Measuring Mental Wellbeing

1. Measuring Mental Wellbeing

2. Positive or Negative • Great majority of measures of mental health focus on the negative/ disease / distress • Public and patients prefer positive measures Crawford et al. Selecting outcome measures in mental health. J. Mental Health 2011(20)336-346 • Positive measures better support positively focused interventions

3. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS)

4. The Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) I’ve been feeling optimistic about the future I’ve been feeling useful I’ve been feeling relaxed I’ve been dealing with problems well I’ve been thinking clearly I’ve been feeling close to other people I’ve been able to make up my own mind about things

5. WEMWBS • Self report measure of mental well-being • Covering both eudemonic and hedonic components • Adopting a single continuum model • Focusing entirely of positive aspects of mental health

6. Distribution of WEMWBS scores: student and population samples Student sample: median score: 50 Population sample: median score: 51

7. GHQ-12 Socres

8. One Week Test-Retest ReliabilityStudent sample ** P<0.01

9. Sensitivity to Change

10. Minority Ethnic ValidationPakistani, Chinese, Urdu, Bangla Qualitative findings • Understood the instrument • Found it easy to complete and acceptable • Half items posed no problem: 7 created discussion • Context • I’ve been feeling useful/relaxed/loved • Cultural differences • I’ve been able to make up my own mind about things • I’ve had energy to spare • Comprehension • I’ve been feeling optimistic about the future • I’ve been feeling interested in other people

11. Validation of WEMWBS in 13-15 year olds Quantitative findings – instrument valid Qualitative findings: • Understood the instrument • Found it easy to complete and acceptable • Two items which created most discussion in focus groups: • I’ve been feeling optimistic about the future • I’ve been feeling interested in other people

12. WEMWBS research http://www2.warwick.ac.uk/fac/med/research/platform/wemwbs

13. Surveys Scotland Scottish Health Survey – 2008 – Health Education Population Survey 2006/7 WELL? What do you think survey since 2006 SALSUS survey – young people England Health Survey for England Understanding Society 2010- British Social Attitudes Survey 2007 British Psychiatric Morbidity Survey Iceland(SWEMWBS) Catalonia

15. Other Measures of Mental wellbeing: • Office of National Statistics: http://www.ons.gov.uk/ons/dcp171766_310300.pdf • WHO 5 : feeling good; energy and vitality • http://www.psykiatri-regionh.dk/who5/menu/ • Short Form Mental Health Continuum: psychological and social wellbeing http://calmhsa.org/wp-content/uploads/2013/06/MHC-SFEnglish.pdf • SF -36 : PCS and MCS http://www.sf-36.org/tools/sf36.shtml • GHQ- 12 • EQ5D ??

16. Office of National Statistics Approach • Overall how satisfied are you with your life nowadays? • Overall how happy did you feel yesterday ? • Overall how anxious did you feel yesterday ? • Overall, to what extent do you feel things you do in your life are worthwhile ?

17. A word of caution Preference based measures, favoured by health economists, eg EQ5D do not adequately capture the impact of mental illness on subjective wellbeing Bokerman et al Health Policy 2011;100:91-95

18. Measures of mental wellbeing: Children • Child Behaviour Checklist (2 yrs +) • Achenbach 1983 • Negative behaviours • Strengths and Difficulties Questionnaire (3 yrs +) • Goodman 1994 • Negative behaviours and emotions plus prosocial scale • Adaptive Social Behaviour Inventory (3 yrs +) • Hogan 1992 • Mostly positive behaviours and emotions • WEMWBS 13- 15 year olds (13 yrs +) • Child Well-being Innocenti Research Centre 2007 • Material and educational wellbeing, mortality relationships • Stirling Children’s Wellbeing Scale • Ian Liddle & Greg F.A. Carter (2015): Emotional and psychological wellbeing in children: the development and validation of the Stirling Children’s Well-being Scale, Educational Psychology in Practice: theory, research and practice in educational psychology, DOI: • 10.1080/02667363.2015.1008409 published online 18 Mar 2015.

19. Its: • ‘woolly’ • ‘soft, fluffy’ • ‘all subjective’ Mental wellbeing was not credible asa goal for publicly funded services ‘Tree huggers’ ‘They thought we were nuts’ ‘You could see [the effect of {mental health promotion], you could feel it, but you couldn’t measure it’ ‘What’s this got to do with us? … yeah.. bewilderment I suppose’ ‘The key indicator was the suicide rate’

20. ‘We were just desperate for a measure that recognised positive mental health’ ‘Eureka moment’ ‘A great solution because there is nothing else’ Reaction to WEMWBS ‘Not clinical’ ‘Didn’t medicalise’ It was ‘easy, simple, no floor or ceiling effects; robust validation’

21. ‘It makes [MWB] more solid, Tangible’ Gave • ‘confidence’ • ‘credibility’ [it helps people] ‘relate to the concept [of MWB} and address it’ Why ? ‘Raised profile of MWB’ ‘Enabled us to pull down money; increased investment’

22. Summing up: Measurement • Mental wellbeing is measureable • Measuring mental wellbeing changes the landscape • More sophisticated measures may be necessary in future • At present WEMWBS works well enough for purpose

23. Paradigm 1 Positive Focus Focusing on the positive is an intervention in its own right