AHSW's Director, Trustees, and Members reflect on various aspects of arts, health and wellbeing.

The Wellbeing Evidence Base

Two recent reports contain contradictory messages on measuring wellbeing with regard to mental health and to the wider determinants of health in relation to policy making. In this short piece, AHSW Director Alex Coulter aims  to summarise the perspectives of the Chief Medical Officer and the All Party Parliamentary Group on Wellbeing Economics and ask how this will impact on our approach to arts, health and wellbeing.

The recent annual report by the Chief Medical Officer, Sally Davies, throws into doubt the evidence base for wellbeing in relation to mental health. This affects those working in the arts and health because many of us see the arts and culture as contributing to both community and individual mental wellbeing. One of the most popular measurement tools that arts and health practitioners use is the Warwick Edinburgh Mental Wellbeing scale. Sally Davies reviews the evidence and concludes that wellbeing doesn’t have a sufficiently robust evidence base commensurate with the level of attention and funding it receives in public mental health at national and local government level. She emphasises that she only refers to wellbeing evidence with regard to mental health not as it applies more broadly across the business of Government or indeed to ‘health’ more generally and welcomes the consideration of the wider determinants of health in policy making. She asks us to take the lead from WHO and frame the subject as ‘mental health promotion’, ‘mental illness and prevention’ and ‘treatment and rehabilitation’. This seems to me to be an issue of language and definitions as much as one of evidence.

In parallel to this the recent report: Wellbeing in Four Policy Areas, published by the New Economics Foundation on behalf of the All Party Parliamentary Group on Wellbeing Economics, argues that wellbeing evidence is gaining in credibility and influence across four areas: labour markets; planning and transport; mindfulness in health and education; and arts and culture. Last week I attended the launch of the report where former UK Cabinet Secretary Sir Gus O’Donnell argued that improving mental health is at the core of wellbeing issues. He is an economist by background and absolutely focused on the evidence base. His Legatum Commission on Wellbeing and Policy report states that mental illness should be treated as professionally as physical ill health and people with depression and anxiety should have access to treatment on exactly the same basis as people with physical illness. The report shows how to measure wellbeing, how to analyse it and how to act on it.


There is no contradiction between the position of Sally Davies and Sir Gus O’Donnell on the need for parity of esteem between mental health and physical health. It has also been in the recent news with Nick Clegg placing it at the heart of his party conference speech. Despite the rhetoric, recent developments have seen mental health services suffer significant funding and staffing cuts. Everyone seems to agree that the impossible task is to shift resources from acute services to a focus on prevention.

I don’t understand how we can separate wellbeing in relation to the wider social determinants from wellbeing as an issue relevant to mental health. Surely if we are focusing on mental health promotion, resilience and prevention we are talking about the general wellbeing of the population and the wider social determinants such as access to green spaces, secure employment, education and the richness of a rewarding cultural life are key to this. The wellbeing word, if language is the issue, is well and truly in general parlance now and I think we all know what it means in an instinctive way. The New Economics Foundation defines it here. The Care Act makes a statutory requirement for Local Government to place wellbeing at the heart of delivering services. I am now quite confused about how we articulate this in relation to mental health promotion and resilience building and how we apply it practically to our work and measuring outcomes.

I would welcome your views on this knotty subject – if you’d like to send your thoughts, please email me.

Alexandra Coulter
Director, Arts & Health South West.

November 2014

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