Including a measure of mental wellbeing in the ONS Wellbeing Framework
Measuring National Wellbeing Technical Advisory Group Paper
Department of Health
April 2013
This paper provides the basis for discussion around the inclusion of a measure of mental
wellbeing, such as the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) in the ONS
wellbeing framework. It gives a brief background to mental wellbeing and why it is important.
It then gives four options for taking forward the inclusion of a mental wellbeing scale.
Technical Advisory Group members are asked to consider the information in this paper, discuss
the proposed options and provide a recommendation. Further comments and any issues relating
to this paper should be directed to Danielle De Feo ([email protected]).
1. Policy background
1.1. Mental wellbeing is more than just the absence of disease; it is a positive state of mind and
body, underpinned by social and psychological wellbeing. It enables and supports good
relationships, improved resilience, improved health, meaning, purpose and control.
1.2. Mental wellbeing is an important aspect of wellbeing and highlights the importance of positive
mental health in people’s overall wellbeing. The World Health Organisation (WHO) supports this
view and suggests that mental health is “the foundation for wellbeing and effective functioning
for an individual and for a community”i. The positive dimension of mental health is also
presented in the WHO definition of health: “health is a complete state of physical, mental and
social wellbeing and not merely the absence of disease or infirmary”ii.
1.3. The concept of mental wellbeing reflects how policy debates on mental health have matured in
recent years and lends itself to current policy language. Policy makers speak in a positive way
about wellbeing and health, for example the recent mental health strategy “No Health Without
Mental Health”iii gives six objectives, all of which are positive about mental health (e.g., more
people with mental health problems will recover). In England there is a drive to achieve ‘parity
of esteem’ between mental and physical health; that is, having the same emphasis on mental
health and wellbeing that is on physical health. This change in emphasis has been acknowledged
by a number of stakeholders and it is important that the ONS Measuring National Wellbeing
Framework reflects this current thinking in order to make the Framework useful for policy
makers.
2. Measuring mental wellbeing
2.1. The most widely known measure of mental wellbeing in the UK is the Warwick Edinburgh Mental
Wellbeing Scale (WEMWBS)iv. WEMWBS is a measure of mental wellbeing, developed by the
Universities of Warwick and Edinburgh, and funded by NHS Scotland.
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2.2. WEMWBS includes 14 positively worded items with 5 response categories (ranging from ‘all of
the time’ to ‘none of the time’) – see Annexe A. The minimum scale score is 14 and the
maximum is 70. A short version (7 items) has also been developed. WEMWBS covers most, but
not all, attributes of mental wellbeing including the hedonic and eudaemonic perspectives.
2.3. WEMWBS has been well validated, with good internal consistency and reliability, and no ceiling
or floor effects in a population sample. WEMWBS provides robust results for populations and
groups and is appropriate for those aged 16 and over. More recent testing shows WEMWBS is
also appropriate for children aged 13-16v.
2.4. The 14-item WEMWBS measure has been included in the Health Survey for England since 2010
and, along with the four ONS questions, is a component of the subjective wellbeing indicator in
the Department of Health’s Public Health Outcomes Frameworkvi. WEMWBS is also used as one
of the Scottish Government’s 45 national indicators, which will track progress towards the
achievement of the national outcomes and overall purposevii. WEMWBS data are also collected
in various other surveys, for example the short version is collected regularly though
Understanding Society.
2.5. Although there is not an established time series of WEMWBS at present, we are starting to build
trend data. For example, the measure has been included in the last four waves of the Health
Survey for England and it is intended to be collected every three years in Understanding Society.
3. ONS Measuring National Wellbeing Framework
3.1. The ONS Framework has been developed over the last few years and includes 10 domains.
Between October 2011 and January 2012, ONS launched a consultation on the first set of
domains and measures for the wellbeing programme, with a revised set of measures published
in July 2012.
