Jenny Secker

The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation

BackgroundThere is increasing international interest in the concept of mental well-being and its contribution to all aspects of human life. Demand for instruments to monitor mental well-being at a population level and evaluate mental health promotion initiatives is growing. This article describes the development and validation of a new scale, comprised only of positively worded items relating to different aspects of positive mental health: the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS).MethodsWEMWBS was developed by an expert panel drawing on current academic literature, qualitative research with focus groups, and psychometric testing of an existing scale. It was validated on a student and representative population sample. Content validity was assessed by reviewing the frequency of complete responses and the distribution of responses to each item. Confirmatory factor analysis was used to test the hypothesis that the scale measured a single construct. Internal consistency was assessed using Cronbachs alpha. Criterion validity was explored in terms of correlations between WEMWBS and other scales and by testing whether the scale discriminated between population groups in line with pre-specified hypotheses. Test-retest reliability was assessed at one week using intra-class correlation coefficients. Susceptibility to bias was measured using the Balanced Inventory of Desired Responding.ResultsWEMWBS showed good content validity. Confirmatory factor analysis supported the single factor hypothesis. A Cronbachs alpha score of 0.89 (student sample) and 0.91 (population sample) suggests some item redundancy in the scale. WEMWBS showed high correlations with other mental health and well-being scales and lower correlations with scales measuring overall health. Its distribution was near normal and the scale did not show ceiling effects in a population sample. It discriminated between population groups in a way that is largely consistent with the results of other population surveys. Test-retest reliability at one week was high (0.83). Social desirability bias was lower or similar to that of other comparable scales.ConclusionWEMWBS is a measure of mental well-being focusing entirely on positive aspects of mental health. As a short and psychometrically robust scale, with no ceiling effects in a population sample, it offers promise as a tool for monitoring mental well-being at a population level. Whilst WEMWBS should appeal to those evaluating mental health promotion initiatives, it is important that the scales sensitivity to change is established before it is recommended in this context.

Promoting independence: but promoting what and how?

‘Promoting independence’ is a central theme of recent United Kindgdom health and social care policy development but is rarely defined. Instead it is generally assumed that we know what independence means. Based on a review of the literature on independence in older age, this paper examines the terms and meanings. While the most common conceptualisation equates independence with the absence of reliance on others, for older people themselves independence is a broader concept that encompasses not only self-reliance but also self-esteem, self-determination, purpose in life, personal growth and continuity of the self. Drawing on previous work in the field of health promotion, we therefore put forward a model that takes older peoples views into account and that reconceptualises independence as two intersecting dimensions representing levels of dependence and levels of independence. While dependence equates with reliance on others, independence can be seen as subjectively self-assessed lived experience. Thus it becomes possible to combine high levels of dependence with high levels of experienced or felt independence, a particularly pertinent combination for service providers. Finally we examine the ways in which independence thus conceptualised can be promoted at the individual, institutional, community and societal levels.

Evaluating the impact of participatory art projects for people with mental health needs

Participatory art projects for people with mental health needs typically claim outcomes such as improvements in confidence, self-esteem, social participation and mental health. However, such claims have rarely been subjected to robust outcome research. This paper reports outcomes from a survey of 44 female and 18 male new art project participants attending 22 art projects in England, carried out as part of a national evaluation. Outcomes were quantified through self-completed questionnaires on first entry to the project, during January to March of 2006, and 6 months later. The questionnaires included three measures: empowerment, mental health [Clinical Outcomes in Routine Evaluation (CORE)] and social inclusion. Paired t-tests were used to compare overall change, and mixed model repeated measures analysis of variance to compare subgroups, including age, gender, educational level, mental health and level of participation. Results showed significant improvements in empowerment (P = 0.01), mental health (P = 0.03) and social inclusion (P = 0.01). Participants with higher CORE scores, no new stress in their lives and positive impressions of the impact of arts on their life benefited most over all three measures. Positive impressions of the impact of arts were significantly associated with improvement on all three measures, but the largest effect was for empowerment (P = 0.002) rather than mental health or social inclusion. This study suggests that arts participation positively benefits people with mental health difficulties. Arts participation increased levels of empowerment and had potential to impact on mental health and social inclusion.

The state of arts and health in England

This paper provides an overview of the current state of the arts and health field in England, through an examination of practice, research and policy developments. Five features of arts and health practice are identified: the scale of the sector, regional variations, mapping of arts and health initiatives, recent conferences and symposia, and the role of key agencies supporting arts and health initiatives. Eight areas of arts and health research activity are considered: retrospective qualitative evaluations, prospective evaluations with some quantitative assessments, experimental research on arts and health initiatives, economic evaluations of arts interventions, systematic reviews of arts and health research, theory development to underpin research efforts, and the establishment of dedicated arts and health research centres and research programmes. The final section considers three 2007 arts and health publications from the Department of Health and Arts Council England. There has been disappointment that the policy recommendations in these documents have not been acted upon. At the time of writing, however, there are some signs of renewed efforts to encourage national leadership from the Department of Health.

