How Would You Describe a Mentally Healthy Person? A Cross-Cultural Qualitative Study of Caregivers of Orphans and Separated Children

The researcher-driven conceptualizations of mental health that undergird flourishing measures have not been extensively studied qualitatively for acceptance by people in low and middle income countries. We conducted in-depth interviews with caregivers of orphaned and separated children (OSC) in five geographic regions (Kenya; Ethiopia; Cambodia; Hyderabad, India; and Nagaland, India). Sixty-two participants answered open-ended questions including, “What does mental health mean to you? What does it mean to be mentally healthy?” We coded responses using a priori and data-driven codes and analyzed coded text for themes. Across regions, participants frequently articulated similar conceptualizations, which did not include orientations/values but spanned experiences, functioning, and behaviors, as well as the eudaimonic and hedonic traditions of happiness. Functioning included good states of mind (peaceful mind, thinking clearly, thinking positively) and being physically healthy. Behaviors were contributing to the community and spending enjoyable time in groups. For experiences, participants universally indicated happiness, which was the most prominent feature of good mental health, using terms such as “happy,” “jovial,” and “joy.” Across all geographic regions, mental health was not articulated merely as the absence of mental illness. A two continua model of good mental health emerged spontaneously among half of Kenyan and one-third of Cambodian participants. Altogether, the lay conception of ‘a person who is mentally healthy’ across these diverse non-western cultures supports multiple existing conceptions and measurements of flourishing. Researchers may consider adding to their conceptualizations good functioning in the form of clear and peaceful thinking and the behavior of enjoyable socializing.