Industry Research: Defining “Mental Wellness” vs. “Mental Health”

Defining Mental Wellness

Mental wellness is a term that is increasingly used in the popular lexicon, but it is vague and not well-understood. People associate mental wellness with many different types of activities: meditating, listening to music, talking to a friend, taking a walk in nature, taking a vacation, getting a massage, taking a bubble bath, squeezing a stress ball, or just carving out some time for peace and quiet in daily life. When we talk about mental wellness, we are not just focusing on our mental or cognitive functioning, but also our emotions; our social relationships; our ability to function in daily life; and even our spiritual, religious, or existential state. Most people would agree that mental wellness is different than happiness, but very few could elaborate precisely how the two are different. Sometimes the term mental wellness is used synonymously with mental health or mental well-being, two terms that are also not well-defined. Below we offer a simple and concise definition for mental wellness. A summary of related terminologies and definitions (for mental illness, mental health, mental well-being, and happiness) is provided in Appendix

A. What is mental wellness?

Mental wellness is an internal resource that helps us think, feel, connect, and function; it is an active process that helps us to build resilience, grow, and flourish.

This definition characterizes mental wellness as a dynamic, renewable, and positive resource, and as an active process that requires initiative and conscious action. It recognizes mental wellness as an internal experience that encompasses multiple dimensions:

•Mental: How we think; how we process, understand, and use information.

•Emotional: How we feel; how we manage and express our emotions.

•Social: How we connect; our relationships with others.

• Psychological: How we act or function, or how we “put the pieces together;” taking external inputs along with our internal capacity and then making decisions or doing things.

Our new definition of mental wellness distills the concepts included in many existing definitions, notably from the World Health Organization (WHO) and the U.S. Surgeon General, to align with current practices and understanding. Key concepts included in those definitions are: feeling good, being resilient and functional, enjoying positive relationships, contributing to society or community, realizing potential, and having a sense of fulfilment or coherence. Mental wellness is sometimes associated with the concept of psychological well-being, which includes self-acceptance, growth, purpose, autonomy, environmental mastery, and positive relationships. Mental wellness has been described as a process, a resource, a state of being, or a balance point between resources and challenges. Our definition builds upon well-established (but not widely known) theories from psychology and academic literature, and it frames them in a language that is more understandable to consumers, businesspeople, and policymakers.

Five key things everyone should know about mental wellness.

1. Mental wellness is more than just the absence of mental illness.
There is a tendency to think of mental wellness and mental illness as a simple continuum, with severe and chronic mental disorders on one end, happiness and flourishing on the other end, and varying degrees of resilience or coping with mental and emotional disturbances in the middle. This view does not accurately reflect the nuanced and dynamic relationship between mental illness and mental wellness. The complex relationship between mental illness and mental wellness is best understood by envisioning them sitting on two separate continuums.

•The horizontal axis measures mental illness from high to low. This axis measures the presence or absence of diagnosable mental disorders (e.g., depression, anxiety, personality disorders, etc.), based upon the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Treatment of mental illness typically takes a clinical or pathogenic approach, which focuses on diagnosing a problem, treating the symptoms, and bringing a person back to “normal.” Care is typically delivered by trained mental health professionals (e.g., psychiatrists, psychologists, social workers, etc.).

•The vertical axis measures mental wellness from languishing to flourishing. This axis captures the many factors that shape our overall mental health and well-being, but are not clinical conditions – e.g., stress, worry, loneliness, or sadness at the negative end, and happiness, life satisfaction, strong relationships, or personal growth at the positive end. Mental wellness offers a salutogenic approach that focuses on positive human functioning: preventing illness, maintaining good mental health, and pursuing optimal mental well-being. Mental wellness is self-directed, personal, and subjective; it typically relies on self-care and personal agency to cope with everyday challenges and proactively pursue a higher level of happiness and well-being. Mental wellness can be empowering because it acknowledges the universal desire for peace, joy, happiness, meaning, and purpose.

