Nottingham Insight

Introduction

Mental wellbeing has been defined by the World Health Organisation (WHO) as “a state of wellbeing in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” (WHO, 2014).

As a result of the debate around measuring happiness, the Government launched the National Wellbeing Programme in 2010 so that policies could be developed around “things that matter” (DH, 2010).  The Care Act (2014) sets out the duty of local authorities to apply the ‘wellbeing principle’ using a holistic approach when carrying out their care and support functions.

Positive wellbeing is described as being linked to improved life expectancy and greater life satisfaction (ONS, 2015).  Research shows that people with higher levels of wellbeing are more likely to make healthier lifestyle choices thus reducing the risk of illness and premature mortality (ONS, 2015).  Improving wellbeing can also be associated with factors such as employment, parenting, domestic violence and education that can be the cause or the result of wellbeing thus presenting a two-way relationship. 

Factors such as life expectancy and levels of unemployment are used as objective measures of wellbeing while factors including how people actually feel and overall satisfaction with life and levels of anxiety are considered as subjective measures of wellbeing. Subjective measures are vital to understand how people feel and what matters to them as well as objective measures such as the prevalence of certain issues (DH, 2010).  This chapter focuses on subjective personal mental wellbeing from a public health perspective in the context of wellbeing measures overall. This falls within the ‘personal wellbeing’ domain of the ten domains of wellbeing in the ONS National Wellbeing Measures.

Nationally, the ONS uses a simple four-question format to broadly target what it considers the most important aspects of mental wellbeing while locally in Nottingham the 14-item Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) is used to measure mental  wellbeing.  

The lowest 10% of all WEMWBS scores in the Health Survey for England (HSE, 2012) were associated with a number of potential risk factors indicating possible associations and causes. These included marital status, education status, area deprivation, GHQ12 (12-item general health questionnaires, used commonly to assess psychological morbidity) scores, self-reported general health, provision of informal care and depression and anxiety.  The ONS (2015) also identified worklessness and loneliness as being linked with wellbeing. Locally in Nottingham, the average mental wellbeing score of 52.2 for 2014 has been similar to last year’s score and in line with England but there is variation in mental wellbeing across different group and areas with highest proportions of people with poor mental wellbeing scores being those who have a disability or long term illness, people who are unemployed or ‘Otherwise not in paid work’ and those in social rented housing.

The National Mental Health Strategy, No Health Without Mental Health (2011) sets out the promotion of wellbeing to improve mental health and prevent mental health problems as one of its key priorities.  Locally, The Nottingham Plan to 2020 aims to reduce the proportion of adults with poor mental wellbeing.  The Nottingham City Mental Health and Wellbeing Strategy, Wellness in Mind (2014) also prioritises building wellbeing and resilience in order to prevent mental health problems (Nottingham City Council, 2014).

It is important to note that while mental wellbeing and mental illness are closely linked they are not different ends of the same spectrum and exist in parallel. Therefore good mental wellbeing is not simply the absence of mental illness. For example a person with a severe bipolar disorder may report good mental wellbeing despite experiencing mental illness while a person in poor physical health on a low income may report extremely low levels of mental wellbeing in the absence of an established mental health condition.

This chapter covers wellbeing primarily in adults, although wellbeing across the life course is influenced in many cases by childhood experiences, particularly during the first five years of their lives (DH, 2014). For further information on children and young people’s wellbeing see relevant JSNA chapter.

Helene Denness – Consultant in Public Health Helene.denness@nottinghamcity.gov.uk

Liz Pierce – Insight Specialist – Public Health liz.pierce@nottinghamcity.gov.uk

Uzmah Bhatti – Insight Specialist – Public Health Uzmah.bhatti@nottinghamcity.gov.uk