Sarah Stewart-Brown and David Crepaz-Keay speak to Gareth Jenkins as part of the What Makes Us Happy series, following conversations with Claire Haworth, Eugenio Proto and Andrew Oswald and Libby Burton. David is Head of Empowerment and Social Inclusion for the Mental Health Foundation.
Sarah Stewart-Brown is a professor and Chair of Public Health at the Warwick Medical School (WMS). Sarah worked for the NHS from 1974 until 1994, first as a paediatrician and later as a public health doctor. More recently, Sarah has helped to develop the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), a wellbeing tool recommended and used by the NHS.
Q) Wellbeing appears to be the watchword of the moment, how come?
Health services and governments now see mental wellbeing as a major goal. But what is mental wellbeing? And to what extent does it help us to be happier? Well, it’s more than the absence of mental illness; it covers both how we feel and how we function psychologically. It plays an important role in enabling us to stay healthy and live fulfilling lives.
Q) How can we improve our wellbeing?
The feeling side of mental wellbeing can be influenced by all sorts of things that happen to us in our daily lives, but the functioning side is learnt and can be taught.
It starts in childhood, where we develop our confidence and build relationship skills. At this time in life, neural pathways are developing and becoming moulded in response to the environment, particularly the emotional environment. This happens through our parents and family at home, and also at school. We can still learn these skills and attitudes in adulthood; we just have to believe that things can change, that we are not slaves to the patterns that we developed in childhood.
There are now lots of ways to help people develop wellbeing as adults and there are also lots of parenting programmes which address adults’ wellbeing at the same time as helping parents with their parenting. Talking therapies are one way and approaches like mindfulness can prove to be incredibly useful. Physical activity, especially those which are rewarding for both mind and body, like yoga, tai chi and qi gong can also be beneficial.
People who participate in these approaches start to realise that the mind and the emotions are tied to what is going on inside the body. Mental wellbeing actually feels good in the body as well as the mind - because in happy states the mind releases a number of neuroendocrine factors into the blood stream and these make us feel good all over.
Q) Are there other benefits to improving our wellbeing?
As we get more skilled at functioning in a positive way we find that we have a greater capacity to feel happy. We become more resilient to life’s knocks and recover more quickly when things get difficult. We are also more able be around other people in a way which makes them happy. Happiness, like all feelings, is infectious; we can increase the amount of happiness everyone feels.
Q) How does WEMWBS fit into the story?
For medical professionals, asking the question ‘what is right with you?’ as well as ‘what is wrong?’ can transform consultations, helping people hang on to the positive even in the face of difficulties.
Q) Isn’t talking about what’s wrong with us the British way?
As a nation we like to grumble. We all read the papers and watch the news and they tend to reinforce the negative. What we need are the tools to measure mental wellbeing – to make things more concrete and objective – so we can gain an understanding of the difference our programmes and schemes make. Does a new sports programme help or hinder? How does consulting a nutritionist help with mental wellbeing? And then how does that help an individual function? So they can be both feeling happy and functioning well.
Q) How did WEMWBS come about?
If we think about what mental health and wellbeing looks like, at a population level, in its simplest form it’s a bell curve – a few people with very good mental health and wellbeing, a few people with a poor state of mental health and wellbeing and the majority of people falling somewhere in the middle. The focus, historically, has been at the bottom end of that curve. If you were past a certain point the medical view was ‘you're fine, so no probs, we don’t need to think about you’. Up until recently, there hadn’t been much thinking about mental wellbeing for those 'above the threshold'; what that means and what might determine it.
Most of the tools and instruments that measure mental health and wellbeing at a population level have been developed with this kind of thinking in mind. They’re good at picking out people who are mentally ill, that’s what they’re designed to do, but they stop at that threshold – the instruments have what is called a ceiling effect; you can score the top score without feeling great so they don't allow you to distinguish 'okayness' from wellbeing. We need to look at wellbeing so we can increase our understanding of the things that enable people to be mentally well, and what helps people to improve their mental wellbeing and move people along that bell curve. We need to be able to quantify how effective wellbeing interventions are.
Q) Who helped to develop WEMWBS?
It was very much a collaborative venture. I’ve been working with lots of other people including Stephen Platt, from the University of Edinburgh, and Jane Parkinson at NHS Health Scotland.
Q) Is it being used?
We’ve been inundated with requests to use WEMWBS. A lot of the requests come from the voluntary sector but we’ve also seen interest from government agencies, local authorities and the NHS. NHS Scotland funded its development and its use in Scotland is very exciting. The change in focus there happened at government level and was embraced quite widely a few years ago now.
Q) How does WEMWBS differ from other wellbeing and mental health tools?
WEMWBS only has positive items on it. There are very few instruments out there that are about positive concepts – it invites you to focus on what’s okay in your life and what you can do in your life rather than the opposite.
What does WEMWBS look like in practice? Try the NHS Wellbeing self-assessment which uses WEMWBS.
WEMWBS In Practice
Dr David Crepaz-Keay is Head of Empowerment and Social Inclusion for the Mental Health Foundation.
Q) How did you come across WEMWBS?
I was looking for an alternative to clinical or symptomatic scales that would reflect a social benefit to the work. I also wanted something valid and reliable, easy to use for secondary mental health service users and used widely enough for commissioners and funders to be able to recognise its value.
Q) How do you use the scale?
I’ve been using it since 2010 and the Mental Health Foundation uses the scale for all evaluations where we think it appropriate. We’re now using WEMWBS for two other projects; one with prisoners and another, in a community setting, for single parents.
Q) How do you find using the scale?
Very straightforward; we use a number of scales and this is one of the most positively received tools by both our funders and service users. I have encouraged a number of colleagues to use the scale.
Q) What are the worst misconceptions about mental wellbeing you come across?
That people with a psychiatric diagnosis don't have mental health needs.
Q) What two things would you recommend we all do to improve our wellbeing?
Have meaningful relationships and get a decent night's sleep
Q) What makes you happy?
Chocolate, cheese and decent red wine (though not all at once!). Oh, and any conversation with Sarah Stewart-Brown enhances my wellbeing!
More articles in this series:
There's something about the Danish Andrew Oswald and Eugenio Proto, Department of Economics
Is happiness in our genes? Claire Haworth, Department of Psychology
Is happiness homemade? Libby Burton, WMS, School of Engineering