Over April and May 2020, we sought a range of views to start developing an outcomes framework for mental health and wellbeing.

When we started this work, our aim was to ensure that everyone could have their say on how the system will monitor, measure and improve our country's mental health and wellbeing. However, due to COVID-19 we had to change our approach and target organisations that represent the people and diversity of Aotearoa New Zealand.

We have worked with people from across the mental health and wellbeing system to:

Defining mental health

We asked what people thought of the World Health Organisation (WHO) definition of mental health, “a state … in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”.

People said the WHO definition does not reflect an indigenous view, is too individualistic, and is overly focused on what the person can do for society through ‘work’. People thought we should have a definition that reflects Te Tiriti o Waitangi, acknowledges people have a social nature and acknowledges the concepts of whānaunatanga, belonging and connection.  A definition should also talk about meaning and purpose rather than production. Language should be non-binary, ‘their’ rather than ‘his or her’.

People spoke about challenges defining ‘mental health’ as the term is often associated with ‘mental illness’, carries stigma and is associated with a medical approach, such as illness, diagnosis and medication.

Defining wellbeing

People saw ‘wellbeing’ as a broad and positive concept, compared to ‘mental health’, which is associated with a medical approach and with a deficit or illness.

We heard that a definition of wellbeing should be strengths based, incorporate a cultural-based definition and be holistic -incorporating community and social determinants of wellbeing.

We also heard that wellbeing is not fixed, but an aspirational state. Some said it’s about being able to function when life is more challenging, and many mentioned the importance of being able to access support when needed.   

Connecting mental health and wellbeing

There were two main views of the connection between mental health and wellbeing. People either saw mental health and wellbeing as one and the same thing or, saw mental health as a component of overall health and wellbeing.

Some people suggested this should be a ‘wellbeing outcomes framework’ rather than a ‘mental health and wellbeing outcomes framework’.

Some people warned of losing sight of those with the most serious needs if there is a shift to a wellbeing focus. People also emphasised mental health and wellbeing can be in the absence or presence of a mental illness diagnosis, or distress.

Addiction was noted as important to keep visible in definitions, and the concept of freedom from addiction.

Models and frameworks that would be relevant to draw on

Te Whare Tapa Whā was mentioned by nearly all people. A further 34 models or frameworks were mentioned; 18 of these developed in Aotearoa, and 16 overseas.

Non-medical models were more commonly mentioned, that offer a broader and more holistic understanding, in preference to those with a narrower focus on mental health.

Domains of wellbeing

We asked if the Child and Youth Wellbeing Framework(external link) with six areas of wellbeing, developed in Aotearoa, could cover wellbeing for everyone (including adults and older people). People thought there was some areas of wellbeing that are universal across the life-course, but there are some aspects that change as you get older.

We compiled a list of what people thought should be considered as important for wellbeing. Areas covered in responses included

  • human rights,
  • connectedness to other people and the wider community,
  • dignity,
  • self-determination / rangatiratanga,
  • spiritual and cultural needs,
  • sense of purpose,
  • relationships,
  • being a provider and a teacher,
  • skills,
  • support,
  • material resources,
  • environment and
  • physical health.

People said wellbeing is fluid, and that wellbeing needs are the same for people with mental distress as for everyone.

Testing a vision

We tested a vision statement; “An Aotearoa New Zealand where everyone has good mental health and wellbeing and can get the support we all need to live our best lives.”

Most people did not like the statement. Many found the term “support” problematic, getting easy access to support, when we need it was preferred as a concept, rather than implying “we all need support”. People also thought the statement didn’t reflect that wellbeing is not a permanent state. The report includes lists alternative vision statements proposed.

What people and organisations want to see in an outcomes framework for it to be useful

To develop the framework, the participation of the groups we are expected to work with was supported, such as Māori, Pacific people and people with lived experience of mental health and addiction.

Outcomes need to be what truly improves people’s wellbeing, and it needs to be simple and practical, with supports put in place for implementation.  

People said it needs to:

  • focus on equity and relevance for Māori,
  • be relevant for specific and diverse populations,
  • support a paradigm shift to wellbeing,
  • be focussed on strengths, and
  • be relevant to all age groups.

Measures need to be meaningful, and be across quantitative, qualitative and mixed methodologies.

To learn more about the co-define phase of this work, download the full report:

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