The 5-Elements of Systemic Wellbeing Framework: A Conceptual Model for Preventive Mental Health
Nadine Wilches, LCSW | August, 2022 | Mind the Class
Author Note
This conceptual framework was initially presented at La Sorbonne University, Paris, on September 1, 2022. Correspondence concerning this article should be addressed to Nadine Wilches, 25 Health Sciences Drive, Stony Brook, NY 11790
Abstract
Psychological approaches to mental health rely primarily on a medical model of assessment, diagnosis, and treatment, which reacts to symptom presentation, affect, and behavior. This approach is limited in that it neither demonstrates a reduction in the rates of mental illness nor prevents future mental health problems in those previously treated. A significant 11-year gap exists between the onset of symptoms and intervention in the current model (National Alliance on Mental Illness, 2021). Furthermore, individuals with preventable physical illnesses are more likely to experience mental health problems, and evidence for treating multimorbidities is limited, compounding the issues of a single-disease response model (Barnett et al., 2012). A comprehensive thematic analysis of research on wellbeing for the application of preventive mental health practices could not be identified, signaling a critical gap. This paper introduces The 5-Elements of Systemic Wellbeing Framework, a conceptual model developed from a reflexive thematic analysis of over 2000 research studies and expert interviews. The analysis identified five core themes of wellbeing (Secure, Regulated, Valued, Decided, Related), each supported by evidence from 36 or more credible resources. Within each theme, twelve subfactors with the strongest evidence were organized into two subcategories: six internal (personal) and six external (environmental) factors. This structure provides a comprehensive, evidence-informed definition of wellbeing designed to serve as a launch point for the systemic prevention of mental health conditions and the promotion of wellbeing as a proactive solution. This is presented as a conceptual framework with limitations in that its application and outcomes are yet to be empirically examined on a large scale.
Keywords: Wellbeing, integrative, mental health, prevention, analysis
The 5-Elements of Systemic Wellbeing Framework: A Conceptual Model for Preventive Mental Health
The landscape of mental health is at a critical juncture. Despite increased awareness, mental health conditions have seen a 13% rise since 2017, and with 20% of the world’s youth experiencing a mental health problem, the impact is pervasive (National Institute of Health [NIH], 2022). The current paradigm, largely a reactive crisis-response model, is proving insufficient. There is, on average, an 11-year gap between the onset of symptoms and the initiation of treatment (National Alliance on Mental Illness, 2021), and suicide remains the second leading cause of death for youth aged 10 to 34 (National Institute of Mental Health [NIMH], 2022). The economic burden is staggering, with depression and anxiety alone costing the global economy an estimated US$1 trillion annually, yet mental health receives less than 2% of US government funding (WHO, 2018). This reactive approach fails to reduce the incidence of mental illness and inadequately addresses the complexities of multimorbidity, where preventable physical illnesses and mental health problems often coexist (Barnett et al., 2012).
The need for a paradigm shift toward prevention is evident. A public health approach to disease does not wait for emergencies; it moves into the community with preventive resources like screenings, education, and environmental regulation (Kamenetz, 2018). This manuscript argues for a similar approach to mental health. We must get ahead of the problem using preventive systems of care that address both the individual and the environmental factors that protect against mental illness. We know that the environment surrounding our youth, including the mental health of adults in those settings, is vital. Therefore, a systemic model that is more feasible and cost-effective than a prescriptive, individual treatment model is necessary to address the significant shortage of mental health professionals and the high costs of care.
This work was born from an observed opportunity. A review of existing literature and interviews with clinical research advisors from four universities, alongside ten clinical and professional advisors, revealed a lack of a clear, operational definition of wellbeing and a scarcity of evidence-informed preventive practices for mental health. To address this gap, this paper introduces The 5-Elements of Systemic Wellbeing Framework. This conceptual framework was developed to define the elements of wellbeing by examining research that demonstrates results in reducing psychological and physiological distress. It is offered not as a prescriptive treatment, but as a model to understand and assess the internal and external factors that contribute to wellbeing, thereby guiding the development of proactive, systemic, and preventive mental health strategies.
