Author: Joep van Agteren
van Agteren, Joep, 2023 Helping those who languish: innovating psychological mental health promotion solutions for people with poor mental wellbeing, Flinders University, College of Education, Psychology and Social Work
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The Australian mental health system is under strain, with advocates calling for reform to counter the growing burden of poor mental health. One suggested area of reform is early intervention, including an increased focus on mental health promotion efforts. To date these efforts have lacked impact, which may be explained by a problem with the theoretical conceptualisation of mental health in our system, and subsequently the solutions we have utilised for early intervention.
Traditionally, mental health is conceptualised as a singular continuum ranging from mental illness or disorder to high wellbeing on both extreme ends. Empirical research contradicts this model, showing that states of mental wellbeing and illness are related but separate, having both common and unique characteristic and drivers. The combined body of prior published works that make up this thesis aim to demonstrate the utility of targeting these mental states of wellbeing via psychological solutions as an overlooked avenue for early intervention.
Study 1 is a narrative review that provides a theoretical justification for expanding our focus on wellbeing, arguing for the systematic integration of dedicated wellbeing measures and interventions into our system, rather than repurposing solutions that were designed to target states of illness. Two observational studies give insight into the compounding effect that including wellbeing assessment has on estimates of poor mental health in the general population (study 2) and university students (study 3). Together the studies’ findings point to the merit of targeting people who are languishing, i.e., have low wellbeing, as the group is non-trivial in size.
Through two intervention studies, evidence is contributed showing that scalable intervention formats can be effective in improving mental wellbeing. Study 4 tested technology that relied on the so-called ‘experience sampling method’ to deliver a low-intensity wellbeing intervention that revolved around building meaning and purpose. In study 5 a train-the-trainer framework was tested to deliver a multi-facetted group-based psychological intervention relying on upskilled peers rather than clinical staff.
Although the content within the first intervention studies proved effective, it targeted certain aspects of wellbeing with specific components rather than relying on a broad range of proven techniques. To determine the state of evidence for different psychological approaches on improving mental wellbeing, a systematic review and meta-analysis was conducted in study 6. The findings from this review, and studies 4 and 5, formed the basis for the final studies centring on designing (study 7) and testing (study 8) a psychological intervention that was purposefully developed to help those who languish or struggle with distress, without the need to rely on scarce clinical resources in the traditional system.
The contextual statement for this thesis provides a backdrop to the papers and combines them in a joint narrative, by placing the studies within the wider context of the Australian mental health system and the evolution of psychological interventions for wellbeing. After discussing the findings from my studies, the contextual statement concludes by discussing the implications of my studies’ findings for the mental health system, their limitations, and suggestions for further research.
Keywords: Mental wellbeing, mental health, wellbeing science, mental health reform, wellbeing interventions, wellbeing measurement, dual-factor models
Subject: Psychology thesis
Thesis type: Doctor of Philosophy
Completed: 2023
School: College of Education, Psychology and Social Work
Supervisor: Mike Kyrios