Recovering from Illness or Recovering your Life? Implications of Clinical Versus Social Models of Recovery from Mental Health Problems for Employment Support Services

Although valuable research has been undertaken in the United States little is yet known about the processes engaged in by supported employment projects for people with mental health problems. The study reported here explored these processes using semistructured interviews with employment project clients, their project workers and workplace managers. Of five projects involved in the research, two exemplified radically different approaches, one implicitly underpinned by a clinical model of recovery and the other by a social recovery model. In this article we draw on data from the seven cases studied from these projects to describe the two approaches and to consider their strengths and limitations. We conclude that approaches based on the social recovery model hold more promise, although such approaches would be enhanced through greater liaison with mental health professionals. In addition, funding structures are required that take account of job retention rates, rather than placement rates alone.

Mental health service users' experiences of returning to paid employment

Research into mental health and employment has focused largely on people who are unemployed. This paper reports the experiences of 20 clients of employment support agencies who had succeeded in returning to work. A number of barriers to getting back to work were identified, but receiving employment support could enable people to overcome them. There was consistency with previous studies of factors associated with high and low levels of job satisfaction. Even those participants who were less satisfied with their jobs identified benefits and none described any negative effects. The quality of the employment support provided was important, including advice and counselling during the job search, enabling informed choice about disclosure and support in work. Job retention targets are required for funding programmes in addition to placement targets. Further research into the timing and processes of disclosure and into occupational health screening processes would be helpful.

Mental Health and arts participation: the state of the art in England

Although participation in arts activity is believed to have important mental health and social benefits for people with mental health needs, the evidence base is currently weak. This article reports the first phase of a study intended to support the development of stronger evidence. Objectives for the first phase were to map current participatory arts activity, to identify appropriate indicators and to develop measures for use in the second phase of the research. A survey of participatory arts projects for people with mental health needs aged 16 to 65 in England, identified via the Internet and relevant organizations, was carried out to map the scale and scope of activity and to establish the nature of current approaches to evaluation. The results indicate that the scope of activity, in terms of projects’ settings, referral sources, art forms and participation is impressively wide. In terms of scale, however, projects reported low funding and staffing levels that may have implications for the feasibility of routine evaluation in this field. Current approaches to evaluation were limited, but entailed considerable effort and ingenuity, suggesting that projects are keen to demonstrate their benefits. The survey has enabled us to build on the best evaluation practice identified to develop a measure for assessing the mental health, social inclusion and empowerment outcomes of arts participation for people with mental health needs. For the second phase of the study we will work with arts and mental health projects, using the measure alongside qualitative work in a realistic evaluation design, in order to identify the characteristics of effective projects.

Development of a measure of social inclusion for arts and mental health project participants

Background: Promoting the social inclusion of mental health service users is a UK policy priority, but the development of outcome measures in this area is at an early stage. Aim: To develop a social inclusion measure for use in a study assessing the outcomes of arts participation for people with mental health needs. Method: Concept and question development based on literature review, national and European surveys and results of a survey of arts and mental health projects. Measure piloted with 23 arts participants/service user researchers and field tested with 88 arts project participants returning questionnaires including the social inclusion measure, a measure of empowerment and the CORE mental health measure. Results: Three scales were constructed measuring social acceptance, social isolation and social relations. Internal consistency was good for the individual scales and for the measure as a whole. Correlations with empowerment and CORE scores indicate reasonable predictive power for the population. Conclusions: Tests to date indicate the measure is acceptable and measures relevant concepts with good internal consistency. Test-retest reliability and construct validity are not established and replication is required to confirm internal consistency and establish a normative profile for the population.

The how and why of workplace adjustments: contextualizing the evidence.

PURPOSE To identify the problems experienced in the workplace by service users returning to work and to explore how and why adjustments can help overcome them. METHOD Semi-structured interviews were carried out with 17 people in five employment projects and with their workplace managers. Interviews were tape recorded, fully transcribed and analyzed to identify and compare emerging themes. RESULTS Problems experienced by individuals included low energy and stamina levels, lack of confidence and psychological barriers to particular types of work. Adjustments to working hours, work schedules and job tasks proved crucial for some people in enabling them to overcome these problems.

Empowerment and arts participation for people with mental health needs

Empowerment has been described as the ‘holy grail’ of health promotion. This article describes an evaluation of arts participation for people with mental health needs that both measured empowerment outcomes and explored the processes by which positive outcomes were achieved, through six qualitative case studies. For the outcomes study, 62 arts and mental health project participants returned a questionnaire, including a measure of empowerment, soon after joining their project and again six months later. The follow‐up questionnaire asked participants to rate the impact of their arts involvement on the issues addressed in the measure. Six diverse arts and mental health projects took part in the case studies. Interviews with project participants explored what they saw as the benefits of arts involvement and how these came about. Results from the outcomes study showed significant improvements in empowerment and were suggestive of a strong causal link with arts participation. Analysis of the case study interviews revealed five processes through which benefits relating to empowerment were brought about. We argue that psychological empowerment is in itself important for people with mental health needs. In addition, our case studies indicate that some arts and mental health projects do empower participants at a social as well as individual level.