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Measuring Mental Wellbeing

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What effect do lifestyle and the attitudes of those around us have on mental wellbeing and how can we best understand this? …

What effect do lifestyle and the attitudes of those around us have on mental wellbeing and how can we best understand this?

See Me (a government funded organisation tackling the stigma attached to mental health conditions in Scotland) wanted to determine current attitudes amongst children and young people. A collaborative approach with Face and Leith helped identify sensitive attitudinal data for which the results which were frightening, emotional and revealing in equal measure. These insights have informed a comprehensive communications and media strategy for See Me Scotland.

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  • Hello. We’re going to talk to you today about a really important aspect of wellbeing. Mental wellbeing or wellness.
  • This is us. I’m XX, this is Claire, Clare, Philip, Rachel and Suzie.
  • We’re going to chat to you for about 30 minutes about a couple of projects we’ve worked on that saw us exploring different areas of mental wellbeing. Rachel and Clare are going to talk you through a large scale quant project measuring mental wellbeing in the North West of England. And then Philip and Suzie are going to take you through a piece of online qual looking at attitudes towards mental ill-health amongst young people. We’re planning to leave 10 minutes for questions at the end of the session so store up all your burning questions til then if you please. And we’ll crack on.
  • Mental wellness or mental health is a complicated area when it comes to measurement. There are many different diagnoses. It’s a subject area that’s widely misunderstood, even by the people meant to be treating it. It often doesn’t have any physical or, more to the point, visible symptoms. It couldn’t be further from the neat (though uncomfortable) simplicity of breaking a leg like poor Pedro here. So when it comes to measuring mental wellness, we are faced with three challenges.
  • Most people with a mental health problem will tell you up front that you won’t be able to understand what they’re going through. So how to understand the impossible to understand?
  • Can it be quantified? Is there a scale of ‘wellness’?? Well, as it happens, there is. There are a couple of options. One of them is catchily called WEMWBS. And Rachel’s going to tell you a bit more about that shortly.
  • Will people really say what they think? When you’re trying to investigate such a sensitive area as attitudes towards people with mental health problems, it can be really difficult to get people to speak frankly. With kids, it can be a bit easier. This was the product of a co-creation session with young teenagers – what mental health means. But as soon as they get a little bit older, political correctness prevails. A piece of quantitative research in Scotland suggested that the general public is open-minded and supportive of people with a mental health problem. It’s only when you ask them about their behaviour in a series of imaginary scenarios that the truth begins to slip out. People were more than happy to socialise with, live next door to, make friends or work with people with a mental health problem. But less than half of the sample of over 1,000 adults would let someone with schizophrenia babysit for their child. But how close does this really get to the truth?
  • Finally, is it possible to learn stuff when discussing such a complicated and sensitive subject area that is genuinely insightful?
  • So, 3 challenges. Measuring mental wellness. Encourage people to be honest. Extract genuine insight from all the misconceptions and misunderstandings. Now we’ll take you through a couple of examples of how we tackled them.
  • Within the North West, as elsewhere, there’s been a growing interest in having local and regional quantitative data on mental health status and the determinants of mental health and well-being, in order to support local promotion strategies. Given the challenges of measuring mental health and wellbeing it’s perhaps not surprising that there is limited data available on the subject. Whilst there are data on a number of proxy indicators, it was felt that this survey could fill a gap in available data. The North West Public Health Observatory was commissioned to conduct the work on behalf of the Care Services Improvement Partnership; with the support of local PCTs and the Strategic Health Authority. CELLO mruk were commissioned to assist with survey design and conduct the fieldwork. A programme of 18 and a half thousand face-to-face household interviews were conducted last year across the region using a computer aided self completion methodology. The chosen design sought to provide a representative sample at a regional level, as well as by individual PCT. Therefore a minimum of 500 interviews were conducted in each participating PCT area. Each of these areas was then split into strata linked to index of multiple deprivation ranking. This sampling process ensured that a representative sample of the population was interviewed, while also allowing the data to investigate the relationship between deprivation and mental health and wellbeing.