Theoretical Rationale for Model Design
The 5-Elements of Systemic Wellbeing Framework is a multi-theoretical construct, integrating principles from various psychological and sociological schools of thought. This approach acknowledges the complexity of human wellbeing, which is shaped by internal cognitions, interpersonal dynamics, and systemic forces. The following theories provide the foundational rationale for the framework's design:
Systems Theory: This theory posits that one event has a rippling effect on the whole, meaning systems thrive through consideration of the entire interworking organism (Buckley, 1967). This underpins the framework's focus on both internal (personal) and external (environmental) factors, recognizing that an individual’s wellbeing is inseparable from the health of the systems in which they operate.
Social Learning Theory: We learn by observing others; therefore, what is modeled by leadership and peers is essential (Bandura, 1989). The framework acknowledges that promoting wellbeing requires creating environments where healthy coping, communication, and self-worth are actively modeled.
Self-Worth Theory: To feel competent, confident, and self-accepting, one must achieve a sense of healthy self-worth, often through achievement and gratification, which in turn promotes further motivation (Covington, as cited in Weiner, 1994). This theory informs the Valued element of the framework.
Psychosocial Development Theory: Erikson's theory suggests that adjustment to social crises influences developmental progress and future capacity to cope with adversity (as cited in Greene et al., 2004). The framework considers developmental stages and the need for age-appropriate support in building resilience.
Incremental Theory (Mindset): The belief that intelligence and ability are not fixed but can be developed promotes a growth mindset, fosters opportunities for change, and reframes failure as a learning opportunity (Dweck, 1986). This is central to the Decided and Valued elements.
Grounded Theory: This research methodology emphasizes data collection and analysis to develop a framework from a baseline understanding, structuring the change process based on emergent themes from the data itself (as cited in Brown, 2006). This aligns with the inductive method used to create the 5-Elements Framework.
Conflict Theory: This perspective suggests that change often requires navigating conflict, vulnerability, and risk to reduce disparities and improve quality of life. The framework recognizes the need for skills and environments that support constructive conflict resolution and vulnerability, as detailed in the Related element.
Social Constructionist Theory: This theory posits that social and cultural factors influence learning and that meaning is developed through language and socialization (as cited in Gergen, as cited in Ritzer, 2021). The framework accounts for how cultural and social contexts shape an individual’s understanding of themselves and their relationships.
Transpersonal Theory: Maslow's later work on self-transcendence suggests that when we see ourselves as part of something larger, our perspective shifts (Koltko-Rivera, 2006). This informs the framework's emphasis on purpose, connection, and meaningful impact as components of wellbeing.
Method
A reflexive thematic analysis was conducted using an inductive and latent approach to develop The 5-Elements of Systemic Wellbeing Framework. The research, conducted between 2020 and 2022, aimed to define the elements of wellbeing through a comprehensive examination of research demonstrating results in reducing psychological and physiological distress.
Data Sources and Collection
The analysis drew from multiple sources. First, an extensive literature review of over 2,000 research papers on wellbeing, mental health, and integrative studies was conducted. The search was intentionally broad to allow for an inductive process. Second, semi-structured interviews were conducted with clinical research advisors from four universities, as well as ten clinical and professional advisors, to identify perceived gaps in the understanding and application of preventive mental health practices. This qualitative data helped to inform and redefine the problem-definition and direct the examination of studies related to surfaced themes.
Analysis Process
The analysis followed an inductive and latent approach. Research was reviewed without preconceived themes or codes, allowing themes to emerge directly from the data. Both direct results (manifest content) and underlying meanings or assumptions (latent content) were examined. The coding process was iterative and reflexive; codes were continuously reviewed, changed, and reorganized as more qualitative and quantitative data from the studies were analyzed.
The analysis concluded when data saturation was reached, meaning new themes were no longer emerging from the review. The five most robust and consistently supported themes were labeled the "5-Elements." A theme was considered to have sufficient evidence if it was supported by 36 or more credible, distinct resources.
