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Measuring mental health

The final part of this chapter considers what can or should be done to measure mental health. Clearly, from the arguments already made, those who think mental health is the absence of mental illness will make a different measurement from those who take a salutogenic view. Those who see it in individualistic terms will measure it differently than those who look at mental health in population terms.

Stewart-Brown argues that many current population surveys tend to measure the prevalence rates of mental illness rather than of mental health. Instruments such as the General Health Questionnaire that do measure positive aspects of mental health tend to skew the results so that most of the population reports near perfect mental health and thus offers little room for improvements. Stewart-Brown surveyed six instruments against 17 different aspects of mental health: both positive and negative. Illustrating the earlier point, one of these instruments (the Psychological Well-being scale; see Ryff and Keyes (1995)) concentrates on those elements of mental health identified through a literature review as being considered important by psychotherapists. Another instrument (the General Health Questionnaire; see Goldberg and Hillier (1979)) includes elements such as happiness, optimism and resilience, but excludes what Stewart-Brown identifies as, ‘widely regarded components of positive mental health’ such as assertiveness, autonomy and agency. The instrument that comes out as being the most comprehensive is the Affectometer 2 scale. This instrument uses two sets of questions with Likert-type responses: one about yourself (for example, ‘My life is on the right track’; ‘I wish I could change some part of my life’), and one about how you feel (for example, ‘I feel: satisfied; impatient; confident; loving; helpless’).

However, this instrument has no element regarding ‘autonomy’ which some may regard as too important to omit. There is a need to see how well the Affectometer scale (developed in New Zealand) transfers to the UK, and how sensitive it is in detecting changes in population mental health. There is also an international need. A report in 2005 from the WHO observed that ‘internationally agreed measures of the mental health of populations are often inadequate or unavailable and lack relevance to policy’. Measuring the mental health (not just the absence of disease) of whole populations would enable truer international comparisons to be made. Stewart-Brown (2002) also argues that population measures of positive mental health are needed because:

Mental health does not fit into traditional epidemiological distributions, which means that there is no obvious cut off point within a population that could be used as a targeting device.

Any empirical evidence for the effectiveness of mental health promotion work is only going to be generated if there are ways of measuring the mental health status of populations, and if these can be fairly compared pre and post intervention.

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