become -- if you want to take a WRAP class [inaudible]

actually -- you have to pay to attend them.

>> A couple.

>> Yeah, a couple [inaudible] but you have to pay to take them. So they basically cost [inaudible] for

people who are in lower incomes who don't have money to take a class like this. But then it is really

unique in that we do have classes available in English and so hopefully we can get them in the other

languages as well.

>> Yes?


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>> It's from Lisa [assumed spelling]. She says I agree with Sarah. I just want to remind people that

many of these meds do cause some very serious and sometimes permanent problems, such as weight gain,

about 200 pounds, and then she mentions [inaudible] syndrome, diabetes, or involuntary muscle movement.

It can be [inaudible]. People often have very good reasons for not taking meds.

>> Yeah, oh absolutely, you know. And maybe it's not for everybody. It's a trade-off. It's a tremendous

trade-off to have to accept a 100 pound weight gain in order to have your brain leveled out.

>> I used to [inaudible] at around 104 pounds.

>> Yeah.

>> I could not keep the weight on me until they put me on meds. Then they put me one that's an anti-

psychotic and I first admit I was [inaudible] stabilizer I gained 60 pounds in three months, three


>> That's like my friend.

>> Yeah.

>> In three months. And then later I was put on a different medication and I gained 100 pounds on top

of that, so [inaudible] at 250, 260 pounds. And people are like, well you should be taking your meds.

I'm like look what they're doing to me.

>> Uh-huh, uh-huh. [inaudible].

[ Inaudible ]



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>> You know, the weight gain does happen. I remember --

[ Inaudible ]

>> People with serious mental illness, their mortality rate is just incredible. And they live -- people

with serious mental illness live an average of 25 years or less than the rest of the population. And

it's all those things that contribute. You know, certainly the medications, the living on the street.

There's just so many -- so many things that contribute to that. But it's shameful, shameful. Joe

[assumed spelling]?


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>> It's kind of like a young lady that came to our class the other day, she said she gained all the

weight because of the medication and she's -- was saying is it better for me to be a little bit chubby

like she said, or be suffering this disease or whatever, this mental illness, so she chose the prior.

But in my case, I stopped taking my medications because, like you said, it's a choice. I find that

there's way to me -- for me to control and deal, even though I don't have a WRAP I was going to several

groups in the [inaudible] and they had something similar to a wrap where they gave us a book.

It was [inaudible] and they gave us some charts in the book where you have to chart, and that's

probably something that you can include into your [inaudible] is charting how you feel each day at the

beginning, middle, and the end of the day, did you take your medications yes or no, did you take

alcohol, and all that. We had to write it down and the next day we would come and say okay this whole

week this is my schedule of events of what happened last week and that's how they determined how we

were doing. And also, they also told us about like, what's your name?

>> My name is Sarah.


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>> Like Sarah said, where I would say well this didn't work for me and somebody else would say well

that didn't work for you but it worked for me. So we interchanged ideas.

>> So was it helpful?

>> It was until the program was over.

>> And then you didn't keep doing it.

>> And then it's kind of like something like Sarah saying, if it was -- if you had it [inaudible] as a

reminder to help you, you know, do this at a certain time of the day that would be great. And I notice

that it did help me for a certain period of time but after that, since I stopped doing it, I had the

rollercoaster. I mean I felt like I was in Magic Mountain all day long throughout the weeks.

>> Yeah, I can see that. Anything else? I don't want to -- we have -- we have 10 more minutes if you

want it. If you don't want it that's fine.

>> Thank you, Marge.

>> You're welcome. My pleasure.

[ Applause ]


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