Following the identification of the five primary themes, a further analysis identified numerous subfactors within each. The 12 subfactors with the strongest evidence base for each of the 5-Elements were included and labeled "Key Factors." After organizing these subfactors, it became evident that they could be categorized into two distinct subcategories beneficial for understanding and application: "internal" (personal) and "external" (environmental) factors of wellbeing. This resulted in a final structure of five Elements, each containing six internal key factors and six external key factors, for a total of 60 key factors across the framework. This organized data was then structured into a professional development format, labeled The 5-Elements of Systemic Wellbeing Framework.
Results: The 5-Elements of Systemic Wellbeing Framework
The thematic analysis produced a conceptual framework comprising five core elements of wellbeing: Secure, Regulated, Valued, Decided, and Related. Each element is composed of internal factors (Psychological Health Factors) that represent an individual's personal resilience and capacities, and external factors (Protective Factors) that represent the environmental conditions that buffer stress and promote wellbeing.
Element 1: Secure
The Secure Element relates to the internal sense of security and emotional vulnerability, influenced by environmental conditions. A calm, consistent, and dependable environment is crucial for developing internal security, establishing healthy boundaries, and reducing fears. This element draws on the foundational work of researchers such as John Bowlby on attachment theory, Bessel van der Kolk on trauma's disruption of safety, and Frances Kuo on the restorative effects of nature (Bowlby, as cited in Bretherton, 1992; Kuo & Sullivan, 2001; van der Kolk, 2014).
Internal (Psychological Health) Factors:
Self-awareness: The ability to recognize and understand one's own thoughts, emotions, and behaviors.
Self-compassion: Treating oneself with kindness and understanding, especially in moments of difficulty.
Safety: A state of being free from harm, danger, or threat, allowing for authentic expression and growth.
Agency: The sense of autonomy and control over one's choices and actions.
Boundaries: The limits individuals establish to protect their physical, emotional, and psychological well-being.
Beliefs: The core ideas, values, and assumptions that shape an individual's perception and behavior.
External (Protective) Factors:
Calm: An environment free of disruptive, destructive, or harmful conditions that promotes emotional security.
Protection: Feeling safe from physical and emotional harm, fostering trust and help-seeking behaviors.
Belonging: A sense of being valued and accepted within one's environment, which improves social confidence and resilience.
Connection: Meaningful and authentic relationships that buffer against loneliness and isolation.
Reliability: Dependability and consistency in relationships and environments, which promotes a sense of safety.
Equity: Fairness and justice in relationships and social systems, which contributes to worthiness and self-respect.
Element 2: Regulated
The Regulated Element encompasses self-regulation, both internally regarding biological needs and emotional responses, and externally by utilizing the environment for intentional regulation. This element is informed by research from Peter Sterling on allostasis, Antonio Damasio on the somatic marker hypothesis, and James Gross on the process model of emotion regulation (Bechara & Damasio, 2005; Gross, 1998; Sterling & Eyer, 1988).
Internal (Psychological Health) Factors:
Sense: A deep self-awareness of one's body and surroundings, empowering informed decision-making.
Nutrients: Proper nutrition that supports brain health, cognitive function, and emotional stability.
Somatic regulation: The conscious management of bodily sensations to manage stress and connect physical and emotional states.
Sensory regulation: The ability to manage and adapt to sensory experiences from the environment.
Emotional regulation: Managing emotions adaptively to respond intentionally to feelings and maintain stable relationships.
Hydration: Adequate water intake, crucial for cognitive clarity and emotional stability.
External (Protective) Factors:
Conscious: Environments that promote mindfulness, presence, and intentionality, enhancing focus and self-control.
Exposure: Conscious exposure to natural elements like sunlight and nature, which promotes physical and mental clarity.
Energy: Environments and practices that help individuals manage and optimize their physical and mental energy through activity and rest.
Stimuli: An environment that provides engaging, relevant stimuli while managing overwhelming input to foster focus.
Balance: Environments and practices that promote physical and emotional equilibrium to better cope with stressors.
Routine: A structured and consistent routine that promotes stability, productivity, and a sense of control.
