World Health Organization and other definitions of mental well-being
The founding Charter of the World Health Organization describes health as ' ... a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity'.2 This resonant phrase offers an indication that many medical practitioners see a focus on well-being as being central to their profession. The European Commission has gone further, and in 2001 defined mental health as ' ... a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.' It sees mental health as: 'a resource which enables them to realise their intellectual and emotional potential and to find and fulfil their roles in social, school and working life. For societies, good mental health of citizens contributes to prosperity, solidarity and social justice'.3 The European Commission, interestingly, also suggests that: 'the mental condition of people is determined by a multiplicity of factors including biological (e.g., genetics, gender), individual (e.g., personal experiences), family and social (e.g., social support) and economic and environmental (e.g., social status and living conditions)'. This seems entirely compatible with the vision for psychiatry offered by Dinesh Bhugra, Pat Bracken and colleagues that I described in the introduction
I'm occasionally accused of being an incurable optimist. But it does seem to me that these approaches to the support of mental (and material) well-being are becoming key elements of government policy and professional activity. In physical health, and especially in primary care, physicians actively promote health, as well as treating illnesses. In mental health care, we see similar developments. The present UK government strategy for mental health, launched in 2011, places mental health problems in an economic context, estimating that they cost the UK at least ?77 billion each year, and probably closer to ?105 billion. It comments that a million people in the UK are receiving incapacity benefit, with 40% of these off work because of emotional or psychological problems, that a third of GP consultations are estimated to be as a result of mental health issues and that such problems constitute the largest proportion of
'disease burden' in public health. Finally, it discusses the physical health threats faced by people with mental health problems. This places mental health in a public health perspective, and implies a strong psychosocial ethos with an emphasis on well-being rather than 'illness'.4
Of course, well-being means different things to different people. The UK Office for National Statistics has the unenviable - and controversial - task of measuring well-being. The general consensus is that well-being is dependent on a broad set of issues that, taken together, determine our satisfaction with life. This offers an intriguing basis for considering what clinical psychologists or other professionals working in mental health care could consider reasonable areas for intervention.
Relationships are a vital component of well-being. That means that our social relationships with friends, our relationships with our parents, and our relationships with our children, loving or intimate relationships and relationships with work colleagues, are all important. Our physical health is important too, as is physical security - freedom from crime and the fear of crime. The quality and security of our housing is important, too - if we are homeless, live in poor-quality housing or have little security in accommodation, we're unlikely to be happy. This is equally true of our work - the extent to which our jobs are rewarding, our relationships with colleagues and bosses and the financial security that employment can bring.5 Other aspects of well-being can include access to and appreciation of sports and leisure, and arts and culture. Most people also include our spiritual and religious lives. Perhaps two of the most important aspects of well-being are a sense of 'meaning and purpose' and active democratic political participation.