• Overview
• Definition
• Incidence, prevalence and trends
• Risk factors
• Health consequences
• Costs
• Contributors

Definition

Positive mental health

There is a debate on what constitutes the necessary and sufficient elements of positive mental health health. Ryan and Deci identify the importance of both hedonic (pleasure or happiness) and eudaimonic (meaningful and fulfilling) elements to well-being. ¹

Positive mental health can therefore be seen as a state of positive mood and/or life satisfaction with evidence of functioning that includes self acceptance, positive relations with others, autonomy (ability to think for yourself), environmental mastery (the ability to feel you can change your circumstances for the better), purpose in life (having goals and not feeling helpless) and personal growth (being able to learn from the stresses and challenges of life). ²

Keyes has described five mental health states, as follows: ³

• Flourishing: an individual is free of mental illness and has high levels of emotional, psychological and social well-being
• Moderately mentally healthy: an individual has no mental illness and moderate well-being
• Languishing: an individual with low levels of wellbeing but no mental illness
• Pure mental illness: an individual with moderate or flourishing levels of mental well-being
• Mental illness and languishing: an individual with mental illness in the presence of low emotional, psychological and social well-being.

Flourishing individuals have high levels of positive mental health determined by the presence of one or both of the following markers of positive mood:

1. Regularly cheerful, in good spirits, happy, calm and peaceful, satisfied and full of life (in the last 30 days)

2. Feels happy or satisfied with life overall or domains of life such as employment and close personal relationships (in last 30 days).

Also present are six or more high levels on the following 11 markers of positive functioning: self acceptance, social acceptance (positive attitude to people’s differences); personal growth, social actualisation (believe that people and society has potential to grow positively); purpose in life; social contribution; environmental mastery (can manage complex environments); social coherence (interest in social life and society and feel it makes sense); autonomy; positive relations with others; social integration (sense of belonging to a community).

Languishing individuals have low levels on one of the two markers 1 and 2 above and low levels on 6 of the markers of positive functioning.

Mental illnesses

Mental illnesses are defined by groups of symptoms and levels of functioning set out in the Diagnostic and Statistical Manual of Mental Disorders. ⁴ Mental illnesses are often divided into common mental illnesses (sometimes called neurotic disorders) and severe mental illnesses.

Common mental illnesses include: mixed anxiety/depression; generalised anxiety disorder; depressive episode; any phobia; obsessive compulsive disorder; panic disorder.

Severe mental illnesses include: psychotic disorders such as schizophrenia and bipolar disorder (manic-depressive illness).

Interventions targeting mental health

There is considerable overlap between interventions that prevent mental illness and those that promote mental health and therefore these are generally looked at together, apart from a few interventions targeted at specific disorders such as eating disorders or post-traumatic stress disorder.

Mental health interventions can be delivered to individuals or groups of individuals, through organisations or via whole population, policy or structural level interventions.

Organisation level

Delivery through organisations benefits from an embedded approach to mental health due to impact on the policies of the organisation, and there is an additional benefit of many people experiencing an intervention over a similar time period.

Population, policy and structural level

Population level, policy or structural level interventions seek to address social determinants of mental health. For maximum impact, mental health promotion should engage with each level of delivery.

Perceived level of risk

Mental health promotion interventions are sometimes categorised by the perceived level of risk faced by the target population. ⁵

Universal interventions

Universal interventions are delivered to the whole of a population regardless of their risk.

Selective interventions

Selective interventions are delivered to a subset of the population defined by their increased risk of poor mental health, such as people who are recently divorced.

Indicated interventions

Indicated interventions are delivered to people with risk factors in addition to early symptoms of a mental health disorder.