  • Key to the success of this survey was the use of a computer aided self completion methodology to ensure that respondents answered honestly and in complete confidence. While this is a challenge for any survey, it is of particular concern when addressing such a sensitive issue to mental health and wellbeing. Interviewers also carried a letter of authentication from the respective PCT to provide further reassurance. The survey needed to stand up to scrutiny, so the selection of individuals within chosen households was also important. Consequently the person in the household with the next birthday was invited to take part, rather than the person answering the door. Fieldwork took place across all days and times of day to maximise participation, and measures were in place to ensure that respondents speaking minority languages and those with a disability were able to take part. Questions were thoroughly piloted to ensure that there were no comprehension issues and interviewers thoroughly briefed on the survey objectives. And because of the sensitivity of some of the question areas it was also important to put mechanisms in place for respondents should they become distressed. This included provision of contact numbers for various helplines and organisations, as well as the employment of highly skilled interviewers trained to deal with situations should they arise.
  • The survey used The Warwick Edinburgh Mental Well-being Scale ( or WEMWBS) which Claire referred to earlier. Research suggests that WEMWBS is a user-friendly tool for monitoring positive mental health for a population, and respondents have found it easy to understand, unambiguous and easy to complete. The question rates positive affect (by this we mean feelings of optimism, cheerfulness, and relaxation), satisfaction with interpersonal relationships and positive functioning (such as energy levels, clear thinking, self acceptance and personal development among others). Of course in addition to the WEMWBS scale, there were questions relating to other determinants of positive mental wellbeing. These covered perceptions of local area, social networks, relationships, general health, life events, lifestyles, financial situation and background questions. The resulting questionnaire took approximately 20 minutes to administer.
  • We do a lot of work with ‘see me’, a government funded organisation that tackles the stigma attached to mental ill-health in Scotland. Talking to young people before they grow into judgemental adults is a vital part of their remit. But how to find out what children and young people really thought about mental ill-health?
  • Alongside the online qual, we ran real life qual with 8 to 15 year olds. And the two pieces together helped us to narrow our focus on the age group where we could make most difference. We discovered that if we tried to talk to kids when they were too young, they just didn’t get it. This picture was drawn by a 9 year old - his take on mental health. The apple is angry – hence the angry face and his angrily waving arms. But as he’s an apple, he’s healthy…!
  • But by the time we got to the 17 year olds and up, they’d already made up their mind for the most part. No matter whether or not they started out with good intentions – or continued to have good intentions – their behaviour gave them away. It was clear that we had to try and catch young people when they were old enough to understand but not so old that they’d already made up their mind.
  • Following on from this, we ran a couple of co-creation sessions with our chosen audience, 13 to 15 year olds. This feisty bunch are a selection of them. And what came through really clearly from this was: They recognise, even at that age - that a mental health problem can make your life very difficult They show real empathy for individuals in that situation They want to help – but they don’t want to lavish attention on someone who doesn’t want it. Standing out from the crowd is the worst thing that most of them can imagine – unless it’s for a good reason! As a consequence, our suggested proposition – your support can make a difference for someone with a mental health problem – was rejected by them. They felt it was too formal, too pompous almost. They wanted their friends to be there but they didn’t want the heavy handedness that ‘support’ implied.
  • So we ended up with various permutations of this. Creatively executed in the follow-up session in all sorts of ways but one of our favourites was….
  • This.
  • In summary then, we hope we’ve demonstrated that there are a whole variety of ways to measure mental wellness. When you need to find out about numbers of people who are very mentally well – or very unwell – there are various existing scales of measurement that can be applied using a quantitative methodology to give you a result for a population group. When you’re looking at fluffier stuff – attitudes and opinions about mental health – we’ve used a variety of techniques with ‘see me’ including traditional qual, online qual and co-creation to uncover the truth about what – in this case – young people think. There aren’t any right or wrong answers. There definitely isn’t a one size fits all approach. But with a bit of smart thinking and imagination, it is possible to find answers that are real, honest and can help you move forward. Thank you.
  • Transcript

