Wellness Plan – Early Warning Signs

The next step in the WRAP Plan is to list the signs that indicate I need to take action before things get worse. They are changes in the way I think, act or feel, so they are observable, either to myself or others.

This section of the Wellness Recovery Action Plan requires that I face my fears about the initial red flags which indicate an episode is possible. It’s more than just Stressors; it’s actual changes in my thinking and behaving. This is a key part to the WRAP – to recognize these signs as serious and do something about them before they get worse!

These are behaviors or attitudes that point to a potential problem – perhaps a descent into a mental illness episode. For me, indicators include things like listening to my music really loud – perhaps to drown out my spiraling negative thoughts. I apologize a lot, and have excessive guilty feelings. I have a strong desire to speak to my old-time long-term therapist, Ted. I find it hard to concentrate, even for a short TV sitcom. I begin to think “What’s the point?” which is an elusive question, as I don’t define “it;” I guess I just feel fatalistic. I desire to be alone with my self-blaming thoughts. I have trouble making decisions, feel easily overwhelmed, and have a lack of energy.

The Wellness Recovery Action Plan book (copyright 2018) suggests that I review this list of early warning signs regularly, perhaps even daily, so that I become familiar with them and can respond before things get worse. A list like this can be an inventory of emotions and behaviors to note. If I am experiencing several of them, I need to ask myself what’s going on, and why I’m feeling out of sorts. And I need to put the next part of my Action Plan into place.

The wellness tools I will use if I see these early warning signs are:

  • Tell my husband, sister, and friend
  • See my therapist
  • See my psych doc
  • Listen to my music playlists that are encouraging and uplifting
  • Have a coffee date with a friend
  • Rock in my glider
  • Try to interrupt the spiraling thoughts with the truth of God’s Word
  • Email, maybe even FaceTime, my old therapist.

Other actions might be to take a walk, or do some stretching exercises.

In the future, I might make this into two lists – one of actions I must take, and one of actions I might take, when I observe these early warning signs. And I can always go back to my Wellness Tool Box and pull activities from there to help me avert a depressive episode.

Wellness Plan – Stressors

If you’ve been reading this blog lately, you know I’ve been working on my Wellness Recovery Action Plan – WRAP. I invested in the guide from Mental Health Recovery – it gives more explanation, details and examples than the WRAP app did. I’m really glad I bought the book – I’ve found it very helpful, and have added to my Wellness Toolbox and the next step in the process, The Daily Plan.

The Daily Plan is an outline of what I look like – my moods and attitudes – and what I “do every day to stay well and stay on track with my goals.” (Reference: WRAP app) It includes an outline of a typical day of wellness. It was fairly easy to write.

The Stressors section was much more difficult. Stressors, sometimes known as triggers, are “things that happen that can cause a reaction. Sometimes they are reminders of specific events, or they may evoke a feeling that takes you back to a time when you felt helpless, scared, or out of control.” (Reference: Wellness Recovery Action Plan – Renewing Your Wellness Your Way, copyright 2018)

The first step was to write down “things that might make me feel unwell or throw me off track if they happened” (Reference: WRAP app) and just the question sparked anxiety in me. I started with a list of five stressors – certain times of year, when my husband travels, when my meds stop working, grief, and major life transitions. But as I worked on this section with help from the book, I came up with seven more. That’s a total of twelve potential stressors! Argh!

Thinking of these stressors was difficult – indeed, it caused a stress reaction in my body. Heart racing, shallow breathing, a lump in my throat. I put the list away several times to take mental breaks from it – had to calm down before I came back to it.

Working on the relief to those stressors brought relief to my physical reactions. Again, originally I had twelve stress relievers, but with the help of the book and deeper consideration, I came up with a total of 22 tools to use when stressors hit my life. Things like walking around the block, savoring a cup of tea or coffee, reading fiction, sitting in my glider, practicing deep breathing techniques, writing in my gratitude journal. These are good wellness tools to add to my mental health toolbox.

I know the process of writing the WRAP will continue to be difficult. The next two sections are When Things Are Breaking Down or Getting Much Worse, and Crisis Plan, which first caused me anxiety when I read about it. And while the point of the plan is steps toward mental health, it’s anxiety-producing in the process of writing it. But I’ll take my time and persevere, because I’m sure the end result – my personalized detailed wellness tool – will be worth it.

Post script – in an effort to be transparent and maybe helpful to someone else writing a WRAP plan – here is a complete list of my stress relievers:

  • See therapist
  • See psych doc
  • Tell husband, sister, and friend that I’m struggling
  • Nap
  • Walk around the block
  • Dance
  • Savor a cup of tea or coffee or mocha
  • Journal
  • Pray
  • Watch Netflix
  • Read fiction
  • Coloring books
  • Knit
  • Listen to playlists (I have several made for my “moods”)
  • Gratitude journal
  • Tell folks at Fresh Hope support group and ask for prayer
  • Coffee date w/friend
  • FaceTime w/my kids
  • Take a break from obligations (work, volunteering)
  • Practice deep breathing, relaxation techniques
  • Rock in my glider
  • Have a date with my husband
  • Take a trip to see the kids

Wellness Plan Toolbox

The first step in writing my wellness plan is determining the helpful steps I already have in my daily life. When I am healthy, what is it I’m doing to make me that way? What are my day-to-day activities that signify health and wellness for me? “What things do I already do to help myself be well, stay well, and live in the way I want to live?” (reference: WRAP Plan app)

This toolbox of activities is critical to my Wellness Plan, as I’ll draw from this list at different stages along my path from wellness to illness and back again. When I feel stressors, or triggers, that might signify a depressive episode is coming, what can I do to alleviate it? Are there any tools in my toolbox that I can pull out and implement to avert an episode?

