This focus on deficits and the other Ds: Up close, nobody is normal: An alternative approach is possible [ 84 ]. In assessment, this involves a greater emphasis on the individual's goals and strengths, an approach which has been developed and evaluated in the Strengths Model [ 85 ]. Other approaches which emphasise well-being over deficits in assessment processes are person-centred planning [ 86 , 87 ] and Wellness Recovery Action Planning [ 88 ].
What these have in common is an assumption that it is more productive to focus on what the person wants in their life and what they can do towards their own goals than on what the professional thinks is in the person's best interests and on what the person cannot do. What interventions increase levels of well-being or amplify existing strengths? This psychological intervention will be familiar to most clinical readers, so no introduction will be given.
Competently-provided CBT is aligned with many elements of promoting recovery and personal well-being: If unhappiness is caused by a mismatch between self and ideal-self images, then CBT has the potential to focus on the environmental reality as much as the personal interpretation of experience. This points to a wider role for professionals, a point we will return to. Recent approaches to CBT explicitly focus on building strengths and resilience [ 89 ]. Meditation is " a family of techniques which have in common a conscious attempt to focus attention in a non-analytical way, and an attempt not to dwell on discursive, ruminative thought " [ 90 ].
Teaching meditation to members of the public increases self-reported happiness and well-being, changes which are corroborated by healthier EEG readings, heart rates and flu immunity [ 91 ]. Meditation has been applied to mental health issues, such as anger [ 92 ] and - in the form of mindfulness-based cognitive therapy MBCT - depression [ 93 ]. Mindfulness, like prayer [ 94 ], is a form of meditation which involves attending non-judgmentally to all stimuli in the internal and external environment but to avoid getting caught up in i.
Mindfulness requires a different mind-set to the quick-fix of a magic pharmacological or psychological bullet. Just as becoming a top-class violinist requires 10, hours of practice with a competent teacher [ 95 ], so too mindfulness needs to become a way of life if it is to transform identity. It involves changing habits:. The pay-off in terms of well-being is high.
Mindfulness has the potential to lead to a reconstructed, more complex identity, in which self and thought are separated. Development of a watching self gives a different means of responding to and working on experiences of mental illness. Developing habits of greater occupation of the available attention reduces rumination and increases being in the moment - the flow concept we discussed earlier [ 96 ]:. Assuming that attention is a zero-sum game, the most efficient way to reduce negative and increase positive thoughts and emotions may be to focus on increasing the positive.
Overall, the personal qualities cultivated through mindfulness practice are nonjudging, nonstriving, acceptance, patience, trust, openness, letting go, gentleness, generosity, empathy, gratitude and lovingkindness [ 97 ] - qualities which are highly relevant to the personal recovery journey of people with mental illness. A further clinical approach emerges from a sub-discipline called narrative psychology , which investigates the value of translating emotional experiences into words.
This brings together insights from three strands of research primarily from European and American cultures [ 98 ]:. One approach involves asking people to write about or in other ways generate an account of their experiences, as a means of making sense of their own story. The most beneficial story content includes placing the story in a context appropriate to its purpose, the transformation of a bad experience into a good outcome, and the imposition of a coherent structure [ 99 ]. Developing stories about growth, dealing with difficult life events and personal redemption all contribute to a positive narrative identity [ ].
Empirical evidence suggests that this approach is particularly beneficial for groups who, as a whole, are not as open about their emotions: An approach which brings together several of these methods is positive psychotherapy PPT [ ]. The focus in PPT is on increasing positive emotion, engagement and meaning.
For example, groups for depression undertake a series of weekly exercises. Week 1 Using Your Strengths involves using the Values in Action Inventory of Strengths [ 81 ] to assess your top five strengths, and think of ways to use those strengths more in your everyday life. Week 4 Gratitude Visit involves thinking of someone to whom you are very grateful, but whom you have never properly thanked, composing a letter to them describing your gratitude, and reading it to the person by phone or in person.
Week 6 Savouring involves once a day taking the time to enjoy something that you usually hurry through, writing write down what you did, how you did it differently, and how it felt compared to when you rush through it. These exercises are intended to amplify components of Authentic Happiness [ 51 ]. We have considered some approaches to focussing more on strengths, goals and preferences. However, if mental health services are to fully support recovery and promote well-being, it may not be enough to simply counter-balance a focus on individual deficit with a focus on individual capability, since this leaves unchallenged the clinical belief that treatment is something you do first, after which the person gets on with their own life.
This is highlighted as an unhelpful approach in the accounts from people who write about their recovery from mental illness. For example, Rachel Perkins notes [ ]:. Mental health problems are not a full time job - we have lives to lead. Any services, or treatments, or interventions, or supports must be judged in these terms - how much they allow us to lead the lives we wish to lead.