Element 3: Valued
The Valued Element incorporates personal investments in thoughts and behaviors, as well as investments in external factors that provide a sense of value. Investing energy in meaningful ways is crucial for emotional balance and fulfillment. This concept is supported by the work of Carol Dweck on mindset, Edward Deci and Richard Ryan on Self-Determination Theory, and Mihaly Csikszentmihalyi on flow (Csikszentmihalyi, 1990; Dweck, 1986; Ryan & Deci, 2000).
Internal (Psychological Health) Factors:
Worth: Recognizing one's intrinsic significance and unique qualities, reducing reliance on external validation.
Self-acceptance: Embracing one's strengths and weaknesses without self-criticism.
Joy: Finding happiness and pleasure from internal experiences rather than external circumstances.
Purpose: Understanding life's meaning and intentionally pursuing aligned goals, providing direction and motivation.
Character: An individual's moral and ethical principles that guide actions and foster self-respect.
Capacity: The belief in one's potential to learn, adapt, and achieve, fostering self-efficacy and resilience.
External (Protective) Factors:
Interest: Environments that promote genuine interest and passion, leading to engagement and motivation.
Time: The ability to allocate time to activities that are perceived as important and fulfilling.
Cohesion: A sense of unity and collaboration within a group that fosters a positive social environment and shared purpose.
Meaningful impact: The experience of contributing to something larger than oneself, promoting fulfillment and self-worth.
Feedback: Environments where meaningful feedback and recognition are provided, promoting growth and competence.
Relationships: The presence of positive and meaningful relationships that provide a sense of belonging and support.
Element 4: Decided
The Decided Element emphasizes the importance of self-efficacy and intentionality in relation to wellbeing. Decisions are influenced by one's environment, values, and perceptions. This element builds on research from Albert Bandura on self-efficacy, Roy Baumeister on willpower, and Ellen Langer on mindfulness (Bandura, 1997; Baumeister & Vohs, 2007; Langer, 1989).
Internal (Psychological Health) Factors:
Insight: A deep understanding of one's own thoughts, emotions, and behaviors.
Control: The perceived ability to influence and manage one's circumstances and reactions.
Values: The guiding principles and beliefs that inform individual choices and actions.
Mindset: A cognitive framework that influences one's interpretation of and response to challenges.
Perception: How an individual integrates information to form a view of themselves and the world, which informs rational decisions.
Reasoning: The ability to analyze situations, evaluate options, and make informed choices.
External (Protective) Factors:
Intention: Environments that encourage clear and positive intentions aligned with values and goals.
Attitude: Situations and environments that model and promote a positive attitude and growth mindset.
Habits: Environments that support the cultivation of positive habits and routines aligned with desired outcomes.
Process: The availability of clear and efficient processes for achieving goals, which reduces fear of failure and supports an internal locus of control.
Effort: A culture that values and recognizes consistent and focused effort toward goals, supporting a mastery mindset.
Influence: Environments where individuals are encouraged to understand their influence and make thoughtful, informed decisions.
Element 5: Related
The Related Element refers to how individuals relate to adversity and challenges within social contexts. This is influenced by social roles, cultural norms, and belief systems. This element is informed by the work of Susan Folkman on coping, Shelley Taylor on the "tend-and-befriend" response, and Marsha Linehan on dialectical balance (Folkman & Lazarus, 1980; Linehan, 1993; Taylor et al., 2000).
Internal (Psychological Health) Factors:
Presence: The capacity to fully engage with the immediate moment and one's internal experiences, reducing reactivity.
Flexibility: Psychological adaptability in the face of challenges, allowing for constructive problem-solving.
Empathy: The ability to understand and share in the feelings of others, fostering deep connections.
Vulnerability: The willingness to be open about one's emotions and struggles, facilitating authentic connections.
Perspective: The ability to consider various viewpoints to gain a broader understanding of one's experiences.
Identity: A clear and stable understanding of one's core values, beliefs, and self-concept.
External (Protective) Factors:
Rapport: Environments that facilitate the building of positive connections, trust, and collaboration.
Role: The existence of clear and meaningful roles within a group or organization, promoting a sense of purpose.
Listening: A culture that promotes active and empathetic listening, leading to effective communication and understanding.
