When considering mental health and well-being, Liz Felton, CEO of Together for Mental Wellbeing, thinks that health, physical activity and social interaction are vital.
Well-being is defined by the Oxford English Dictionary as “the state of being comfortable, healthy, or happy.” However, it is important to realise that well-being is a much broader concept than moment-to-moment happiness. While it does includes happiness, it also includes other things, such as how satisfied people are with their life a whole, their sense of purpose, and how in control they feel. In this respect, the New Economics Foundation describes well-being as the following:
‘Well-being can be understood as how people feel and how they function, both on a personal and a social level, and how they evaluate their lives as a whole.”
Most people would agree that well-being is something they strive towards and the subjective measure of people’s well-being is deemed so important that it is included alongside health and the economy in measures of national well-being.
But once we look beyond the definition it is difficult to drill down into what well-being really means to people day to day, the factors that may influence it (both internal and external), how we can best measure it and how we can support people to improve it. Yet that doesn’t mean we should shy away from it either.
When supporting people with mental health issues, by focusing on well-being we avoid relying on more traditional measures of mental health such as symptoms of illness. Many people who use mental health services consider these to be outdated and not in line with how they view their own well-being. In addition, they don’t take into account all of the factors that may affect someone’s health or happiness of which symptoms of illness could be just one. We must also consider how external conditions (such as income, housing and social networks) and a person’s internal resources (such as optimism, resilience and self-esteem) can affect their well-being. In this respect, how we go about measuring well-being is as challenging as it is worthwhile.
Measuring well-being can be done in a number of ways – there is no ‘one size fits all’ approach. However, one useful way of measuring well-being is the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). This is a scale of 14 positively worded items, designed to measure both the feelings and functioning aspects of positive mental well-being. For example, the scale includes items such as ‘I’ve been feeling optimistic about the future’, ‘I’ve been thinking clearly’ and ‘I’ve been interested in new things’. Participants are asked to choose the answer that best describes their experience of each item over the last two weeks, using a five point scale. The end result is a score between 14 and 70, with a higher score indicating better well-being.
Whilst this is a robust and commonly used measure that can be used to show improvements in well-being over time both at the individual level, but also in making meaningful comparisons against national averages, it’s important to also look beyond the numbers and actually ask people how they are feeling. Furthermore, it's important that people's view of their own well-being is balanced with indicators relating to quality of life such as health, physical activity and social interaction. Having this information enables you to get the broadest possible perspective on someone's overall well-being and how well they manage day-to-day.
As a provider of mental health services we think it’s crucial to measure the well-being of those that use our services and ensure we are working alongside people to improve this. Measuring well-being helps us to evaluate the impact of our services on people’s lives, but also which aspects of their lives people feel most dissatisfied with – which can help us to tailor our services to meet their needs. To us, this means looking at how people are 'in themselves', how well they feel they are coping with everyday life and how hopeful and confident they are about achieving their personal goals.
The Mental Health Foundation recently completed a three year evaluation of our community mental health support services known as Your Way. One of the outcomes measured by the researchers to assess the impact of Your Way support was people's well-being. This included measures such as the WEMWBS scale, in-depth interviews and lifestyle indicators.
We found that for people who took part in the evaluation within a month of first using Your Way their mental well-being (as measured by WEMWBS) had improved within three months. In addition, other lifestyle indicators measured as part of the evaluation showed that there were significant improvements in relation to the following areas:
- social support and relationships
- finding a sense of meaning
- relationships with health professionals
These findings are positive and encouraging. But we won’t stop there. We want to support as many people as possible to lead the life they want to lead. We understand that working with people with mental health problems is not like fixing a broken leg – we can’t just treat the immediate symptoms and expect that person to make a full recovery. Instead, we must see the whole person and all the factors that may affect their well-being. Only by doing so can we fully support individuals to lead independent, fulfilling lives in their communities.
- New Economics Foundation (2012) Measuring Wellbeing: A guide for practitioners, London: New Economics Foundation.