If I’m further down the path toward depression, and an episode is imminent, which activities can I use to lessen the severity of the episode?

If I’m on my way out of a depression, which tools will I use first to help me post-crisis?

My initial list was 14 wellness tools:

  • time alone with God in Bible reading and prayer (TAWG)
  • taking my meds
  • journaling
  • eating well
  • good sleep hygiene
  • spending time with friends
  • sufficient down-time
  • seeing my therapist regularly
  • keeping my psych doc appointments
  • blogging or writing
  • taking naps
  • reading
  • watching movies
  • Fresh Hope Support Group

But as I thought about steps I can implement in a pre-crisis, I realized I have several more tools, even though I’m not currently using them. Things like savoring a cup of tea, or coloring, or taking a walk in nature. I certainly need to tell my support team that I’m struggling, so they can help me watch for warning signs.

One thing I’ve learned about depression is that it clouds my thinking. I can have this wellness toolbox, but in the midst of a crisis, I’m paralyzed and don’t know how to get out of it. That’s the reason for writing a wellness plan when I’m mentally healthy: so when I’m not thinking straight, I can look back and see what I recommend to myself.

I intend to share my wellness plan with my support folks (husband, sister, therapist, friend) so that they can help me remember to reach into my toolbox when I need to. As soon as I’m done writing the whole thing, I’ll pass it on to my care team.

Wellness Plan

I started working on a wellness plan for my mental health. It was inspired by a video from Fresh Hope, and I did a little research on WRAP. While it’s not an official WRAP plan, since I’m not in the class (it’s copyrighted), I have the components.

A wellness plan addresses my mental state when I am healthy, what my triggers are, and how I intend to respond if my mood darkens. It’s designed to outline in detail the steps I will take to remain or return to health. It’s to be shared with support people, so there’s accountability to taking those steps when they’re needed.

I was doing fine filling in the blanks until I got to the question about my crisis plan: how I want to be supported if I experience crisis.

I got to this section and felt my heart rate speed up and my breathing become more shallow. I remembered my times of crisis, and a wave of anxiety hit. I suppose that’s natural; reflecting on negative experiences brings back negative feelings. Still, I was caught off guard.

I don’t want to experience crisis again. But considering past ones makes me think I’ll go through it again. This is silly, since the whole point of a wellness plan is to put steps in place to keep a crisis from happening. Yet the possibility always exists that my wellness steps won’t be enough to avert the crisis, and I could find myself in the depths of depression again.

In recent years, any dip in my mood for longer than two weeks – any journey back into depression – has been mild, quickly treatable, and short-lived. But what if I go through a big one? What if grief brings back depression? What if I can’t handle a life transition? What will I do to keep depression at bay?

That’s the point of the wellness plan – to address those “what-ifs.” To have steps in place in the case of triggering events. Which tells me that, as difficult as it may be, I need to write these steps down and share them with my trusted others, so I’m not left without direction, without actionable steps toward mental health.

I’ll finish writing it all down – my health, my triggers, my warning signs, my crisis and post-crisis plans. I’ll share it with my husband, sister, and best friend. I might even blog it, as an example so someone else can write one.

And I’ll pray that I never have to use the crisis portion of the plan.

The cost of mental health meds

I don’t want to get political here, but I think this blog might be. How does anyone without insurance do this?

I’m temporarily without prescription insurance, and my psych doc phoned in some orders for meds that I don’t need to refill immediately. But I didn’t tell that to CVS, and the pharmacy filled them and sent me a text that the meds are ready for pickup. I looked up the prices on their app. Two that I take are name-brand, not yet available as generics. A 30-day supply of one of them is over $2900, and the other is over $800. That doesn’t include the ~$150 for each generic drug!

I’ll be able to afford my meds once my new insurance kicks in, so I’m not concerned for me. But I truly wonder about this for others – for those with less or on fixed incomes.

I have a couple of friends who don’t have the insurance to help offset the costs of their antidepressants. I’ve seen their tears of frustration as they struggle for mental health and feel defeated, which just adds to depression misery.

What about folks on a fixed income with reduced medical benefits? How are they supposed to pay for their mental health medications if insurance companies remove effective medications from their approved lists?

What about newer medications that are improvements over what’s currently available, but they aren’t the reduced price of a generic drug? Many people are denied access to those improved meds, simply because the cost is out of reach.

What’s the pharmaceutical companies’ responsibility in this? Their research takes years and costs gazillions of dollars to find formulas and get meds approved, but do they recoup those costs on the back of the ill? How should this really work, and be fair? How can we get mental health medicines to the people who need it, in an affordable and timely manner? I don’t have answers, am not pointing fingers to blame. I’m truly asking – how can this be affordable? Is it the PollyAnna in me that wants this to be equal and easy?