Mental illness and well-being: the central
importance of positive psychology and recovery
Background: 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. The aim of this paper is to support the re-
orientation of health services around promoting well-being. Mental health services are used as an example to
illustrate the new knowledge skills which will be needed by health professionals.
Discussion: New forms of evidence give a triangulated understanding about the promotion of well-being in
mental health services. The academic discipline of positive psychology is developing evidence-based interventions
to improve well-being. This complements the results emerging from synthesising narratives about recovery from
mental illness, which provide ecologically valid insights into the processes by which people experiencing mental
illness can develop a purposeful and meaningful life. The implications for health professionals are explored. In
relation to working with individuals, more emphasis on the person’s own goals and strengths will be needed, with
integration of interventions which promote well-being into routine clinical practice. In addition, a more societally-
focussed role for professionals is envisaged, in which a central part of the job is to influence local and national
policies and practices that impact on well-being.
Summary: 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. For mental health services, this will involve the
incorporation of emerging knowledge from recovery and from positive psychology into education and training for
all mental health professionals, and changes to some long-established working practices.
The World Health Organisation (WHO) declares that
health is “A state of complete physical, mental and social
well-being and not merely the absence of disease or infir-
mity “. However, creating health-oriented rather than ill-
ness-oriented services has proved rather more difficult
than the clarity of this declaration would suggest. Efforts to
generate a science of illness have been very successful, with
shared taxonomies to identify types of illness, established
and validated interventions to treat and manage these iden-
tified illnesses, and clinical guidelines and quality standards
available to increase efficiency and equity. These successes
have not been mirrored by equivalent advances in applying
the science of well-being within health services. The typical
health worker will know a lot about treating illness, and far
less about promoting well-being.
In this article we use mental health services as an
exemplar of the issue, and explore how mental health
services could more effectively promote well-being. Our
central argument is that mental health workers will
need new approaches to assessment and treatment if the
goal is promoting well-being rather than treating illness.
Well-being is becoming a central focus of international
policy, e.g. Canada  and the United Kingdom . In
the same way that tertiary prevention is an important
health promotion strategy, well-being is possible for
people experiencing mental illness.
We will discuss two new emerging areas of knowledge
which are highly complementary, and provide a
* Correspondence: email@example.com
Health Service and Population Research Department (Box P029), Institute of
Psychiatry, King’s College London, Denmark Hill, London, SE5 8AF UK
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counter-balance to the traditional focus of mental health
services on deficit amelioration. We will identify how
they link (and differ), and then explore their implica-
tions for mental health workers. Specifically, we will
argue that assessment and treatment of the individual
will need to change if the goal is promoting well-being
rather than treating illness, and that there are also
broader challenges for mental health professionals to
become more outward-looking in their view of their
role, and to construct their job as more than working
with individuals. We will conclude that a focus on
improving social inclusion, becoming social activists
who challenge stigma and discrimination, and promot-
ing societal well-being may need to become the norm
rather than the exception for mental health professionals
in the 21stCentury.
The WHO declaration about mental health is also clear:
it is “a state of well-being in which the individual rea-
lizes 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 “
. A relative lack of workforce skills in promoting
well-being is particularly important in mental health ser-
vices, since mental disorders directly impact on personal
identity and ability to maintain social roles.
This distinction between mental illness and mental
health is empirically validated, with only modest correla-
tions between measures of depression and measures of
psychological well-being, ranging from -0.40 to -0.55
[4,5]. A more statistically robust approach is a confirma-
tory factor model, which showed that the latent factors
of mental health and mental illness in a US sample (n =
3,032) correlated at 0.53, indicating that only one quar-
ter of the variance between measures of mental illness
and mental health is shared .
Why is this distinction important? Because it points to
the need for mental health professionals to support both
the reduction of mental illness and the improvement of
mental health. This will involve the development of
further skills in the workforce. These skills will be based
on two new areas of knowledge, each of which have
emerged as distinct scientific areas of enquiry only in
the past two decades.
New area of knowledge 1: Recovery
People personally affected by mental illness have
become increasingly vocal in communicating both what
their life is like with the mental illness and what helps
in moving beyond the role of a patient with mental ill-
ness. Early accounts were written by individual pioneers
[7-12]. These brave, and sometimes oppositional and
challenging, voices provide ecologically valid pointers to
what recovery looks and feels like from the inside. Once
individual stories were more visible, compilations and
syntheses of these accounts began to emerge from
around the (especially Anglophone) world, e.g. from
Australia , New Zealand [14-17], Scotland [18,19],
the USA [12,20,21] and England [22,23]. The under-
standing of recovery which has emerged from these
accounts emphasises the centrality of hope, identity,
meaning and personal responsibility [13,24,25]. We will
refer to this consumer-based understanding of recovery
as personal recovery, to reflect its individually defined
and experienced nature . This contrasts with tradi-
tional clinical imperatives - which we will refer to as
clinical recovery- which emphasise the invariant impor-
tance of symptomatology, social functioning, relapse
prevention and risk management. To note, this distinc-
tion has been referred to by other writers as recovery
“from” versus recovery “in” ; clinical recovery versus
social recovery ; scientific versus consumer models
of recovery ; and service-based recovery versus user-
based recovery .
Opinions in the consumer literature about recovery
are wide-ranging, and cannot be uniformly charac-
terised. This multiplicity of perspectives in itself has a
lesson for mental health services - no one approach
works for, or ‘fits’, everyone. There is no right way for a
person to recover. Eliciting idiographic knowledge -
understanding of subjective phenomema - is an impor-
tant clinical skill. Nonetheless, some themes emerge. A
first clear point of divergence from the clinical perspec-
tive is that recovery is seen as a journey into life, not an
outcome to be arrived at: “recovery is not about ‘getting
rid’ of problems. It is about seeing people beyond their
problems - their abilities, possibilities, interests and
dreams - and recovering the social roles and relation-
ships that give life value and meaning “ .
Many definitions of recovery have been proposed by
those who are experiencing it [8,18]. We will use the
most widely-cited definition that “recovery is a deeply
personal, unique process of changing one’s attitudes,
values, feelings, goals, skills, and/or roles. It is a way of
living a satisfying, hopeful, and contributing life even
within the limitations caused by illness. Recovery involves
the development of new meaning and purpose in one’s
life as one grows beyond the catastrophic effects of men-
tal illness “ . It is consistent with the less widely-
cited but more succinct definition that recovery involves
“the establishment of a fulfilling, meaningful life and a
positive sense of identity founded on hopefulness and self
determination “ .
One implication of these definitions is that personal
recovery is an individual process. Just as there is no one
right way to do or experience recovery, so also what
helps an individual at one time in their life may not
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The pre-publication history for this paper can be accessed here:http://www.
Cite this article as: Slade: Mental illness and well-being: the central
importance of positive psychology and recovery approaches. BMC
Health Services Research 2010 10:26.
Slade BMC Health Services Research 2010, 10:26
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