Improving wellbeing for everyone – and the challenges for research

Research in the news - wellbeingWellbeing is currently a buzzword in the world of public health. In July, CentreForum released a report on happiness and wellbeing which recommended that a focus on wellbeing be embedded across Governmental and community work, and that subjective wellbeing should be used to evaluate and allocate health resources. We welcome this emphasis at The McPin Foundation, where we’re passionate about conducting user-focused research that improves wellbeing and mental health. We recently completed a research study mapping Community Health Networks by exploring the connections people with severe mental illness had to people, places and activities and assessed each contact’s impact on wellbeing. The very start of the study involved some consultations to think about which term to use to cover everything that impacts on mental and physical health. We found that the term ‘wellbeing’ was understood implicitly by most of the people with mental health problems who took part as incorporating a wide-ranging and holistic sense of wellness, happiness, and how you feel your life is going. From that point on the study was focused on wellbeing rather than health; so we have been thinking about how to evaluate wellbeing for a while.

One of the attractions of the concept of ‘wellbeing’ in mental health research and practice is that it’s quite a positive idea which doesn’t have the negative connotations of more medical and stigmatised terms like mental health problem or mental illness; this attractiveness may be behind a growth in popularity in recent years for wellbeing programmes, such as wellbeing at work and the 5 ways to wellbeing project. However, there is still the question of what exactly wellbeing means or subjective wellbeing as called for in the CentreForum report. If we’re going to help improve wellbeing, we need to measure it accurately and consistently. There are some conceptual and methodological problems, with no fixed consensus on what wellbeing actually means or the most reliable way to measure it. Many studies use the term, but the way that they measure it differs from one study to the next, making comparison difficult – and definitions often overlap with other terms such as quality of life and life satisfaction. This is not a new problem – we have seen the same in work seeking to ‘measure’ social inclusion or exclusion.

A few weeks ago in June, I attended a symposium to debate the issues involved in researching wellbeing at the University of Manchester. The interdisciplinary event included speakers from the fields of politics, business, public policy, psychology, nursing and economics. It was great to see researchers from so many different backgrounds interested in wellbeing but it was also apparent that this multidisciplinary interest could be both a strength and a weakness in wellbeing research.

On the one hand, multiple perspectives no doubt help provide a richer understanding of any topic and despite the differences in background, there was a general agreement that improving wellbeing for everyone, rather than just focusing on the absence of illness, was something that we should be striving for in society. The ethical view that people should be supported to live satisfying and full lives was apparent in the majority of perspectives offered and I thought it echoed the recovery approach found in mental secondary mental health services: the sense that recovery is not necessarily the absence of mental illness, but a process of living life to the fullest regardless of the effects of mental ill-health.

On the other hand, it was also obvious that many of the speakers meant different things when they spoke about wellbeing, and measured it in different ways which often seemed to clash. I heard it was a state of being or behaving physically or mentally well, or of being in work without absence due to illness. I heard it was about a wide range of factors such as quality of family and friend relationships, job satisfaction, autonomy, self-confidence and hope for the future. For some it was a catch-all term to include physical and mental wellness but others felt strongly that wellbeing is distinct from physical or mental health. The CentreForum’s report includes ‘mental wellbeing’ suggesting there are various other sub-types on offer too. It’s not always clear if wellbeing is seen as the outcome of healthier minds, relationships and societies, or a factor that leads to these. The presence of so many definitions will be a problem for tracking wellbeing over time and is something to remember when reading about new research that claims something is good for your wellbeing!

It seems that we still have some way to go before there is agreement on how to conceptualise and measure wellbeing. It’s also important to recognise that different things may be important to people’s wellbeing – for example some might value their career most highly, others their family. This was echoed in our Community Health Networks findings – people value a very wide range of activities, hobbies, community resources and relationships to support and maintain their personal wellbeing.

Perhaps therefore one specific definition is not possible or desirable; it may be preferable to think of wellbeing in ways that are specific to different groups of people. For example, last year a conceptual framework for wellbeing for people with psychosis was published. This is useful because it outlines some issues that are specific to those who experience psychosis such as the impact of medication and mental health services on wellbeing. But everyone has mental health and the vast majority of factors outlined in this framework – such as relationships, activities, self-worth and empowerment – can apply to anyone, so wouldn’t it be better if we thought of wellbeing in terms of the whole population? We will be taking an active interest in discussions of wellbeing; will it become an enduring term like “poverty” within social research or pass us by like the “big society”? I hope to contribute to thinking and writing on wellbeing through my PhD study research and would be interested in anyone who wanted to get in touch to discuss.