A Review Study of the Concept of Mental Health

The paper addresses the research question: What is mental health? It is motivated by a global mental health crisis marked by substantial treatment gaps, especially in low- and middle-income countries where up to 76–85% of individuals with severe mental disorders receive no treatment. Despite mental disorders’ links with other chronic diseases, there is limited societal understanding and no consensus on what is meant by mental health or mental disorders. Historically, scholars have disagreed: Kraepelin framed abnormality as inefficiency relative to an average; Freud viewed normality as an idealized fiction; Menninger emphasized effectiveness and happiness in social relations; and WHO emphasizes well-being, functioning, and contribution to community. Prior critiques (Jahoda, Mechanic) note the term’s vagueness and inconsistent use, often without explicit definitions. The review seeks to clarify the concept to inform policy and practice by synthesizing definitions and explanations across disciplines and contexts.

The review synthesizes conceptualizations of mental health across multiple traditions: (1) Universal/WHO framing: WHO defines health as complete physical, mental and social well-being, not merely absence of disease; mental health is a state of well-being enabling individuals to realize abilities, cope with normal stresses, work productively, and contribute to community. This definition is widely cited (Breslow, Piko, Prince et al., Mehta). (2) Psychosocial functioning and well-being: Mental health is influenced by social, psychological, and biological factors, including poverty, education, discrimination, social exclusion, violence, and individual predispositions; poor mental health can cause distress and impairment comparable to major depression and lies on a continuum with mental illness (Keyes; CMHA; Epp). (3) Disease/medical model: Equates mental health with presence/absence of mental disorder, emphasizing diagnosis and classification (ICD-10) and psychiatric perspectives; community perceptions may equate mental health problems with severe psychiatric disorders requiring detention (Fuller et al.; Dey et al.; Scott; Albee; Macklin; Goldstein). (4) Social constructivist perspectives: Mental health is context-dependent and shaped by social, economic, political, and cultural factors; it is broader than the absence of disease and should emphasize strengths and positive functioning (Jahoda; Albee; Sainsbury; Manwell et al.; Valliant). (5) Legislative frames: Mental Health Acts often define mental disorder/illness rather than mental health itself (Singh; Durham; Jones & Williams; Dawson). (6) Cultural/traditional beliefs: In some contexts, mental ill-health is attributed to ancestors, witchcraft, pollution beliefs, and ritual transgressions (Hammond-Tooke; Cheetham & Cheetham). Across studies, terms like positive mental health, well-being, and resilience are used variably, often without clear, operational definitions, and usage patterns vary by discipline and geography (e.g., positive mental health in Canada/Australia; global reliance on WHO).

Design: Systematic literature review to answer “What is mental health?” Inclusion criteria: Studies, reports, and papers that explained the meaning or provided a definition of mental health and/or mental illness; inclusion keywords included definition, understanding, literacy, meaning, clarification. Search strategy: Searches (English only) conducted across academic databases, websites, and archives including Web of Science, Psychiatry Online, Semantic Scholar, WHO website and publication database, WebMed Central, Scopus, Medline, PsycINFO, Social Science Citation Index, IBSS, SciELO, JSTOR, EBSCOhost, African Index Medicus, AccessMedicine, BioMed Central, PubMed, Biomedical and Life Sciences Collection, PsycNET, Sociological Abstracts, ScienceDirect, Science Online, SciFinder Scholar, LexisNexis, Psychodessey, ResearchGate, and Google Scholar. Search strings: “mental health” OR “mental illness” OR “mental disorder” OR “psychosocial wellbeing” OR “psychosocial functioning.” Additional sources: Reference lists of journal articles and an article from the Lancet Mental Health Commission were screened; consultations with local and international experts on conceptualization of mental health. Screening and selection: ~6,500 records identified; screened using inclusion criteria; 450 full texts obtained; 26 papers retained. Appraisal: Documents were critically evaluated based on relevance to the review question; strengths and limitations of each included study were integrated into the summaries of findings.

• Volume screened and included: ~6,500 records identified; 450 full-texts screened; 26 studies included. - Definitions vary widely: Ranged from detailed prescriptive definitions to brief descriptions; some defined mental health by what it is not. - Competing models: (a) Medical model equates mental health with mental illness/disorder (disease-oriented, ICD codes); (b) Psychosocial/positive models emphasize well-being, functioning, resilience, and strengths; (c) Social constructivist views stress contextual social, economic, political, and cultural determinants. - Interchangeable usage: Mental health is often used synonymously with mental illness/disorder in research, policy, and legislation, leading to conceptual confusion. - Determinants: Social and psychological determinants include poverty, low education, rapid social change, stressful work, gender discrimination, social exclusion, unhealthy lifestyles, violence, physical ill-health, human rights violations, as well as biological factors (e.g., genetics). - Continuum: Poor mental health and mental illness are not mutually exclusive; individuals can have good mental health with mental illness or poor mental health without a diagnosable disorder; poor mental health can cause impairment comparable to major depression. - Geographic and disciplinary variation: Sociological literature emphasizes social determinants; medical/psychiatric and legal fields focus on disorders and diagnostic codes; positive mental health is more emphasized in Canada and Australia; global literature often adopts WHO definitions. - Legislative focus: Mental Health Acts frequently define mental disorder/illness rather than mental health. - Cultural interpretations: Traditional belief systems attribute mental ill-health to ancestors, witchcraft, pollution beliefs, and ritual noncompliance in some communities. - Terminological ambiguity: Terms such as psychosocial well-being, positive mental health, mental health problems, mental health disorders, mental ill-health, and psychosocial support lack clear, operational definitions.

The review directly addresses the question “What is mental health?” by mapping how the term is defined and used across disciplines and contexts. Findings reveal no universal consensus, with significant consequences: conflation of mental health with mental illness impedes accurate epidemiology, policy formulation, and service design. Emphasizing only disease neglects strengths-based and community-level dimensions of mental health that influence prevention and promotion. Conversely, broad well-being definitions can be overly prescriptive and difficult to operationalize. Recognizing mental health as context-dependent, shaped by social determinants and cultural beliefs, supports a more comprehensive, multi-sectoral approach that integrates medical care with social policies addressing poverty, education, discrimination, and violence. Standardized, context-sensitive definitions would improve clarity in research, measurement, and legal frameworks, aiding coherent policy and implementation and enabling better monitoring of promotion and prevention outcomes.

Using systematic review methods, the study clarifies that there is no consensus definition of mental health. The term is widely and variably used—often interchangeably with mental illness—creating conceptual and practical challenges. While the medical model remains dominant, there is growing recognition of mental health as a broader, socially constructed concept that goes beyond disease to encompass well-being, functioning, and strengths. Mental health is best understood as a generic, continuous state that everyone possesses, distinct from but related to mental illness. The paper recommends: (1) adoption of a standardized, context-specific definition of mental health within policies and legislation; (2) mainstreaming mental health promotion through multi-sectoral strategies beyond the health sector; and (3) expanding research to enhance societal understanding of mental health and its determinants across individual, family, and community levels. Future research should operationalize core terms (e.g., positive mental health, psychosocial well-being), develop measurable indicators aligned with standardized definitions, and explore culturally grounded frameworks to inform policy and practice.

• Conceptual conflation: Many included studies used “mental health” interchangeably with mental illness/disorder, complicating synthesis. - Scope: The review focused on definitions and understandings of mental health as a holistic concept and did not analyze mental illness/disorder per se. - Geographic representation: Although searches were global, included papers were primarily from North America, with limited evidence from other regions specifically addressing the concept of mental health. - Language: Searches were conducted in English only, potentially excluding relevant non-English literature.