"I want to be well, and just the word wellness gives me hope."
Wellness is a holistic approach
—Behavioral health services consumer
[Swarbrick, 1997, p. 3]
to health that is vital for improving outcomes among people with behavioral health conditions.
"This framework," states wellness expert Margaret Swarbrick, "is useful for consumers, professionals, and families to take control of their lives and capitalize on their strengths, abilities, and personal aspirations in order for every individual to take on and fulfill meaningful roles within their families and in today's society" (Swarbrick, 2006, p. 313).
Why Do We Need a Wellness Approach?
People living with serious mental or substance use disorders are dying decades earlier than the general population, mostly from preventable, chronic medical conditions.
Factors contributing to premature mortality include
• Higher rates of cardiovascular disease, diabetes, respiratory disease, and HIV and other infectious diseases
• High rates of smoking, substance misuse, obesity, and unsafe sexual practices
• Increased vulnerability owing to poverty, social isolation, trauma and violence, and incarceration
• Lack of coordination between mental and primary healthcare providers
• Prejudice and discrimination; side effects of psychotropic medication
• Overall lack of access to health care, particularly preventive care [https://www.samhsa.gov/wellness-initiative, last updated 09/05/2017]
To help address these health disparities, the Substance Abuse and Mental Health Services Administration (SAMHSA) launched its Wellness Initiative based on a wellness model Dr. Swarbrick created for people with behavioral conditions. This effort
encourages individuals, families, and behavioral health and primary care practitioners, as well as peer-run, faith-based, and other community organizations, to improve mental and physical health by making positive lifestyle changes.
What Is Wellness?
Wellness Is a Whole-Person, Strength-Based Approach
SAMHSA envisions wellness not as the absence of disease, illness, and stress, but as the presence of a positive purpose in life, satisfying work and play, joyful relationships, a healthy body and living environment, and happiness, in accordance with Halbert Dunn's seminal wellness concepts (Dunn, 1961).
WELLNESS IS MULTIFACETED.
The Wellness Initiative identifies eight dimensions of wellness, along with basic needs related to each one. The dimensions influence one another and affect a person's overall health and quality of life. The dimensions are
WELLNESS IS PERSONALLY DEFINED,
1. Emotional: Coping effectively with life and creating satisfying relationships
2. Environmental: Enjoying good health by occupying pleasant, stimulating environments that support well-being
3. Financial: Satisfaction with current and future financial situations
4. Intellectual: Recognizing creative abilities and finding ways to expand knowledge and skills
5. Occupational: Personal satisfaction and enrichment from one's work
6. Physical: Recognizing the need for physical activity, healthy foods, and sleep
7. Social: Developing a sense of connection and belonging; and having a [good] support system
8. Spiritual: Expanding one's sense of purpose and meaning in life [Swarbrick, 2014, p. 13; adapted from Swarbrick, 2006, p. 311]
meaning that how we address our needs in each dimension depends on our goals, beliefs, values, culture, personality, preferences, and life experiences. For instance, one person might find swimming therapeutic, while another might fear swimming because of past trauma but enjoy long walks. SAMHSA's fact sheet "What Individuals in Recovery Need to Know About Wellness"
gives examples of types of activities for meeting needs in the eight dimensions.
WELLNESS ACTIVELY INVOLVES THE CONSUMER IN DECISION-MAKING.
The practitioner serves as an educator, coach (Swarbrick, 1997, p. 3), facilitator, and consultant. If a consumer hears voices, the practitioner asks how he or she experience the voices (e.g., as disruptive, as a source of positive guidance), and what has helped manage them in the past (SAMHSA/CMHS, n.d.). The practitioner and consumer explore the voices' characteristics and meaning. If the voices are disruptive, the practitioner educates the consumer about possible strategies for reducing them such as medication, talks about medication side effects, and assists the consumer in weighing the pros and cons of each option.
WELLNESS USES COLLABORATION.
The practitioner and consumer work together on finding effective ways of managing the voices (SAMHSA/CMHS, n.d.).
WELLNESS RECOGNIZES AND BUILDS ON THE CONSUMER'S STRENGTHS
(Swarbrick, 1997, p. 3). If the consumer experiences the voices as disruptive, wants to avoid medication because of the side effects, but reports the voices stop when he or she listens to music, the practitioner coaches the consumer on using this strength (and others) to manage the voices (SAMHSA/CMHS, n.d.).
WELLNESS AIMS TO INCREASE OVERALL QUALITY OF LIFE, HEALTHY HABITS, AND PERSONAL CONTROL.
(Swarbrick 1997). The practitioner and consumer look at all aspects of the person's life and decide together that quality of life could be better without medication. They create a plan that includes listening to music and using other strategies to manage the voices as well as steps for developing a healthy daily routine (e.g., getting to sleep earlier, eating more nutritious food, exercising).