3.2. One of the 10 domains is the health domain. Currently, the health domain includes the GHQ-12
as one of the indicators. GHQ-12 is a screening instrument of current mental health status and
focuses on two major areas: the inability to carry out normal functions, and the appearance of
new and distressing experiences. GHQ-12 is a well validated and well used measure of mental
health, however it is a screening instrument of mental illness, not a measure of mental
wellbeing. Using the GHQ-12 alone suggests that wellbeing is simply the absence of mental
illness, which is not the case (see paragraphs 1.1 to 1.3).
3.3. Including a measure of mental wellbeing alongside the GHQ-12 was recommended by a number
of stakeholders including the Department of Health during the ONS-led consultation on the
proposed domains and headline indicators for the wellbeing frameworkviii. As part of the
consultation, ONS also asked if the four ONS subjective wellbeing questions were appropriate
measures of subjective wellbeing. A number of responses suggested WEMWBS would be a more
appropriate measure for the individual wellbeing domainix.
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3.4. ONS have been keen to stress to stakeholders how the Framework is still being developed. From
on-going dialogue between the Department of Health and ONS, whilst ONS are anxious about
time series and UK coverage (WEMWBS has not been used in Wales or Northern Ireland as far as
we are aware), ONS have been open to including a measure of mental wellbeing, and were keen
for it to be discussed among Technical Advisory Group members.
4. Options for incorporating mental wellbeing in the wellbeing framework
4.1. We believe there are four options for taking forward this issue. These are presented below, but
in short, the four options are:
a) Incorporate WEMWBS in the health domain
b) Incorporate WEMWBS in the individual wellbeing domain
c) Incorporate an alternative measure of positive mental wellbeing into the framework
d) Do nothing; leave the domains as they currently are
a) Incorporate WEMWBS in the health domain
4.2. Include a measure of mental wellbeing such as WEMWBS in the health domain, alongside GHQ12, in order to provide a more balanced approach to understanding mental wellbeing. Both
measures are important and complement each other, however both are designed to measure
distinctly different things: GHQ-12 is a measure of symptomology and reflects the likelihood of a
person being a “case” of mental illness; WEMWBS is a measure of mental wellbeing.
4.3. Similarly, WEMWBS is a positive measure as all items are positively worded. By contrast, GHQ12 uses the deficit model for half of the items, which focuses on the negatives. This suggests
WEMWBS is more in line with the current policy thinking and language in this area.
b) Incorporate WEMWBS in the individual wellbeing domain
4.4. Currently the subjective wellbeing measures in the Framework are the four ONS questions.
These questions cover a number of dimensions of subjective wellbeing, however they do not
currently incorporate the psychological perspective.
4.5. Given WEMWBS measures the psychological aspects of subjective wellbeing, there is a case for it
to be included alongside the four ONS questions in order to give a more holistic view of
subjective wellbeing. Similarly, incorporating WEMWBS in the individual wellbeing domain is in
line with the WHO view that positive mental health underpins wellbeing and functioning.
c) Incorporate an alternative measure of positive mental wellbeing into the framework
4.6. Whilst the focus of this paper has been on the inclusion of WEMWBS into the ONS wellbeing
framework, there may well be other measures of mental wellbeing which should be considered
instead of WEMWBS. As far as the Department of Health is aware, WEMWBS is the best
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measure of mental wellbeing given how thoroughly it has been developed and validated and
already used in a number of studies.
d) Do nothing; leave the domains as they currently are
4.7. If the domains are left as they currently are, the inclusion of GHQ-12 alone in the health domain
suggests that wellbeing is simply the absence of mental illness, which is not the case and does
not reflect policy thinking both nationally and internationally.
4.8. Leaving the domains as they are will not result in a fully comprehensive view of wellbeing as
positive mental wellbeing is not currently included in the framework. Positive mental wellbeing
is a crucial component to wellbeing, and a measure should be included.
5. Discussion points
5.1 In forming a view and making a recommendation to ONS, Technical Advisory Group members
may want to consider the following points:
Should the ONS Measuring National Wellbeing Framework include a measure of mental
wellbeing?
