WRAP (Wellness Recovery Action Plan) for schizophrenia

WRAP — the Wellness Recovery Action Plan — was developed in the late 1990s by Mary Ellen Copeland, a peer educator who had spent years living with severe mood symptoms herself. She was tired of being told what to do by clinicians and started compiling, with a group of fellow peers, the practical strategies that had actually worked for them. The result was a structured framework that has now been used by hundreds of thousands of people across mental health, substance use, and physical illness contexts. It is endorsed by SAMHSA as an evidence-based practice.

The six sections of a WRAP

1. Wellness Toolbox

A list of the things — activities, people, practices, foods, places — that help you feel well. Not aspirational items; the things that have actually worked. Common entries include sleep routines, walks outside, particular friends, music, prayer or meditation, gardening, journaling, exercise, pets. The toolbox is the raw material drawn on by every other section.

2. Daily Maintenance Plan

Two parts: what you are like when you are well (so you have something to compare against), and the things you need to do every day to stay well. Specific. Achievable. Not "be active" but "walk for 20 minutes after lunch." Not "manage stress" but "ten minutes of reading before bed instead of phone scrolling."

3. Triggers and the Action Plan for Triggers

Triggers are external events that, in your experience, can set things off — stressful work periods, family conflict, anniversary dates of difficult events, particular kinds of news. Once identified, the WRAP lays out what to do when a trigger occurs: which items from the wellness toolbox to use, who to call, what to skip.

4. Early Warning Signs and Action Plan

Early warning signs are internal changes that signal you are starting to slip — sleep changes, irritability, withdrawal, unusual thoughts. Each person's signs are individual. The WRAP names them and then specifies a response plan: which tools to use more of, who to tell, what to scale back.

5. When Things Are Breaking Down

The "yellow zone" of a relapse plan — when symptoms are clearly present but you are still able to take action. The WRAP specifies the steps: contact the prescriber, call particular friends, increase a specific medication if your prescriber has authorised it, cancel non-essential commitments, increase rest, avoid certain situations.

6. Crisis Plan

What happens if you become unable to take care of yourself. This section is written in the third person and addressed to your supporters. It includes:

• Signs that indicate others should take over decision-making
• Who should make decisions for you and what their roles are
• Medication preferences (current meds, what has worked, what to avoid)
• Treatment preferences (preferred hospital, preferred providers)
• Things others can do that help; things others do that don't help
• How to know when you no longer need this level of support

Some WRAPs include a seventh section — a Post-Crisis Plan — for the rebuilding period after acute crisis: how to re-engage with work and relationships, how to re-establish daily structure, how to process what happened.

Why WRAP works

WRAP is not a clinical intervention in the traditional sense. It is a framework that helps people organise their own knowledge into a usable plan. The mechanism is partly the planning itself — the act of writing down what works and what to do — and partly the act of reclaiming agency from a system that often takes it away. Many people describe completing their first WRAP as the moment they began to feel like a participant in their own recovery rather than a recipient of treatment.

The evidence

WRAP has been studied in randomised trials. The largest, by Cook et al. (Schizophrenia Bulletin, 2012), randomised 519 people with serious mental illness to WRAP or to a waitlist control. The WRAP group showed significant improvements in symptoms, recovery, hopefulness, and self-advocacy compared to controls. Multiple smaller studies have shown similar benefits, particularly in self-perceived recovery and engagement.

SAMHSA includes WRAP on its recovery resources and lists it as an evidence-based program.

How to make a WRAP

WRAP is typically learned in a group facilitated by certified WRAP facilitators (many of whom are peers). The full curriculum is usually 8 sessions of 2 hours, though shorter versions exist. The structured group context is part of what makes WRAP work — it draws out ideas, normalises difficulties, and connects people to others doing the same work.

You can also work through WRAP individually using Mary Ellen Copeland's books — WRAP: Wellness Recovery Action Plan is the standard text — or with a clinician, peer specialist, or family member who knows the framework. The official WRAP website at wellnessrecoveryactionplan.com provides resources and a facilitator directory.

How WRAP fits with other tools

WRAP is sometimes compared to a relapse prevention plan. There is overlap — both name early warning signs and pre-decide responses — but WRAP is broader. It starts with daily wellness, not only with what to do when things get bad. It is also more peer-developed and less clinically driven. Many people use both: a clinical relapse prevention plan with their psychiatrist and a WRAP they have built with peers.

WRAP also pairs well with Illness Management and Recovery (IMR), which is a more curriculum-based program focused on similar self-management skills.

Common pitfalls

Making it too long. A WRAP that runs to 30 pages is a WRAP that doesn't get used. Aim for something a person can actually pick up and refer to in a difficult week.

Writing aspirations rather than reality. The wellness toolbox should contain things you have actually used to feel better, not things you think you should be doing.

Not updating it. A WRAP is a living document. Review it after every significant change — a new medication, a relapse, a major life event, every six months at minimum.

Keeping it private. The crisis plan section in particular is meant to be shared with supporters. A crisis plan in a drawer that nobody knows about is not a crisis plan.

For families and clinicians

If your loved one or your patient mentions WRAP, take it seriously. Encourage participation. Read what they have written if they choose to share it. Respect the preferences laid out in the crisis plan. WRAPs are most useful when supporters know they exist and follow them when needed.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.