We therefore now raise some potential implications of positive psychology for the job of the mental health professional at the social, rather than individual, level. This is underpinned by an emerging understanding of the importance of relationships and connection for individual and social well-being. For example, an international consortium of academics has recently produced reports about determinants and influences on well-being [ ]. This important document has been summarised by the New Economics Foundation http: Connect to others, individually and in communities ; Be active; Take notice of the world ; Keep learning; and Give e.
It is no coincidence that these are all outward-looking recommendations, more about engaging in and living life to the full than sorting out any internal or intrapsychic disturbances. Stigma and discrimination stop people with mental illness from exercising their full rights as citizens and meeting their human needs for connection [ ]. Therefore, the role of the mental health professional should be about challenging stigma and creating well-being-promoting societies as well as treating illness.
Supporting people using mental health services from accessing normal citizenship entitlements is a central i. We illustrate this in relation to employment.
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If a single outcome measure had to be chosen to capture recovery, there would be a case to make that it should be employment status. Not because of a value about economic productivity, but because work has so many associated benefits. There is now a strong evidence base that Individual Placement and Support IPS approaches which support the person to find and maintain mainstream employment are better than training the person up in separate sheltered employment schemes in preparation for mainstream work [ , ]. Mental health professionals can increase the access of service users to the valued social role of work by supporting the development of employment schemes [ ].
One specific work opportunity is within mental health services. However, health services have a history of poor recruitment and retention approaches to attracting people with declared mental illness to work for them [ 31 ]. Of course, many people working in these services have an undisclosed history of mental illness. This is a wasted opportunity, and reinforces stigmatising us-and-them beliefs in the work-force.
Actively encouraging applications from people who have used mental health services for all posts, and positively discriminating between applicants with the same skill level in favour of people with a history of mental illness are two relevant approaches. They directly challenge " the common tendency in human service organisations to see workers as either health and strong and the donors of care, or as weak and vulnerable recipients " [ ]. There are other ways in which mental health professionals and teams can improve social inclusion.
A common experience of workers in the mental health system is frustration - a sense that these ideas about social inclusion, employment and social roles are all well and good, but impossible to implement within the existing constraints. But resources can become available by spending allocated money differently. This is the approach used by The Village http: The service decided to undergo a 'fiscal paradigm shift', by spending money to promote wellness and recovery especially by creating pathways back into employment rather than promote stability and maintenance. Hospitalisations and living in institutional residence are markedly reduced for members attending the Village [ ], allowing the money saved to be re-invested in work-supporting services.
A further contribution from the clinician can be educating local employers about their legal duties under relevant discrimination legislation and about reasonable work-place adjustments for people with mental illness. The accommodations can relate to People focussing on interpersonal challenges , Places focussing on where the work takes place , Things focussing on equipment needed to do the job or Activities focussing on the work tasks. For people with physical disability, accommodation needs tend to relate to Places and Things.
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This is what employers are used to. In mental illness, People issues are often the central issue. Employers need educating about how these interpersonal needs can be tended to, which might include [ ]:. Alongside this direct contribution to improving social inclusion, well-being focussed mental health professionals of the future will also have a contribution to make to policy. If a new knowledge base around well-being is integrated by mental health professionals into their practice, then this creates opportunities to influence social and political priorities.
The position power and status of the role allow authoritative communication with the aim of influencing society and increasing wellbeing both for the general population and specifically for people with experience of mental illness. A few examples will illustrate this re-orientation. Does money bring happiness? If social comparison influences well-being, what are the implications for policy?
For example, do social structures such as gated communities and private schools harm us all? Contrary to intuition, those within the enclave aren't any happier because they are no wealthier than their comparison group, and those outside have a visibly wealthier reference group. Television is a powerful influence, both because it encourages social comparison and because of its innate effects. Researchers have observed consistently adverse changes following the introduction of television into new communities.
In Bhutan, this was followed by increased family break-up, crime and drug-taking, alongside reduced parent-child conversation [ ]. In Canada, social life, participation in sports and level of creativity were all negatively impacted [ ]. Homicide rates go up after televised heavyweight fights [ ], and suicide rates increase after on-screen portrayals [ ].
Television content leads to an inflated estimate of adultery and crime rates [ ], and negative self-appraisal [ ]. Given the average Briton watches 25 hours of television per week [ ] - with similar levels in the US [ 54 ] - what does this imply for media regulation? When making a social comparison, the reference group influences well-being: Olympic bronze medal winners who compare themselves with people missing out on a medal are happier than Silver medal winners who compare themselves with the victor [ ].
