In brief: Achieving buy-in and support for a mental health agenda within an organization starts with clearly defining the concept of “mental health” in a manner that is succinct, memorable and easy to share. Without a cohesive understanding around mental health, it is challenging to mobilize people in favor of the cause. There are many definitions of mental health that exist but I find that one of the most accessible, personally relevant and understandable explanations is conveyed in a diagram based on Corey Keye’s work around the notion of flourishing. Here I adapt Keyes’s work in order to create a new visual piece (above) for your consideration that takes into account the environmental determinants of mental health.
Note: I talk about mental health strategy development here within the context of my work as mental health coordinator for two major post-secondary institutions in Ontario.
How do you design conditions that shift the thinking, actions, and attitudes of a group of people organized around a particular mission or goal?
It’s tough. I would never assume organizational change to be a trivial task, particularly when one is looking to produce a system-wide cultural shift around mental health. Mental health is often a challenging, interrelated and ambiguous concept as it captures a large slice of the “health and wellness” pie, and is influenced and constructed in multiple ways. Accordingly, it is difficult to find a way to fully capture the social, historical and cultural complexity embedded within the term “mental health” in a few words. Generally speaking, people also tend not to identify with mental health as being a core aspect of their livelihood as it is commonly assumed that “mental health = mental illness, so it doesn’t affect me.” However, unless “mental health” itself is well understood within an organization, rolling out a mental health strategy is tough to achieve. Fertile ground for change starts with a clear definition. Here are some I have been working with that are widely used in public health:
The capacities of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections, and personal dignity (Public Health Agency of Canada)
Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community. (WHO)
These definitions are helpful for the most part, but are arguably challenging to remember, rather intangible and aren’t necessarily worded in a way that is memorable. They also do not explain the relationship between mental health and mental illness, the latter of which is commonly understood as being synonymous with mental health and helpful to differentiate. This is not to say these definitions aren’t easy to understand per se, more that it can be difficult to personally relate to them. Expecting someone, particularly one who does not have a public health background, to relay this language/wording to someone else may not be an easy task…at least that’s what I’ve found from my experience.
There is however one explanation of mental health from Corey Keyes that I have found most helpful. Keyes introduces the notion of the Mental Health Continuum, an understanding of mental health that is grounded in positive psychology, happiness and the concept of flourishing. He describes the “…operationalization of mental health as a syndrome of symptoms of positive feelings and positive functioning in life. It summarizes the scales and dimensions of subjective well-being, which are symptoms of mental health. Whereas the presence of mental health is described as flourishing, the absence of mental health is characterized as languishing in life.”
Unlike the other definitions offered, it is the visual representation of Keyes’s concept of mental health that is most powerful. Figure 1 (below) is adapted from Mental Health for Canadians: Striking a Balance (the original diagram available at CMHA Ontario) and visualizes the continuum of mental health:
- Y-axis: Optimal mental health (aka Flourishing) at one end vs poor mental health (aka Languishing) at the other
- X-axis: Serious mental illness at one end and no symptoms of mental illness at the other
As such, a person can be flourishing with or without symptoms of a serious mental illness. At the same time, one can be in poor mental health and yet living without mental illness symptoms.
All of the explanations above have their strengths and weaknesses, but there is something in particular I like about the visual as a starting point: It embodies the simplicity and complexity of the concept of mental health, all at once. I have found this to be one of the best ways to describe mental health because I am not limited by my own words, rather, I have a tangible map of mental health that is applicable to everyone: We all fit along these continuums and can locate ourselves with respect to where we are at now and where we might want to be. For me, this has been an excellent health communications tool. Not only is the visual easier for people to remember, it does not require a linear or fully verbal explanation.
As you can see in the visual above, I decided to take Figure 1 two steps further. Figure 1 is helpful but limited in that it conveys a more individualized understanding of mental health. Consequently, it visually misses the social and cultural conditions that are also at play in shaping mental health experiences. Alas, Figure 2 offers a third continuum labeled as “environments” (z-axis) that aims to represent external determinants within the greater community/organizational ecosystem that affect mental health. Finally, I added Figure 3 as a way of illustrating where can set our goals when it comes to building a mentally healthy organization. Thus with or without the presence of a mental illness, we should be striving to support people and designing environments where optimal mental health can be achieved.
As always, your thoughts and feedback are appreciated in the comments below. To me, the third dimension of “environments” is a helpful construct — I’d be curious to know if you think this helps portray a fuller picture of mental health. While it may not always make sense to use a visual explanation for mental health, I think it certainly has a lot of utility and carries with it a depth of meaning that could not otherwise be conveyed through words or text alone.