Subsequent research over the last two decades has supported the dual continuum model, which captures several important concepts about mental wellness and mental illness:

•A lack of mental illness does not equate to mental wellness. About 15% of the world’s population suffers from a diagnosed mental or substance use disorder, but that does not mean that the other 85% of the population is “mentally well” or leading healthy, happy, productive, and satisfied lives. Many people who do not have a mental illness still “do not feel healthy or function well,” because of pervasive stress, worry, loneliness, and other challenges. Those who are “languishing” rather than “flourishing” (even when free of a diagnosed mental illness) tend to do worse in terms of “physical health outcomes, healthcare utilization, missed days of work, and psychosocial functioning.” Low mental wellness (“languishing”) can be debilitating; it is more common than depression and is associated with emotional and psychosocial impairment comparable to that of a depressive episode.

•Mental wellness can co-exist with mental illness. Research on the dual continuum model shows that the presence of mental illness does not necessarily imply an absence of mental wellness, and vice versa. For example, a person with obsessive compulsive disorder, attention deficit disorder, or mild depression can still demonstrate moderate or positive mental wellness (e.g., having good relationships, feeling happy, or functioning well at a job). Corey Keyes’ study of Americans ages 25-74 found that 70% of those with a diagnosed mental illness had a “moderate” or “flourishing” level of mental wellness. Meanwhile, among those free of mental illness in the previous year, only 20% were “flourishing” in their mental wellness.

•Mental wellness can mitigate and prevent mental illness. Increasing our level of mental wellness can protect us against developing mental illness and can also mitigate the symptoms of these illnesses. Keyes’ studies showed that those who are “flourishing” function better than those with moderate or “languishing” mental wellness, regardless of whether a person has a diagnosed mental illness or not. People whose level of mental wellness declined from flourishing to moderate were over 3.5 times more likely to develop mental illness than those who stayed flourishing, while people whose mental wellness declined from moderate to languishing were 86% more likely to develop mental illness. Meanwhile, Keyes’ research also showed that improving one’s mental wellness from languishing to moderate reduced the risk of future mental illness by nearly half. We are not suggesting here that mental wellness can solve or cure mental illness, but that the practices that support and improve our mental wellness (e.g., good sleep, good nutrition, exercise, meaningful relationships, reducing stress, meditation) are increasingly recognized as protective factors for our mental health, as well as helping reduce the severity and symptoms of mental illness (alongside conventional treatment regimens).

2. Mental wellness is an active process of moving from languishing, to resilience, to flourishing.
Our mental wellness is not a static state of being. Mental wellness is a lifelong process and a proactive strategy to strengthen our mental, emotional, social, and psychological resources. On one level, mental wellness is about prevention; coping with life’s adversity; and being resilient when we face stress, worry, loneliness, anger, and sadness. On another level, mental wellness moves us toward a deeper, richer, and more meaningful human experience, which is often described as flourishing. The notion of flourishing as the peak mental state has been shaped by developments in the psychology field during the 20th century, including Abraham Maslow’s hierarchy of needs, Carl Rogers and humanistic psychology (a holistic approach of self-exploration and working toward full human potential), and Martin Seligman’s positive psychology (emphasizing eudaimonia and human flourishing). Concepts of self-actualization, the pursuit of fulfillment, and the untapped potential that lies in all people were disseminated and popularized by the Human Potential Movement in the 1960s-1970s.

The psychology field has explored various methods of measuring individuals’ mental wellness (see Appendix B for more information on the approach proposed by Corey Keyes, in relation to the dual continuum model), but these tools depend upon self-reporting and are inherently subjective. Flourishing is a personal experience. For some people, it may mean functioning at the top of their game on a daily basis – staying engaged, sharp, and focused; and achieving their life goals and vision. For others, flourishing could mean moving toward self-transcendence – going beyond the “self” to associate with a higher purpose; living in truth, unity, and harmony with the universal order; and developing a sense of peace and joy that is independent of external circumstances or events. This concept of mental wellness is often associated with the realms of human consciousness, spiritual practices, and religious devotion. Our definition of what it means to flourish is also shaped by culture. For example, in some cultures people put the highest value on individual balance and inner harmony for living a thriving and happy life. Other cultures may take a more collectivist view, placing high value on peace, family relationships, and social harmony. The important point is that flourishing (as a peak level of mental wellness) is different for different people, depending on their values, beliefs, culture, and personal journey.