For mental health, this may mean that anti-stigma campaigns focussed on promoting mental health literacy and identifying when to seek professional help actually increase negative social comparisons and reduce well-being. High-profile people talking about their own experiences are better at reducing the social distance and difference experienced by people with mental illness [ ]. In contrast to salary, 4 weeks holiday when others have 8 weeks is preferred over 2 weeks when others have 1 week [ ].
Would a national policy of compulsory flexible working arrangements e. More generally, the fact that people who win Oscars live longer than unsuccessful nominees [ ] may point to the importance of achievement for longevity. If we want people to live longer, should we focus on developing community-level opportunities for participation, connection and mastery? Should services for particularly marginalised groups, such as people with mental illness, put some of their resources towards celebrating and amplifying success?
What are the sources of happiness? Family relationships, Financial situation, Work, Community and friends, Health, Personal freedom and Personal values [ 54 ]. The effects on happiness of problems in each domain have been estimated, on the basis of international surveys of factors associated with happiness [ , ].
Using a scale from 10 no happiness to total happiness , the fall in happiness associated with separation compared with marriage is 8 points, with unemployment or poor health is 6 points, with personal freedom is 5 points, with saying no to "God is important in my life" personal values is 3. Can these seven identified influences be used by mental health services to directly increase happiness, rather than continuing with attempts to reduce unhappiness? This will involve meeting three challenges. First, traditional professional training only focuses on one of these seven influences: Second, interventions to promote health which increase personal freedom and are concordant with personal values will increase happiness more than those which impinge on personal freedom or which deny or discount personal value.
This will require clinical decision-making to focus as much on values and freedom as on intervention effectiveness - echoing the call for ethics before technology by Bracken and Thomas [ ]. Third, most influences on happiness are social rather than intrapsychic, yet most mental health interventions are at the level of the individual. Overall, this is not to argue for more centralised control per se , but rather to highlight that this knowledge should be more visible in public debate, so that both social policy and individual choices are informed by our best scientific understanding of contributors to well-being.
We finish on an optimistic note. One reason for raising some of these implications is to highlight their relative absence from sociopolitical debate. Although there is good evidence that being happy and cheerful is associated with improved brain chemistry, blood pressure and heart rate [ , ], and with living longer [ ], this kind of evidence does not yet feature prominently in public debate.
If skilled professionals with an interest in promoting well-being don't point out that a high turnover of local residents create communities which are less cohesive [ ] and more violent [ ] then who will inject this information into social policy? Similarly, the pernicious effects of a societal value that we must make the most of everything is becoming clear. People who constantly worry about missing opportunities - so-called hyper-optimisers - have more regrets, make more social comparisons and are less happy than people who are happy with what is good enough [ ].
An empirically-informed policy-making approach would recognise the toxic consequences for well-being of societies which encourage unfavourable social comparison, continuous reoptimisation to make the best of every opportunity, and living for the future rather than savouring the present. Research into mental illness proceeds apace.
Advances in understanding are being generated by genetic, genomic, proteomic, psychological and epidemiological studies, among other disciplines. These advances are to be welcomed, and should continue to inform clinical practice. The challenge is to also integrate and apply the evidence base around well-being, so that mental health professionals of the future inform social policy as well as treating mental illness.
Mike's main research interests are recovery-focussed and outcome-focussed mental health services, user involvement in and influence on mental health services, staff-patient agreement on need, and contributing to the development of clinically useable outcome measures, including the Camberwell Assessment of Need and the Threshold Assessment Grid. He has written over academic articles and seven books, including Slade M Personal recovery and mental illness , Cambridge: Sainsbury Centre for Mental Health downloadable from http: Rethink downloadable from http: Operationalisation, definition and examples of three domains of mental health.
Table showing operationalisation, definition and examples of three domains of mental health. Points of convergence between recovery in mental illness and positive psychology. Table showing points of convergence between recovery in mental illness and positive psychology. National Center for Biotechnology Information , U. Published online Jan Received Feb 18; Accepted Jan This article has been cited by other articles in PMC. Abstract Background A new evidence base is emerging, which focuses on well-being. Discussion New forms of evidence give a triangulated understanding about the promotion of well-being in mental health services.
Summary If health services are to give primacy to increasing well-being, rather than to treating illness, then health workers need new approaches to working with individuals. Background The World Health Organisation WHO declares that health is " A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity "[ 1 ]. Discussion The WHO declaration about mental health is also clear: New area of knowledge 1: Recovery People personally affected by mental illness have become increasingly vocal in communicating both what their life is like with the mental illness and what helps in moving beyond the role of a patient with mental illness.
