Mental Wellness

The University of Louisville has around 3,000 employees, and provides health insurance to most of those workers. The insurance program makes it possible to assess the health status and needs of this workforce, and this information is used to plan programs for improving employee health, seeking ways to manage employee health costs. Of course, information about individual workers is absolutely confidential, but even composite statistics for the workforce as a whole are not routinely broadcast to the community. For example, the University doesn’t necessarily want the public to know how many workers are HIV positive, or how many employees have attempted suicide.

Recently it was made public, barely, that the most common type of prescription drug taken by University employees is an anti-depressant. This is not unique to U of L, but would be typical in most employee groups. Depression is very common among Americans in general. I’ve been thinking about this from a health promotion perspective, and wonder what are the implications for improving health versus responding to illness.

There is a concept of wellness, which traces its roots at least as far back as 1948, with the adoption of the World Health Organization’s constitution. That document includes the famous definition: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The phrase “not merely the absence of disease..” lays out the wellness concept. You can be given certification by a physician that you have no illness, but you can then adopt practices to become healthier still. Included in the wellness concept is also that health is not a dichotomy with which people can be categorized as sick or well. Instead, it is a continuum running from death bed to optimal health; while terminal illness is definable and easy to recognize, optimal health is an ideal, something to which people can strive, but never be really certain when it has been attained. Part of wellness is in the journey towards better, not the destination itself.

We have spent decades since 1948 identifying and promoting ways to promote wellness in the physical dimension. People are used to finding exercise and diet programs in their communities, at their workplaces, in their faith communities, and through out mass media. While there are certainly many sedentary people who eat terrible diets, it is now accepted as normal to be surrounded with information and resources to promote wellness focused living.  Given the extent of mental disease, and the proportion of the population with emotional problems, it is a significant gap in health promotion that relatively little is done to strengthen mental wellness in the population.

Part of this gap is because mental health and disease knowledge is in a relatively primitive state of developoment.  There have been public assertions that much of the practice of community therapists is based on anecdotes and tradition, rather than science-based diagnostic and treatment principles.  Whereas we have lots of data which outlines goals for wellness enhancement, such as diet, exercise, smoking cessation, sleep, and sun exposure moderation, the evidence is much less certain regarding how to promote mental health.

There are dietary supports for good mental health, including adequate intake of B vitamins.  However, usually people have adequate B vitamin intake even if their diets are high in salt, sugar, and fat.  B vitamin deficiency is now more common among senior citizens who have a diet very limited in variety and calories, and among young people with eating disorders who just are not eating enough.  For those groups, vitamin deficiency imparied thinking and emotional adjustment may be something which could be prevented.

Maybe we should promote happiness.  There is actually a field of study called "happiness science," in which psychologists conduct research to better understand what makes people happy, and how it might be promoted.  This is a very small field that does not attract very many research dollars.  There is even some debate about whether happiness is objective enough to warrant attention by serious scientists.  Recently there have been reports that peoples' happiness grows with increasing income, to the point where their income is sufficient to meet all their basic needs, followed by a plateau in which happiness remains constant in spite of growing personal wealth.   Perhaps related to this are the findings of the World Values Survey, which among other things, assesses the happiness of international survey subjects.  In their rankings, the U.S. is not number one, but is in the top ten. In the first and second slots are Venezuela and Nigeria.  This certainly raises questions about the validity of the survey methods.  It does illustrate that happiness is difficult to define for a group or an entire nation, and therefore difficult to measure.

Some people claim that participation in faith communities promotes happiness and mental health, primarily through social support and relationships which naturally occur, and a promised sense of peace of mind from religious devotion.  Unfortunately, the evidence is mixed regarding how mental health is impacted by religious observance and participation. 

There is another construct called meaning in life, often traced back to Viktor Frankel, who's book "Man's Search for Meaning," lays out a basis for happiness, fulfillment, and purpose through meaning in life.  Having a strong sense of meaning in life does not preclude mental health problems, because many mental diseases are biochemically based, and as far as we know, unrelated to our lifestyles or anything we do to be mentally well.  Nevertheless, is seems certain that one way to promote mental wellness is to find ways to instill in children and adults a sense of mission and purpose, that what they are doing matters, beyond meeting their daily needs.  People should relate to the world in such a way that day to day activity, whether fun, exciting, and pleasant or not, is connected to a bigger purpose that matters and is fulfilling.  This trait falls on a continuum with some people totally disconnected from any meaning while others are fully in tune with a big purpose.  Unfortunately, it is not at all clear why some people sense meaning to their lives and others not so much, nor how to promote this trait.

When one thinks about the large number of people who struggle with mental illness of all sorts, and the many people who report being unhappy, and the large numbers of people who are drawn to self-medicating their unhappiness, anxiety, and lack of purpose with mind altering drugs, it is clear that health promotion advocates need to invest far more time in finding ways to promote better mental health in the population.

Where do we start?