Mental illness and well-being: The central importance of positive psychology and recovery approaches

Article (PDF Available)inBMC Health Services Research 10(1):26 · January 2010with73 Reads
DOI: 10.1186/1472-6963-10-26 · Source: PubMed
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. 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. 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.


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    • "This can be contrasted with 'clinical recovery' that emphasises 'the invariant importance of symptomatology, social functioning, relapse prevention and risk management' [25] (p.1). It is claimed that the emphasis that the RA places on exploring individuals' own goals and strengths is advantageous for promoting subjective wellbeing [25]. Although the RA has done much to highlight the importance of the subjective meaning that individuals may take from their mental health difficulties, a number of concerns have been raised about potential limitations associated with the approach. "
    [Show abstract] [Hide abstract] ABSTRACT: Concerted efforts have been made in recent years to achieve equity and equality in mental health for all people across the globe. This has led to the emergence of Global Mental Health as an area of study and practice. The momentum that this has created has contributed to the development, implementation and evaluation of services for priority mental disorders in many low- and middle-income countries. This paper discusses two related issues that may be serving to limit the success of mental health initiatives across the globe, and proposes potential solutions to these issues. First, there has been a lack of sophistication in determining what constitutes a ‘good outcome’ for people experiencing mental health difficulties. Even though health is defined and understood as a state of ‘wellbeing’ and not merely an absence of illness, mental health interventions tend to narrowly focus on reducing symptoms of mental illness. The need to also focus more broadly on enhancing subjective wellbeing is highlighted. The second limitation relates to the lack of an overarching theoretical framework guiding efforts to reduce inequalities and inequities in mental health across the globe. This paper discusses the potential impact that the Capabilities Approach (CA) could have for addressing both of these issues. As a framework for human development, the CA places emphasis on promoting wellbeing through enabling people to realise their capabilities and engage in behaviours that they subjectively value. The utilization of the CA to guide the development and implementation of mental health interventions can help Global Mental Health initiatives to identify sources of social inequality and structural violence that may impede freedom and individuals’ opportunities to realise their capabilities.
    Full-text · Article · Dec 2016
    • "The first is the experience of restoration from mental illness symptoms; the second is the experience of optimization of positive mental health. The first indicator mostly pertains to the clinical recovery approach, while the second mostly relates to themes from the personal recovery approach (Slade, 2010). Positive mental health is defined as a syndrome composed of several manifestations of well-being (Keyes, 2002), at the emotional (e.g., interest, satisfaction), psychological (e.g., purpose in life, personal growth), and social levels (e.g., social contribution, social integration). "
    [Show abstract] [Hide abstract] ABSTRACT: Context: A shift toward person-centered care has been occurring in services provided to people with mood and anxiety disorders. Recovery is recognized as encompassing personal aspects in addition to clinical ones. Guidelines now recommend supporting people's engagement in self-management as a complementary recovery avenue. Yet the literature lacks evidence on how individualized combinations of self-management strategies used by people relate to their clinical and personal recovery indicators. Objectives: The aims of this study were to identify profiles underlying mental health recovery, describe the characteristics of participants corresponding to each profile, and examine the associations of profiles with criterion variables. Method: 149 people recovering from anxiety, depressive, or bipolar disorders completed questionnaires on self-management, clinical recovery (symptom severity), personal recovery (positive mental health), and criterion variables (personal goal appraisal, social participation, self-care abilities, coping). Results: Latent profile analysis (LPA) revealed three profiles. The Floundering profile included participants who rarely used self-management strategies and had moderately severe symptoms and the lowest positive mental health. The Flourishing profile was characterized by frequent use of self-empowerment strategies, the least severe symptoms, and the highest positive mental health. Participants in the Struggling profile engaged actively in several self-management strategies focused on symptom reduction and healthy lifestyle. They concomitantly reported high symptom severity and moderately high positive mental health. The study revealed that Floundering was associated with higher probabilities of being a man, being single, and having a low income. People in the Flourishing profile had the most favorable scores on criterion variables, supporting the profiles' construct validity. Discussion: The mixed portrait of Struggling participants on recovery indicators suggests the relationship between health engagement and recovery is more intricate than anticipated. Practitioners should strive for a holistic understanding of their clients' self-management strategies and recovery indicators to provide support personalized to their profile. While people presenting risk factors would benefit from person-centered support, societal efforts are needed in the long term to reduce global health inequalities. The integration of constructs from diverse fields (patient-centered care, chronic illness, positive psychology) and the use of person-oriented analysis yielded new insights into people's engagement in their health and well-being.
    Full-text · Article · Apr 2016
    • "Angell (2014) suggests that thinking about resilience can be traced back at least to Freud and his successors in their thinking about adaptation to stress; and it is the case that there are many overlaps with ideas such as existential psychology and 'will to meaning' (Frankl 1959), hardiness (Kobasa 1982), post-traumatic growth (Tedeschi 2004; Joseph 2012), recovery in mental health (Velleman 2007b; Slade 2010) and positive psychology (Seligman 2011). Furthermore, others are considering resilience in many areas of study, such as in those at suicide risk (Johnson 2011) and those experiencing mental health issues (Southwick 2011). "
    [Show abstract] [Hide abstract] ABSTRACT: We review how research over the past decade both supports existing knowledge about the risk factors that children in the UK affected by parental substance misuse face, and adds to our knowledge about the protective factors, protective processes and evidence of resilience which can reduce the likelihood that children will experience poor outcomes. Further research is needed to understand what areas of resilience are most important to target and how other variables, such as gender or age, may influence how protective factors affect the development of resilience. Longitudinal research is also needed to better understand how an individual's resilience may change over time. Finally, there remain many considerable challenges which practitioners, service providers, commissioners and policy makers face in better meeting the needs of this population of children.
    Full-text · Article · Mar 2016
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