Measuring Singapore's mental well-being

Economic prosperity no longer the best indicator of societal happiness
Chong Siow Ann & Janhavi Vaingankar, Straits Times 21 Nov 09;

A FEW months ago, France's President Nicolas Sarkozy announced his government's intent to include happiness and well-being as a reflection of economic performance - eschewing the gross domestic product as the indicator of a country's progress and prosperity.

The GDP was originally meant to be a measure of market economic activity: the total output of goods and services a country produces for its own citizens or for sale to other nations. With time, this narrow measure became blurred and grew into an indicator of societal well-being.

In human psychology, there is a concept - espoused by American psychologist Abraham Maslow - called the Hierarchy of Needs. It postulates that within every individual, there is a strong desire to achieve something greater once his basic needs have been met.

Maslow depicts this as a pyramid where the base is the 'basic needs' of food and water. The next level is 'security and stability'. The third level is 'love and belonging'.

Once the individual has these needs satisfied, he would look to accomplish more. The peak of the pyramid is 'self-actualisation' - a state of harmony and understanding, and the realisation of one's potential.

At the collective level, as a nation moves beyond poverty and grows richer, it too would look for the other aspects of what would contribute to a better quality of life.

When this happens, the GDP loses its relevance as a metric of the country's well-being.

Governments and policymakers in developed countries have realised that the rise in their economic output has not and cannot guarantee a rise in life satisfaction and productivity of its people.

Studies have consistently shown that while money does buy happiness, this is only up to a point when it comes to 'positional goods' such as income, material goods, and a sense of one's relative position in society.

People work hard to afford things that they think will make them happy, relishing them only for a time while they think that these goods are limited and they have them while others do not. However, with time, they grow accustomed to what they have, or discover that more and more people have these goods, and in losing that sense of exclusivity, they also lose a sense of contentment.

In the scramble up society's ladder, they also force others to run faster to keep up. Everything is relative in this economic 'arms race'. A survey has found that three decades of economic growth in the United States have not made Americans any happier.

The pursuit of happiness as a policy is, of course, not new: it is enshrined in the US Declaration of Independence as one of three inalienable rights, and in Singapore's National Pledge. Bhutan famously has a measure of GNH, or gross national happiness.

A nation which aspires for its citizenry to attain human fulfilment and mental well-being would need to align the metrics of well-being with what really contributes to better quality of life, which would include not only happiness and life satisfaction but also mental health.

In 2007, Singapore launched its First National Mental Health Policy and Blueprint. Among its lofty goals are the promotion of mental well-being and building of resilience among its population.

Mental health is more than just the absence of mental illness. The World Health Organisation defines mental health as a state 'of well-being in which the individual realises his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to the community'.

A group of researchers at the Institute of Mental Health (IMH) in Singapore, working with the Ministry of Health, Nanyang Technological University and US think-tank Rand Corporation, is developing a culturally appropriate scale to measure the level of positive mental health in Singapore.

Assessing and measuring mental well-being - that ephemeral state of mind and emotion - is decidedly challenging.

In the late 19th century, the utilitarian economist Francis Y. Edgeworth anticipated the invention of a 'hedonimeter' - a sort of psychophysical barometer that records the fluctuations of a person's mood. There is no such machine as yet, but the burgeoning body of recent research in happiness has devised various ways of studying and measuring it.

The simplest way is simply by asking. In most instances, we do know and can report how we feel at a particular time and can place our mood along a scale of zero to 10.

Beyond mere asking, tools such as electroencephalography (EEG), which measures electrical activities in the brain, and functional magnetic resonance imaging (fMRI), which uses radio waves to measure blood flow in the various regions of the brain, have been used.

But to be a useful measure across a country, there must be a broader and easier to use metric that condenses the inter-individual subjective valuations into an overall statistic.

Working on the premise that positive mental health is more than happiness - which is transient and subject to frequent change with external influences - IMH researchers view positive mental health to be akin to an 'ability': something that is more stable, and which is shaped and moulded by the person's innate qualities and forces in his or her environment.

It is more than a current emotional and psychological state; it is an estimate of the capability and potential of an individual to be mentally healthy.

The concept of positive mental health refers to a range of emotional and cognitive attributes that are associated with a sense of well-being and coping skills.

Two philosophies have dominated this field of research - the hedonic and the eudaimonic views. While the hedonistic approach refers to the pursuit of pleasure or happiness, eudaimonia lies in the actualisation of human potential and conveys the belief that well-being consists of fulfilling one's true nature.

The two traditions - hedonism and eudaimonism - are founded on distinct views of human nature and of what constitutes a good society. Dimensions reported under the two have included autonomy, personal growth, environmental mastery, resilience, satisfaction and happiness.

In the work that led up to the development of this scale, the researchers worked with a series of focus groups from among the various ethnic groups in Singapore. What emerged as key to positive mental health were: personal growth and autonomy, close and confiding relationships, good and adaptable coping skills and strategies for life's vicissitudes, personal characteristics like calmness and serenity, and perhaps something that is distinctly Eastern - spiritual beliefs and practices.

To assess the full range of the quality of life of a population would be necessarily complex as it would include the state of the environment, security as well as access to education and health, which are practically impossible to assess with a single indicator.

However, this scale that the IMH researchers are developing could augment the traditional GDP. The additional assessment of mental health would enable us to go beyond economic health, and do a better job of measuring our collective general well-being and welfare.

The writers are from the Institute of Mental Health. Associate Professor Chong is the vice-chairman of the Medical Board (Research), and Ms Vaingankar is a health service researcher.

IMH researchers view positive mental health to be akin to an 'ability'... It is more than a current emotional and psychological state; it is an estimate of the capability and potential of an individual to be mentally healthy.