In an excerpt of their article from the January/February edition of Mental Health Today, Alison Clare and Sharon Lee Cuthbert discuss the importance of the wellbeing approach to mental health services and how it is influencing training programmes. To read the full article, subscribe to the magazine here.

Since mental health services began moving from isolated institutions to local communities in the 1980s there has been a slow but steady shift in health and social care practice from an 'illness approach' to a 'wellbeing approach'. We no longer focus simply on people's problems and what they can't do - a deficit approach - but on people's potential and aspirations in all areas of their lives - a strengths approach.

Over the years, many different initiatives have driven this shift in focus. Although packaged in different ways, recovery models, person-centred planning, self-management and, most recently, personalisation all make the same point: we need to move away from seeing people just in terms of their diagnosis and work with them in defining their own goals.

The concept of 'wellbeing' has permeated all areas of society. For example, The Office for National Statistics is currently developing new measures of national wellbeing, which will cover not just the economic performance of the UK but the quality of life of people as well. Schools are introducing activities such as meditation to promote the wellbeing of children and even leading supermarkets now have 'wellbeing' aisles. The concept of 'promoting wellbeing' is here to stay and is changing what mental health practitioners do.

Benefits for people with mental health needs  

Here are two scenarios that many practitioners will be familiar with. One involves a person already in contact with mental health services and the other is someone who may need mental health support in the future.

Scenario A:  

Adrian is 50 and lives at home with his wife. He tried to kill himself three years ago following bankruptcy and the closure of his business. After a compulsory hospital admission he is still depressed and being monitored by a community mental health nurse. His wife is frustrated because while she's at work Adrian spends his days in bed chain-smoking. The main goal in his care plan - apart from his medication and what should happen in a crisis - is to attend a local job club for people with mental health problems, which he occasionally attends, more regularly.

Scenario B:  

Phillip is 69 and has recently moved into an older people's housing scheme. The scheme manager, Joan, has encouraged Philip to join the weekly coffee morning but he is very shy and finds it difficult to make conversation with the other residents. Phillip has told Joan he is used to being busy but now spends a lot of time sitting on a bench outside. Joan has noticed he has become quite confused and forgetful and she is very concerned about him.

  • There are several features common to both these scenarios, and to many other real life situations, which illustrate the limitations of the illness/deficit approach:
  • Those closest to the service user are trying very hard to give support but are frustrated by the lack of help and don't know what else to do.
  • The service users have the potential to do more with their lives but the response to their needs is limited to what services are currently available and to their immediate problems.
  • There is an unspoken assumption that probably not much else can be done until there is some sort of crisis.

A worker taking a wellbeing approach could bring a new perspective to both these scenarios and to many other people in apparently hopeless situations. They could work creatively with those involved to come up with new ideas and interventions and foster a sense of hopefulness. This doesn't mean abandoning interventions that are intended to help people with their problems, but it does mean giving equal value to other initiatives that may take longer to have an impact, but which have the potential to make a big difference to how people feel and to the quality of their day-to-day lives.

How can learning help workers change their perception?  

The difference between an 'illness/deficit' and a 'wellbeing/strengths' view of people can be described as a 'threshold concept' (Meyer & Land, 2003) because it opens up a new way of thinking about people and, consequently, new approaches to mental health practice. Without this transformed way of understanding a worker cannot progress and begin to see how to change what they do in their day-to-day work.

Wellbeing as a threshold concept therefore presents a challenge to tutors to teach. The Pavilion learning programmes deal with this by using person-centred teaching and learning strategies that:

  • Start from where the learners are, rather than from where managers or trainers would like them to be
  • Break the concept down into small parts, building up slowly to the whole picture
  • Link the approach to everyday experiences and to how we think and feel as individuals.

For example, in Unit 1 of Working in Community Mental Health Care the first session includes an activity in which learners identify what the term 'wellbeing' means to them. Later, they think about the campaign to get us to eat five portions of fruit and vegetables a day as an example of promoting physical wellbeing; and relative effectiveness of self-directed change versus being told what to do.

About the learning programmes  

Both learning programmes have been designed to support learners to achieve a full City & Guilds Award or Certificate in Working in Community Mental Health Care (Level 3) or Promoting the Mental Health and Well-being of Older People (Level 2 or 3). Units 1 and 2 of Working in Community Mental Health Care are also option units in the Diploma in Health and Social Care.

In the current economic climate many organisations are unable to fund qualifications for their staff but the learning programmes can also be used on their own to deliver in-house and work-based training programmes, including cultural change programmes.

To find out more about these learning programmes search the Pavilion website at For more information about the qualifications search the City & Guilds website at using the following codes: 3561 for Working in Community Mental Health Care and 3062 for Promoting the Mental Health and Well-being of Older People.

For a list of references and to read the article in full pick up your copy of Mental Health Today Jan/Feb 2012 here.