New area of knowledge 2: Positive Psychology Positive psychology is the science of what is needed for a good life. Martin Seligman, often identified along with Mihaly Csikszentmihalyi as the founders of the discipline, suggests a definition [ 36 ]: Open in a separate window. Table 1 Prevalence of mental health and mental illness. Personally relevant, rather than meeting the needs of staff There may of course be other reasons for staff-based care planning, but care plans focussed on clinical risk, medication compliance, relapse prevention and symptom reduction will not promote personal recovery.
The right level of challenge The concept of a reasonable goal captures the balance in setting goals which are neither too easy leading to boredom and distraction nor too difficult leading to anxiety and heightened self-awareness. Proximal rather than distal Short-term goals provide more opportunity to become engrossed in the experience, and make engaged goal-striving more likely. Structured so that feedback is immediate and authentic It is this immediate feedback loop that promotes full attentional awareness on the challenge One approach to increasing well-being is therefore to support personally-relevant goal-setting and goal-striving activity.
Parallels between positive psychology and recovery There are parallels between the position of recovery ideas in the mental health system and the position of positive psychology in the family of psychology disciplines [ 65 ]. As Resnick and Rosenheck put it [ 65 ]: Implications for mental health assessment practices How can a person with mental illness be assessed if the clinical goal is to promote well-being?
Clinical assessment should focus on four dimensions [ 80 ]: Deficiencies and undermining characteristics of the person 2. Strengths and assets of the person 3. Lacks and destructive factors in the environment 4. Resource and opportunities in the environment Traditional clinical assessment practice - exemplified by the mental state assessment - focuses almost exclusively on dimension 1.
Interventions in mental health services to promote well-being What interventions increase levels of well-being or amplify existing strengths? Cognitive behavioural therapy CBT This psychological intervention will be familiar to most clinical readers, so no introduction will be given.
Mindfulness Meditation is " a family of techniques which have in common a conscious attempt to focus attention in a non-analytical way, and an attempt not to dwell on discursive, ruminative thought " [ 90 ]. It involves changing habits: Developing habits of greater occupation of the available attention reduces rumination and increases being in the moment - the flow concept we discussed earlier [ 96 ]: Narrative psychology A further clinical approach emerges from a sub-discipline called narrative psychology , which investigates the value of translating emotional experiences into words.
This brings together insights from three strands of research primarily from European and American cultures [ 98 ]: Inhibition - not talking about emotional trauma is unhealthy 2. Cognitive - development of a self-narrative allows closure 3. Social dynamics - keeping a secret detaches one from society. Positive Psychotherapy An approach which brings together several of these methods is positive psychotherapy PPT [ ].
For example, Rachel Perkins notes [ ]: Societal implications We therefore now raise some potential implications of positive psychology for the job of the mental health professional at the social, rather than individual, level. Mental health professionals can improve social inclusion Supporting people using mental health services from accessing normal citizenship entitlements is a central i. Employers need educating about how these interpersonal needs can be tended to, which might include [ ]: Mental health professionals can increase societal well-being If a new knowledge base around well-being is integrated by mental health professionals into their practice, then this creates opportunities to influence social and political priorities.
Competing interests The author declares that they have no competing interests. Pre-publication history The pre-publication history for this paper can be accessed here: Supplementary Material Additional file 1: Click here for file 59K, DOC. Click here for file 43K, DOC. References World Health Organization. Concepts, Emerging Evidence, Practice. World Health Organization; Mental Health Commission of Canada. Mental Health Commission of Canada, Calgary; Towards a shared vision for mental health. Department of Health; The structure of psychological well-being revisited.
Journal of Personality and Social Psychology. Clinical validation of the Quality of Life Inventory: A measure of life satisfaction for use in treatment planning and outcome assessment.
Investigating axioms of the complete state model of health. By , that Association boasted a membership of over 1, individuals from 43 different countries. Co-operative education is common in most Australian high schools, and has been integrated into many university courses as a part of making up final grades. This unpaid work goes towards credits for graduation in both school and universities Australia wide. Many companies in Australia are more inclined to hire an individual who has had proper training within their specific field than those who have not, which has created many more successful applicants and jobs within Australia.
In Germany , the significance of cooperative education has increased in the few last years. In , the importance was underlined in a paper by the economic council , including an official definition of the dual study program. The goal is to enable dual qualification of academic and skilled worker knowledge with a focus on high academic standards.
