A new map for consistent, targeted mental wellbeing promotion

Ask most Australians how they're feeling, and they'll say "fine" or "not bad." We've learned to measure mental health against how bad things could be. But mainstream frameworks define mental health as something fuller, looking at the presence of good, not just the absence of bad.

Our system is built almost entirely around fixing deficits. The rates and costs of mental illness are well known and growing, and so is the strain on the system. There is increasing advocacy for policies to prevent clinical symptoms before they are experienced, or addressed earlier before they progress in severity.

But what if prevention and treatment aren’t the only paths to good mental health? For 25 years, wellbeing science has argued for something different: that the system should promote states of wellbeing as a complement to preventing and treating illness. Prevention removes risk factors. Promotion builds the good things people actually want more of; and they aren't necessarily the same thing.

Stuck in the middle of prevention and promotion is a group of people who are struggling without being ill at all. Psychologists call this languishing, describing a state of low wellbeing where people feel disengaged, lack a sense of purpose, and struggle to function at their best, without meeting the threshold for mental illness. Our national study of more than 16,000 Australians found roughly one in five fall here: upwards of five million people quietly muddling through feeling disengaged, stuck and stagnant.

A taxonomy of positive health

To promote the good however, you first need to define it. And here wellbeing science stumbles. It has produced many models of wellbeing with heavy overlap and little agreement (flourishing, thriving, resilience, quality of life), all used differently across disciplines. Psychiatry focuses on functioning, economists on life satisfaction, GPs on quality of life. Each is individually defensible, but together they had never been assembled into a single, coherent picture of what mental wellbeing actually consists of.

Our latest work set out to address this challenge by building a taxonomy of positive mental health. Across a series of studies, we interrogated the unique dimensions of 155 measures of positive mental health and brought them together into a draft taxonomy.

We then relied on the Delphi method as a structured process to build expert consensus on the taxonomy. We recruited 122 experts from 11 disciplines, including psychology, medicine, public health, sociology, philosophy, economics, and theology. Participants had an average of nearly 20 years of experience in the field. Over three iterative rounds of surveys, we asked them to rate which dimensions of positive mental health belonged in a shared taxonomy.

The threshold for consensus was set at 75% agreement. Nineteen dimensions cleared that bar. Six cleared 90%, landing as the highest-consensus dimensions in the taxonomy: 

• meaning and purpose;
• life satisfaction;
• self-acceptance;
• connection;
• autonomy; and 
• happiness.

The full list of 19 also included engagement, development, optimism, self-congruence, fun, vitality, activities and functioning, competence, acceptance, belonging, achievement, calmness, and sense of safety.

What it means for practitioners

We didn’t aim to create yet another model or theory. You should think of it as a shared vocabulary — a standard language much like the behaviour change technique taxonomy, which brought consistency to a field that had been talking about the same techniques under dozens of different names. 

To us, these dimensions act as targets that can be modified at every level of the socio-ecological model, meaning there's a role for all of health to play. For example, for a GP doing a mental health care plan, the taxonomy offers a checklist worth thinking through. Is this patient lacking connection? Struggling with meaning and purpose? Has their sense of safety been undermined by financial stress or a difficult living situation? These are concrete, targetable dimensions with a body of evidence behind each one.

And crucially, these dimensions can be used to reliably assess struggle when no clinical symptoms are present, ie the languishing state described earlier. A patient can come in without showing clinical symptoms while still floundering on connection, meaning, or safety.

Implications and next steps

The taxonomy gives us a common reference point and the paper opens up interesting questions about which dimensions should be assessed, monitored and funded to best promote wellbeing and prevent illness. 

The work has real limitations though. The expert panel was predominantly Western, English-speaking, and skewed toward psychologists, so the taxonomy captures Western research well but may miss what matters in non-Western, Indigenous, or marginalised communities. For example, concepts like ikigai, the Japanese idea of a "reason for being," didn't make the cut. The next phase is to test this top-down view against perspectives from lived experience, Indigenous knowledge, the voices of people facing chronic illness or disadvantage to name a few. An important work in progress. 

But you don't need to wait for that work to use this. For the patient who isn't unwell yet plainly isn't flourishing, the taxonomy already does something practical: it can turn a vague unease into a named, targetable dimension. Is it connection that's missing? Meaning? A sense of safety? And for anyone setting out to build wellbeing, whether a clinic, a workplace, or a policy, we hope the taxonomy offers a way to approach mental wellbeing promotion with the same rigour we bring to illness treatment and prevention, anchored in evidence rather than intuition or hype.

Dr Matthew Iasiello is an NHMRC Grant-Funded Research Fellow at the University of Adelaide and Head of Data and Research Translation at Be Well Co. His research focuses on the measurement and promotion of positive mental health, the dual-continua model of mental health, and translating wellbeing science into practical, real-world interventions. He completed his PhD at Flinders University in 2023 and has a particular interest in supporting people living with chronic illness, such as multiple myeloma.

Dr Joep van Agteren is CEO of Be Well Co and an Affiliate Senior Lecturer at the University of Adelaide’s School of Public Health. A psychologist by training, his work centres on interventions for people experiencing low wellbeing (languishing), evidence synthesis, behaviour change, and the practical application of mental health science. He leads efforts to translate research into accessible programs and tools that improve everyday wellbeing.