If so, is WEMWBS the best measure?
Are there any alternative measures of mental wellbeing that we should be considering?
How does WEMWBS overlap with the four ONS subjective wellbeing questions?
How does WEMWBS overlap with the GHQ-12?
WEMWBS is not currently available at a UK or local level – how do we collect WEMWBS data at
these levels? Is England and Scotland level data an acceptable starting point for reporting
purposes?
6. Conclusions
6.1. The Department of Health feels strongly that the current omission of mental wellbeing in the
Measuring National Wellbeing Framework is a crucial gap and needs to be included for policy
makers to be able to make maximum use of the Framework. We feel WEMWBS is the most
appropriate measure for this and would therefore recommend either option a) or b). We are
interested in the view of Technical Advisory Group members and whether they would
recommend ONS address this particular aspect and if so, how best to do that.
i
World Health Organisation (2004). Promoting Mental Health: Concepts, emerging evidence and practice.
Summary report. http://www.who.int/mental_health/evidence/MH_Promotion_Book.pdf
ii
World Health Organisation (2011). Mental Health: A state of wellbeing.
http://www.who.int/features/factfiles/mental_health/en/index.html
iii
Department of Health (2012). No Health Without Mental Health: A cross government mental health
outcomes strategy for people of all ages.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_124058.pdf
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iv
Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S, Parkinson, J., Secker, J., and Stewart-Brown,
S (2007). The Warwick Edinburgh Mental Wellbeing Scale (WEMWBS): development and UK validation. Health
and Quality of Life Outcomes, 5 (63)
v
Scottish Government (2010). Warwick Edinburgh Mental Wellbeing Scale acceptability and validation in
English and Scottish secondary school students (The WAVES project).
http://www.healthscotland.com/uploads/documents/12397WEMWBSAcceptability&ValidationInSecondarySchoolStudentsReport0708.pdf
vi
Department of Health (2012). Improving outcomes and supporting transparency: summary technical
specifications of public health indicators.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_132
558.pdf
vii
Scottish Government (2011). National Performance Framework.
http://www.scotland.gov.uk/About/Performance/scotPerforms/indicators
viii
Office for National Statistics (2012). Measuring National Wellbeing: Report on consultation responses on
proposed domains and measures.
ix
Office for National Statistics (2012). Initial findings from the consultation on proposed domanins and
measures of national wellbeing.
http://www.ons.gov.uk/ons/dcp171766_257206.pdf
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Annexe A – Warwick Edinburgh Mental Wellbeing Scale
The Warwick-Edinburgh Mental Well-being Scale
(WEMWBS)
Below are some statements about feelings and thoughts.
Please tick the box that best describes your experience of each over the last 2 weeks
None
of the
time
Rarely
Some
of the
time
Often
All of
the
time
I’ve been feeling optimistic about
the future *
1
2
3
4
5
I’ve been feeling useful *
1
2
3
4
5
I’ve been feeling relaxed *
1
2
3
4
5
I’ve been feeling interested in other
people
1
2
3
4
5
I’ve had energy to spare
1
2
3
4
5
I’ve been dealing with problems
well *
1
2
3
4
5
I’ve been thinking clearly *
1
2
3
4
5
I’ve been feeling good about myself
1
2
3
4
5
I’ve been feeling close to other
people *
1
2
3
4
5
I’ve been feeling confident
1
2
3
4
5
I’ve been able to make up my own
mind about things *
1
2
3
4
5
I’ve been feeling loved
1
2
3
4
5
I’ve been interested in new things
1
2
3
4
5
I’ve been feeling cheerful
1
2
3
4
5
STATEMENTS
Warwick-Edinburgh Mental Well-Being Scale (WEMWBS)
© NHS Health Scotland, University of Warwick and University of Edinburgh, 2006, all rights reserved.
* item is on the short version (7 items)
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