A cooperative study program is a combination of an academic study at a university or vocational college and a vocational education. There are also a few Master's programs. Trade schools focus on educating skilled workers. The first kinds of cooperative education programs, in terms of studies with integrated practical phases, started in The next step was the foundation of a new tertiary education institution, a vocational university. More people have been graduating from high school with the highest degree: This has led to an increase in the number of students attending university and decrease of trainees in vocational trainings.
On one hand, companies were afraid of a lack of skilled workers. On the other hand, there was a need for higher qualified workers which are not provided by vocational training while universities couldn't provide skilled worker qualifications. In , the education minister conference declared vocational university as equivalent to University of Applied sciences. There were 45 cooperative programs in This number increased to by In , the education minister conference approved a vocational university degree as equivalent to a university's bachelor's degree.
Other vocational universities were also being approved as state universities. There were 47, companies providing cooperative study programs in compared to 18, in There are different dual curriculum programs. The number of courses has grown from in to 1, in They can be summarized in the following areas of study: There is a contract between the three participating parties: Mostly, the employer provides payment which is slightly above the payment for a vocational training. Some companies also pay student fees. Therefore, some contracts include terms where students commit to stay with the company for two years after the program.
Even without guaranteed employment, chances of getting a job are high anyways. Not all companies are willing to support a master program since they argue that the result is not worth the investment. In one model, students alternate a semester of academic coursework with an equal amount of time working, repeating this cycle several times until graduation. The parallel method splits the day between school and work, typically structured to accommodate the student's class schedule. Thus, like school-to-work STW , the co-op model includes school-based and work-based learning and, in the best programs, "connecting activities" such as seminars and teacher-coordinator work site visits.
These activities help students explicitly connect work and learning. Other models, such as the sandwich model and the American-style semester model instead have students work a hour work week for a set amount of time, typically between 12 weeks and six months. After this period is over, students return to the classroom for an academic semester after which they may have another work term. This cycle often repeats multiple times, adding a year or more to the students' university career. In this model, students' do not receive a summer break from school but instead are either working or in school for 12 months of the year.
Barton identifies some of the research problems for secondary co-op as follows: Another set of problems involves perceptions of the field and its marginalization. Because of its "vocational" association, co-op is not regarded as academically legitimate; rather, it is viewed as taking time away from the classroom Crow Experiential activities are necessarily rewarded in post-secondary promotion and tenure systems except in certain extenuating situations , and co-op faculty may be isolated from other faculty Crow ; Schaafsma Despite the current emphasis on contextual learning, work is not recognized as a vehicle for learning Ricks et al.
Schaafsma and Van Gyn agree that the field places too much emphasis on placements rather than learning. Other deterrents may include financial barriers, aversion to moving frequently due to family obligations or other pressures as well as difficulty managing the job search during a school semester. Federal investments in school-to-work and community service have resulted in a number of initiatives designed to provide "learning opportunities beyond the classroom walls" Furco , p. Because this has always been a principle of co-op, the field is in a position to capitalize on its strengths and the ways it complements other experiential methods in the effort to provide meaningful learning opportunities for students.
To do this, however, cooperative education must be redesigned. Ricks suggests affirming the work-based learning principles upon which co-op is based. These principles assert that cooperative education fosters self-directed learning, reflective practice, and transformative learning; and integrates school and work learning experiences that are grounded in adult learning theories. Fleming  suggests that a new practical and research focus should be on the relationship between educational institutions and employers - institutions should take more initiative when it comes to training supervisors to be effective mentors.
This would maximize the success of the work term and the amount the student learns, while also increasing the quality and quantity of the students' work. Drewery and Pretti echo this as they call for greater attention on the relationship between the student and the supervisor, explaining that this relationship can greatly impact the students' satisfaction with the co-op term and the benefits they gain from it.
Schaafsma also focuses on learning, seeing a need for a paradigm shift from content learning to greater understanding of learning processes, including reflection and critical thinking.
Co-op is an experiential method, but learning from experience is not automatic. Therefore, Van Gyn recommends strengthening the reflective component that is already a part of some co-op models. A Higher Education Council of Ontario paper reviewing the University of Waterloo's PD programs states that the reflective element of the program is one of the main strengths, as it encourages students to review their own experiences and learn from their work terms. The Bergen County Academies , a public magnet high school in New Jersey , utilizes co-op education in a program called Senior Experience.
Sweeping changes in work and academe are threatening placement centers with irrelevancy. The rise of entrepreneurial firms, the prevalence of career change, the shifting structure of knowledge, and the changing student body demographics demand a creative response. Present proposals for change, however, ignore basic questions and instead focus on technology, programs, and publicity. This book presents a new approach, a nine-part paradigm aimed at creating a more entrepreneurial, proactive, empowering, multidisciplinary future.