3. Mental wellness helps to shift the perspective away from stigma to shared humanity and shared responsibility.
Even though the mental health field has done a lot of work to mitigate the stigma surrounding mental illness, a sense of shame, denial, and secrecy continues to afflict people in communities and cultures around the world. Mental wellness can help shift our focus toward a more positive and empowering approach (how we can feel, think, connect, and function better), rather than just avoiding or coping with illness. Importantly, mental wellness emphasizes our capacity to build resilience; to reduce suffering; to find inner peace, joy, and fulfilment; to seek purpose, meaning, and happiness; and to connect to others. By acknowledging this as a universal condition and longing shared by all people, there is no need to feel shame or to feel that we are alone in this endeavor.

During the last century, modern psychology and its approaches to treating mental illness have tended to focus on individual behavior and individual-level interventions, such as talk therapy and drugs. Mental wellness favors a more holistic approach that encompasses personal agency alongside social and environmental dimensions (e.g., family, friends, community connections, living environments). In doing so, mental wellness helps shift our perspective toward a sense of shared humanity and shared responsibility, while also bringing attention to the many external forces that deeply influence our overall mental health and well-being – including socioeconomic status, culture and values, built environment, technology, and much more.

This approach does not ignore or refute the immense need for more resources and better methods to address and treat mental illness. Rather, it emphasizes that the promotion of mental wellness is an equally important (yet often overlooked) approach that can address a multitude of individual and societal problems (such as loneliness and stress), while also complementing approaches to mental illness and even helping to prevent mental illness and reduce its associated costs.

4. Mental wellness grows out of a grassroots, consumer-driven movement.
There is a huge global need to address mental illness and to help people in mental distress who are vulnerable to developing a full-blown mental disorder. The needs are vast, and resources are scarce, and the “talk and pills” approach does not work for everyone. Meanwhile, people with poor mental wellness (“languishing”) desperately need non-clinical, non-pathologizing strategies and tools to cope. As discussed above, evidence shows that improving our mental wellness can even reduce our risk of developing mental illness. And yet, not enough attention is paid globally to mental illness prevention and mental wellness promotion, and mental health has never been well-integrated into public health structures.

Our healthcare systems (including mental health) are not set up to help the spiraling number of people who are facing everyday mental and emotional challenges like stress, burnout, loneliness, or sadness. In response to these immense gaps, mental wellness has grown out of a grassroots, consumer-led movement that seeks self-directed, alternative solutions outside of the established fields of medicine, psychiatry, and psychology. Mental wellness encompasses many natural and complementary modalities that have been around for millennia, and that have operated on the fringes of modern psychology and medicine for decades. It embraces a holistic approach that recognizes the mind-body connection, and therefore extends to lifestyle strategies such as nutrition and exercise. Mental wellness modalities mostly exist outside of healthcare systems and reimbursement schemes. Presently, many of these modalities lack the validation of clinical evidence and double-blind studies that are required for approval of medical treatment protocols and pharmaceuticals.

5. Mental wellness is multi-dimensional, holistic, and personal.
Mental wellness recognizes the integrated and holistic nature of our health and well-being. The state of our mind affects our body, and vice versa. Our mental wellness is also connected to our beliefs and values, to other people, to nature, and even to the realms of consciousness and spirituality. The approaches for improving our mental wellness are diverse and inclusive, and they are enriched by cultural, social, and religious traditions and contexts. The numerous pathways toward mental wellness have been extensively catalogued in GWI’s 2018 Mental Wellness Initiative white paper and in a recently published chapter in the Oxford Research Encyclopedia of Global Public Health.