When I mention the Advance Directive, many people say to me, I don't need an Advance Directive now that I am using WRAP. In fact, you may be one of the many people who say that since they started using WRAP, they haven't had a crisis. And that is great. Or they will say, I haven't had a crisis in years so I don't need an Advance Directive. I disagree. Given the uncertain circumstances of the world, and of our lives, we never know when we might get overwhelmed and old difficult feelings, thoughts and behaviors return. We may become deeply depressed, very anxious and agitated, begin hallucinating or hearing voices, or begin to abuse substances that we have avoided for a long time.

Without an Advance Directive, others can take over control of your life. Perhaps people you don't want to be involved will be making decisions for you. You may be given treatment that have not helped, or even been harmful in the past. You may be restrained or coerced in ways that are traumatizing.

Having an Advance Directive keeps you in control even when it feels like thing are out of control. The people you have chosen will take over, and do the things you want them to do, things that will help you to recover quickly. If you don't have an Advance Directive, people might take over when you can really use your WRAP to take care of yourself, they might do things that are not helpful and they might assist you in ways that are not helpful to you. They might make the situation worse.

You may have developed the first four parts of WRAP. Those are the parts that you use for yourself. You write it so you can understand it. The Advance Directive or Crisis Plan is different. You have to write it so others can understand it, so that they can do for you whatever it is that would be most helpful to you. When you have completed your Advance Directive, you give a copy to each of the people you want to help you. Review it with them in case they have any questions or there is something they don't understand.

You could even have all your supporters get together and discuss your plan with you to assure that everyone will do what you want them to do.

Some sections of the plan are quite straight forward and you can easily do these on your own or in your WRAP group: what you are like when you are well, who you want to assist you when you are in crisis, the medications you are using, treatments that help and those that don't. The sections I am going to address here are more difficult for most people. They were hard for me.

Signs that others need to give me assistance and make decisions for me. It is really important to take your time developing this section. You don't want people stepping in and taking over when you can take care of yourself. Think back to times when you were having the most difficulty and really couldn't think clearly or take care of your self. This is the worst of it. It is not pleasant. If you think about it for a while and start feeling badly, leave it for a while and come back to it later. Even better, work on it with a friend or in a WRAP book. After you finish, or when you take a break, do some thing special, something that makes you feel good about your self, like listening to a favorite CD, calling a good friend, playing with your pet or doing some art work.

When you write these things you want to be very specific so someone else can understand it. They are different for everyone. Some ideas would include:

-Washing my face so much that it is red and bleeding and I still won't stop

-Counting things- like ceiling tiles-over and over without stopping for four hours

-Shoplifting

-Purposefully breaking up furniture

-Being violent with others

-Non-stop crying for two days

-Thinking I am someone famous

-Spending over $100 on things I clearly don't need- like junk from the dollar store

-Thinking the television is talking to me

-Wearing lots of garish make-up

-Hitting my pets or children

-Not knowing who my family members and friends are

-Not moving for three hours

-Refusing to eat for more than two days

-Consuming alcohol

-Having other signs that I am not OK and telling others I am fine

Home/Community/Respite Plan

Even though you may be having a very difficult time, hospitalization may not be the best option. For me, if I stay at home with my things, sleep in my own bed, have my own food while I am supported by close friends and family members who know what to do that is helpful, I get past the difficult time more quickly. Hospitalization in a place where you have never been before, where you are away from your friends and family as well as many of your wellness tools, may not help and may make you feel worse. In addition, because of insurance issues, hospital stays are often very short, too quick to be really helpful, and are sometimes not even an option.

Many people have benefited from developing a plan so that they can stay at home supported by friends and family members, possibly attend a treatment program during the day, or a peer run crisis respite center. This is a much better option for them.

For instance, a number of years ago, I wrote such a plan for myself. And a time did come when I was deeply depressed. I didn't tell anybody. And I was living alone at the time. However, my counselor and my daughter noticed the signs that I had written in my plan.

As they had been instructed, one of them called all the women in my women's group and several family members I had named in the plan.

They arranged so that someone would be with me around the clock. Mostly they had two-hour shifts, but one person spent the night each night. They knew what food would be most appealing to me so they cooked it for me. They knew what kind of activities to encourage (like walks) and what not to encourage (playing board games or watching the news on television). They knew who my care providers were, were in touch with them, made arrangements to take me to see them, and actually took me there. When I was rude and told them to leave, they didn't pay any attention.

My plan also told them that if I became abusive to them or they felt they could not keep me safe, who they should contact and what should be done. It worked. In a few days I was feeling much better and could begin the process of recovering from this crisis.

My more recent plan contains several crisis respite centers as options. I haven't had to use it recently, but if I had to, I have already made those arrangements. There are also several programs in the community that I could attend during the day that might be helpful and that would give my supporters a break.

When you are thinking about this plan for yourself, thinking about answers to the following questions might be helpful. You could discuss them in your WRAP group:

-Is hospitalization always an option when you are having a hard time?

-Is hospitalization the best option when you are having a hard time?

-What are the pros and cons of hospitalization? (Advantages of staying home rather than going to the hospital when you are having a difficult time).

-Why is it important to have a plan so that you could stay at home or in the community?

-Why might you feel better more quickly if you stayed at home or in the community?

-What would you need in order to stay home when you are having a difficult time?

-What could you do for yourself if you stayed home when you were having a difficult time? What are the Wellness Tools you could use?

-What could others do for you if you stayed home when you were having a difficult time?

-Do you have friends or family members who could take turns providing you with care and support? Who are they?

-Are there any programs in your community that you could attend during the day and be at home in the evening? What are they?

-Are there any respite programs in your community? What are they?

-What health care providers would be available to support you and how could they help?

This is a very hard time in the world. Every time we read the newspaper or watch television, we see pictures of terrible things that are happening. This can be very upsetting. Some people are noticing that they are feeling more depressed and anxious.

Difficulty feelings are coming up more often. Several things you might do that would help:

-Decide if there is some action you could take based on your beliefs and concerns. It might be an e- mail, letter or phone call to a public official, sending a letter to the editor of your newspaper, attending a public meeting, taking part in a vigil or demonstration or sharing your concerns with others.

-Avoid reading the newspaper or parts of the newspaper that are disturbing, be selective about what you watch on television and listen to on the radio.

-Do lots of good things for yourself that affirm the wonderful person you are-take a walk, visit a friend, make yourself something special to eat, play with a child or grandchild-whatever it is that makes you feel good.

-Do something nice for someone else. Bake a loaf of bread for a neighbor. Help them with household chores. Visit someone who is sick.