The disease treatment model concentrates on what is wrong (hearing voices) [SAMHSA/CMHS, n.d.]. The practitioner decides how best to solve this problem (he or prescribes medication; ensures the consumer is taking the medication as prescribed; helps the consumer identify stressors that exacerbate symptoms; and suggests he or she avoid risks, as they would precipitate stress (SAMHSA/CMHS, n.d.; Swarbrick, 1997, p. 3).
Wellness Integrates Behavioral and Physical Health
The wellness approach recognizes that the mind and body are interconnected and that behavioral health is inseparable from physical health. Behavioral health practitioners can help clients recognize physical health risks and unmet care needs (e.g., a person living with a severe mental illness is twice as likely to have diabetes, to be obese, and to smoke) [Torres–González et al., 2014, p. 3] and connect with a primary care practitioner. Behavioral health clinicians can talk with consumers about lifestyle concerns (e.g., smoking, lack of physical exercise) that affect whole health and about side effects of psychotropic medications (e.g., metabolic syndrome) that need to be monitored.
A wellness approach can make primary care practitioners more aware of how a person's behavioral health may affect his or her physical health and encourage the individual to work more closely with the consumer's behavioral health practitioner. For example, a person with diabetes and schizophrenia may need a lot more support to follow a life-saving diabetes treatment protocol. The behavioral health clinician may be uniquely positioned to help the primary care practitioner and client improve compliance with the protocol.
Wellness Is Empowering and Prevention Oriented, Unlike the Disease Treatment Model
As Swarbrick points out, "Wellness is a conscious, deliberate process whereby a person makes choices for a self-defined lifestyle that is both healthier and more satisfying (Swarbrick, 1997, 2006)" (Swarbrick et al., 2011, p. 329). This approach emphasizes having positive goals, learning self-management skills (e.g., self-care when hearing disruptive voices), and developing healthy habits (Swarbrick et al., 2011, p. 329; Swarbrick, 2014, p. 11). "A focus on health, positive features (strengths), and personal responsibility rather than dependence and illness can engender optimism and a belief in the client's capacity to exert personal control in managing health needs…" (Swarbrick, 1997, p. 2).
Wellness Is a Journey, Not a Destination
Swarbrick developed her nationally recognized wellness model to help herself cope with severe mental illness that struck in adolescence. "Initially," she writes, "this [wellness vision] kept me alive and now it has helped me live each day more fully" (Swarbrick, 2006, p. 312). Wellness is a lifelong journey of striving for good mental and physical health and quality of life, to the best of a person's ability, given his or her unique circumstances. Behavioral health and physical health clinicians, peer specialists, and others can facilitate this journey for consumers by creating the necessary opportunities and supports (Swarbrick, 2014, p. 6). Having a severe mental illness does not preclude a wellness journey. On the contrary, it makes the journey essential.
Many free resources for individuals, families, communities, organizations, and clinicians are available. SAMHSA's Wellness Initiative website
and the SAMHSA–Health Resources and Services Administration's Center for Integrated Health Solutions website
offer a wealth of information.
Publications that can be ordered or downloaded from the SAMHSA store
(type "wellness" in the Search box) include fact sheets, brochures, self-help guides, podcasts with transcripts, posters, and a customizable wellness slide presentation.
Specific strategies and tools for promoting wellness will be highlighted in a future article.
Dunn, H. L. (1961). High-Level Wellness. Arlington, Va.: Beatty Press.
SAMHSA/Center for Mental Health Services (CMHS). (n.d.). What are recovery-oriented practices? Rockville, Md.: Author.
SAMHSA/CMHS. (2010). Information for general health care providers: What is wellness? [10 X 10 Wellness Campaign Brochure]. Rockville, Md.: Author.
Swarbrick, M. (1997). A wellness model for clients. Mental Health Special Interest Section Quarterly, 20, 1–4.
Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29(4), 311–314.
Swarbrick, M. (2014). A wellness approach. [Seminar]. New York Association of Psychiatric Rehabilitation Services, Inc.: Albany, N.Y.
Swarbrick, M., & Moosvi, K. V. (2010). Wellness: A practice for our lives and work. [Guest editorial]. Journal of Psychosocial Nursing, 48(7).
Swarbrick, M., Murphy, A., Zechner, M., Spagnolo, A., & Gill, K. (2011). Wellness coaching: A new role for peers. Psychiatric Rehabilitation Journal, 34(4), 328–331.
Torres–González, F., Ibanez–Casas, I., Saldivia, S. Ballester, D., Grandón, P., Moreno–Küstner, B., . . . Gómez–Beneyto, M. (2014). Unmet needs in the management of schizophrenia. Neuropsychiatric Disease and Treatment, 10, 97–110. doi: 10.2147/NDT.S41063