    • 1. measuring mental wellbeing Cello Wellbeing Conference 27.04.2010
    • 2. Clare Perkins, Deputy Director of the North West Public Health Observatory Claire Wood, Senior Planner, Leith Philip McNaughton, Research Director Rachel Cope, Regional Director, CELLO mruk research Suzie Vestri, Campaign Director of ‘see me’
    • 3. large scale quantitative project to measure mental health and wellbeing in England online & offline qualitative research to understand and explore the impact of the stigma attached to mental ill-health
    • 4.  
    • 5. “ It’s like trying to explain to somebody what a broken leg is like. You can talk about the pain till you’re blue in the face but until you actually snap the thing, you have no idea.” Male, 51, Lanarkshire, April 2010
    • 6. 1. Can it be quantified?
    • 7. 2. Can people be honest?
    • 8. 3. Making it meaningful
    • 9.
      • Measuring
      • Truth
      • Insight
    • 10. North West Mental Health & Wellbeing Survey “ to fill an identified gap in available data on well-being including aspects of lifestyle likely to impact on mental health”
    • 11. Measuring mental health quantitatively – the challenges
      • Gaining honest responses and building trust
      • Representativeness of respondents
      • Question comprehension issues
      • Respondent becomes distressed by questions
    • 12. Question areas Satisfaction with area Feeling safe WEMWBS Contact / interaction with others General health Life experiences Caring Physical activity / leisure Smoking, alcohol & drug use Financial worries Day-to-day difficulties Belonging
    • 13. Your Mental Wellbeing
    • 14. WEMWBS – Interpreting the Results Low wellbeing Moderate wellbeing High wellbeing
    • 15.
      • Mental Wellbeing Distribution
      • Gender – there is no difference between men and women;
      • Age – high mental wellbeing is highest among 25-39 year olds, but then decreases and is significantly lower among 40-54 year olds;
      • Deprivation – mental wellbeing reduces as deprivation increases.
      • Ethnicity – lower amongst white than non-white;
    • 16. Low, moderate and high wellbeing
    • 17.
      • Five Ways to Wellbeing
      • ‘ Connect’ - regularly meeting friends and neighbours
      • ‘ Be Active’ - reporting recommended levels of physical activity
      • ‘ Take Notice’ - strong feelings of belonging in the immediate neighbourhood
      • ‘ Keep Learning’ - having the time to do things you enjoy
      • ‘ Give’ - regularly participating in local groups and organisations
      All five ways to wellbeing are strongly associated with the WEMWBS categories.
    • 18.
      • Investment in effective mental health promotion;
      • Tackle health inequalities;
      • Aligned wellbeing policy;
      • Resilient communities;
      • Sustainable employment;
      • Five ways to wellbeing;
      • Mental Wellbeing Impact Assessment;
      • Further research and analysis.
      “ achieving a small change in the average level of wellbeing across the population would produce a large decrease in the percentage with mental disorder, and also the percentage who have [low levels of mental wellbeing]”. (Foresight) Recommendations
    • 19.  
    • 20. The brief To explore awareness of and attitudes towards mental health problems amongst 16 to 25 year olds in Scotland
    • 21. we built an online community of 40 young people aged 16-25 which run for 3 weeks 20 of them had no direct experience of mental health conditions or problems 20 of them did – either personally or through close friends and family
    • 22. perceptions, attitudes and experience around mental health and wellbeing mixed with communal forums to share views private diary work for personal opinions multi-media to allow participants to bring their own perceptions of mental health to life
    • 23. with some clear benefits trust & openness built over time anonymity for honesty hear real unmediated language
    • 24. I found other people to be particularly unhelpful ... I wished that someone would say something because it was always whispers but no actual talk of it. Some people eventually stopped calling and visiting and if they did speak to me then they would criticise and tell me to just snap out of it I did tell my best friend at the time who at first seemed happy I had told him but then he started to hang about with other people and exclude me and eventually not talk to me at all Raving mad loonies, schizophrenics and the like. Mad paranoid men in straight jackets and padded cells A guy in a room with padded walls The guy that’s got a split personality on Hollyoaks SSssshhh we don’t talk about things like that
    • 25. and some interesting areas for analysis of difficult issues exploring gaps between privately held views & open ‘posturing’ around mental health encourage participants to ‘peer review’ their own entries and views explore differences between immediate response & more considered views
    • 26. from the outside - perceptions of mental health are negative and centred around ill-ness rather than wellness people don’t consider and think about mental health or wellbeing existing on a spectrum sense of isolation from those suffering – and rejection from those around them main challenge to shift attitudes of young people towards an understanding and awareness of different degrees of mental wellness at the right time
    • 27.  
    • 28. The sad thing was that after a year of so, she had beaten the condition but along the way she had lost all of her friends due to her acting out and acting weird around us, now we are no longer close friends but we do talk from time to time Courtney Flynn, 18, secondary experience
    • 29.  
    • 30.  
    • 31.  
    • 32.  

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