Alignment: A shared sense of direction where individual values and goals align with a collective mission.
Self-expression: Environments that encourage and embrace authenticity, creativity, and personal identity.
Power: Environments that promote shared power, autonomy, and influence, fostering self-efficacy and agency.
Discussion
The 5-Elements of Systemic Wellbeing Framework represents a departure from the traditional medical model of mental health. Rather than focusing on deficits and pathology, it provides a strengths-based, comprehensive language for understanding and cultivating the conditions that allow individuals and communities to flourish. Its conceptualization of wellbeing as an interplay between internal capacities and external conditions aligns it with a public mental health approach, where the goal is to lower background levels of risk factors like bullying and discrimination while actively promoting protective factors (Kamenetz, 2018; Saxena et al., 2006).
Implications for Preventive Practice
This framework is designed to be a practical tool for prevention. By defining specific, measurable factors of wellbeing, it provides a roadmap for educational institutions, workplaces, governments, healthcare and community organizations to assess their current state and identify areas for intervention. For example, a school finding low scores in the Secure element’s external factors might implement programs to improve feelings of belonging and establish more reliable routines, drawing on research in health-promoting schools (Langford et al., 2015; Markham & Aveyard, 2003). An organization with low scores in the Valued element could focus on creating more opportunities for meaningful impact and providing more consistent, constructive feedback, thereby enhancing employee engagement and reducing burnout.
The framework’s dual focus on internal and external factors is critical. It suggests a two-pronged approach to prevention: 1) empowering individuals with the skills and mindsets to build their own psychological health (e.g., teaching self-compassion, emotional regulation), and 2) architecting environments that are inherently protective and health-promoting. This systemic view moves beyond blaming individuals for their struggles and places shared responsibility on the systems to create conditions conducive to wellbeing. This is particularly relevant in educational settings, where student wellbeing is inextricably linked to academic achievement, effort, and positive behavior (Gutman & Feinstein, 2008; Stewart, 2007; Zins et al., 2004).
A Strengths-Based Approach to Assessment
The framework provides the conceptual basis for developing new assessment tools that measure wellbeing from a positive, strengths-based perspective. Unlike many clinical tools designed to identify pathology, assessments based on the 5-Elements can quantify the presence of favorable conditions that enhance mental health. The Psychological Health assessment can measure an individual's perception of their internal capacities, while the Protective Factors assessment can measure the perceived quality of their environment. This allows for pre- and post-intervention measurement to track progress and validate the impact of initiatives, shifting the focus from an absence of symptoms to the presence of flourishing.
Limitations
This manuscript presents a conceptual framework, and several limitations must be acknowledged. First, the framework is newly developed and has not yet undergone large-scale empirical validation. While its components are derived from an extensive review of existing research, the framework as a whole requires rigorous testing to establish its psychometric properties and predictive validity. Second, while early trials in clinical and educational settings have shown promise in model adoption, controlled studies are needed to determine the efficacy and effectiveness of interventions designed using this framework. The causal links between improving the 60 identified key factors and long-term mental health outcomes need to be systematically examined. Finally, the framework is broad and comprehensive, and its application will require careful tailoring to the specific cultural, social, and economic contexts of different populations.
Conclusion
The rising rates of mental health conditions globally demand a fundamental shift from a reactive to a proactive, preventive paradigm. The current medical model, with its inherent delays and focus on pathology, is insufficient to stem the tide. The 5-Elements of Systemic Wellbeing Framework offers a research-informed, comprehensive, and actionable alternative. By defining wellbeing through five core elements—Secure, Regulated, Valued, Decided, and Related—and distinguishing between internal psychological health factors and external protective factors, it provides a clear structure for assessment, intervention, and systemic change.
This framework is not a final answer but a launch pad. It is a call to action for researchers, practitioners, educators, and community leaders to collaboratively build systems that do more than just treat illness but rather build and strengthen systems that actively cultivate the conditions for human flourishing. By investing in prevention and promoting wellbeing systemically, we can move beyond simply reacting to crises and begin to build a future where more individuals have the internal resources and external support to lead psychologically healthy lives.
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