Review: Mental Illness and Well-Being

The paper reviewed here is ‘Mental Illness and Well-Being: The Central Importance of Positive Psychology and Recovery Approaches’ by Mike Slade and freely available at the BMC Health Services Research site here.  In the abstract, Slade writes that

‘A new evidence base is emerging, which focuses on well-being. This makes it possible for health services to orientate around promoting well-being as well as treating illness, and so to make a reality of the long-standing rhetoric that health is more than the absence of illness….If health services are to give primacy to increasing well-being, rather than to treating illness, then health workers need new approaches to working with individuals‘

In the 54-page PDF article, Slade begins by discussing the concept of the deficit model of illness and by noting the partial dissociation of mental health and  mental illness implying that the two may require separate approaches. He then looks at recovery – a big topic. He outlines a number of taxonomies – service based recovery, service based user recovery, clinical and social recovery while emphasising the essence of recovery as a continuous and personal process. As a result of this he challenges the use of traditional methods used in management of illness including the care pathway (although I would argue that a more ‘dynamic’ type of pathway would make it possible).

Next he turns to positive psychology. Here he gives the reader a broad overview of the subject and writes about the dimensions that have been used in defining in well-being. He writes about the use of a framework for mental wellbeing which uses the concepts of flourishing, struggling, languishing and floundering and the prevalence of these different states of well-being in the population.  He also describes Seligman’s four types of good life and the subsequent importance of ‘flow’ in lifestyle and that

‘Feeling good is not always necessary for a good life‘

He also describes how goal-setting and goal-striving can be structured within services. What I was particularly intrigued by was the concept that mental illness and mental wellbeing could be addressed both independently and simultaneously.

Slade goes on to draw parallels between the recovery and positive psychology movements. From his description it sounds like a top-down versus bottom-up approach with the recovery movement also having more influence as a result of the approach used. He goes on to ask how this should impact on healthcare services and notes that the assessment process can be modified to incorporate an assesment of characteristics important for well-being. He also considers interventions including CBT, mindfulness-based therapy, narrative therapy and positive psychotherapy.

The last section on societal implications is very interesting and I would recommend a close reading of this section. Here is just one of the interesting insights from this section

‘This opens up innovative environmental approaches to fostering well-being, like the simple act of closing most points of entry to a housing estate which led to an increased sense of community and a 25% reduction in mental illness rates‘

In conclusion, I thought Slade’s article was extremely interesting, rich in content and filled with evidence-based approaches that have the potential to have significant benefits for society. These approaches may well cause a re-evaluation of the ways in which healthcare are delivered and a recognition of this emerging movement which complements the management of illness is essential for a better understanding of the delivery of healthcare in the 21st century.

References

Slade M. Mental Illness and Well-Being: The Central Importance of Positive Psychology and Recovery Approaches. BMC Health Services Research. 2010. 10:26.

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