Personal Wellbeing Plays Increasing Role in Our Field

Behavioral health remains a decade behind health, and the United States remains a decade behind progressive countries in the implementation of personal wellbeing as a foundational societal measure. Personal wellbeing—the level of satisfaction and happiness one derives from an overall assessment of one’s life—is exceptionally important because it occurs at the intersection of one’s overall physical and mental wellbeing and one’s community wellbeing.

Beginning in 2010, the Affordable Care Act introduced the concept of “person-centered care,” which provided a necessary philosophical underpinning for initiating a transition from a deficit-based to a strength-based approach for behavioral care and healthcare. Although this transition is far from complete, it now is well underway. Personal wellbeing is an essential strengths-based measure that parallels a strength-based approach to care.

At about the same time, work in the United States and elsewhere highlighted the critical role that community wellbeing plays in one’s personal wellbeing, and vice-versa. A low level of personal wellbeing, including physical and mental wellbeing, is very closely associated with a low level of community wellbeing. The latter is based on the relative balance of positive and negative life determinants in a community and their relative strengths.

From these foundations, the Substance Abuse and Mental Health Services Administration (SAMHSA) worked with primary behavioral health consumers to define personal wellbeing. Eight dimensions were identified, 4 of which come primarily from the person (physical, mental, spiritual, and intellectual), and 4 of which come primarily from interaction with the community (social, job, financial, and housing). Collectively, a person’s overall assessment of these eight domains comprises that person’s personal wellbeing.

Deployment of the 8 wellbeing domains, especially on a population level, can produce very useful information. One can learn how the different domains correlate with each other, e.g., how mental wellbeing relates to physical wellbeing. Further, one also can begin to understand how the life determinants operate through the community domains to influence mental and physical wellbeing, an issue of great current concern.

For 2022, the CDC’s National Center for Health Statistics has begun to include a life satisfaction measure in the National Health Interview Survey. Life satisfaction is a good proxy for overall personal wellbeing. This question asks: “In general, how satisfied are you with your life? Are you very satisfied, satisfied, dissatisfied, or very dissatisfied?” “Refuse to answer” and “don’t know” are also provided as response choices. Once data from this survey become available, we will be able to begin to develop a very general picture of personal wellbeing in the adult US population.

Two questions remain for us: First, how can we incorporate all this work into the outcome and performance assessments undertaken in behavioral healthcare programs? Second, how can the national work be broadened to incorporate the additional detail that would be available from the domains developed by SAMHSA?

As behavioral healthcare moves progressively closer to a strength-based approach to care, “first-person” accounts of the recovery journey and personal wellbeing will become integral. Primary consumers should ask to have personal wellbeing measures included in their care. Payers should do so as well.

International developments will continue to influence personal wellbeing measurement at the national level. Although the United Kingdom, New Zealand, and several European Union countries have been conducting national wellbeing surveys for some time, more dramatic recent developments also have occurred. The UK has created a National Health and Wellbeing Directorate designed to “save lives, promote wellbeing and create environments where individuals, families, and communities can feel informed, empowered, healthier and happier.” New Zealand has been even bolder by instituting a national wellbeing budget. In 2022, the country already is in its fourth wellbeing budget, under which “New Zealanders' overall wellbeing drives the decisions we make, and we measure progress on a broader range of measures than the more traditional fiscal and economic considerations.” Clearly, we need to broaden our awareness of these important developments and advocate that the US adopt them as well.

Increasing the personal wellbeing of behavioral health clients and increasing the equity in personal wellbeing across different population groups and geographical areas are both very worthwhile social justice goals. Better personal wellbeing can lead to a better society for all of us.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.