Positive Mental Health: The 19-Dimension Taxonomy

For decades, psychologists have agreed that mental health is more than the absence of mental illness.

However, defining positive mental health has remained challenging, with different theories emphasizing well-being, resilience, meaning, self-determination, and social connection.

Although these perspectives overlap, inconsistent terminology and measures have made research difficult to compare and findings harder to apply in practice.

In 2025, 122 experts reached consensus on the core dimensions of positive mental health, creating the first shared taxonomy (Iasiello et al., 2026).

This article explains the taxonomy, outlines its key dimensions, and explores how practitioners can use it to assess and foster lasting mental well-being in their clients.

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Why Has Positive Mental Health Been So Difficult to Define?

Researchers have developed a range of complementary frameworks to explain what it means to live well and thrive mentally over the past three decades.

Some have focused on subjective well-being and life satisfaction, others on psychological well-being, social well-being, meaning, strengths, resilience, or self-determination.

Although these frameworks emphasize different aspects of human functioning, they all contribute to our understanding of the broader construct of positive mental health.

This diversity has enriched ‌science yet simultaneously led to conceptual fragmentation. This has limited comparisons across studies, common assessment frameworks, and clear intervention targets across different therapies.

Recognizing this fragmentation, a group of researchers sought to develop a common framework that could integrate these different perspectives without replacing them. Before examining that framework, however, it’s important to understand how our broader understanding of mental health evolved.

The Dual Continua Model: Positive Mental Health Explained

Many of psychology’s (and psychiatry’s) first decades were based on what’s often referred to as the binary model of mental health.

Mental illness and mental health are seen as opposite ends of one continuum (Keyes, 2005). As symptoms decrease, mental health improves.

However, this assumption is not always well supported by the scientific literature, and it was soon replaced by the idea that mental health is more than the absence of mental illness (Iasiello et al., 2020).

The WHO Constitution (World Health Organization, 2020 edition, p. 1) established this principle in its inaugural Constitution by defining health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

A decade later, Marie Jahoda (1958) argued that freedom from mental illness alone was an insufficient definition of positive mental health.

In the following years, researchers including Carol Ryff, Ed Diener, and Corey Keyes provided extensive empirical evidence showing that psychological well-being is not simply the absence of symptoms but also reflects how people function psychologically and socially, experience meaning and purpose, and engage with life (Galderisi et al., 2015).

Perhaps the best evidence for this idea comes from Keyes’s (2005) research, ultimately resulting in the dual continua model. Rather than viewing mental illness as extreme on the lower end of the spectrum and mental health on the opposite end of the spectrum, the model proposes two related but independent continua.

• One continuum represents the presence or absence of mental illness.
• The other is the presence or absence of positive mental health, ranging from languishing to flourishing.

This distinction is crucial to practice. Someone may have no symptoms of anxiety or depression, yet feel little purpose, little social connection, and low vitality. On the other hand, a person might have been diagnosed with depression, yet have strong relationships, strong personal values, hope, and a deep sense of purpose.

Over the past two decades, there has been excellent evidence for this dual-continua view across clinical and nonclinical populations, age groups, and cultures. A recent review concluded that mental illness and positive mental health are consistently related but distinct constructs, each with unique predictors and outcomes (Iasiello et al., 2020).

Reducing symptoms alone is unlikely to produce optimal mental functioning unless someone actively cultivates it.

But until recently, there has been remarkably little agreement about what is needed to do that. This is where the 2026 consensus taxonomy comes in.

What Is Positive Mental Health? The 2026 Taxonomy Defined

In 2025, a group of researchers invited 122 international experts from 11 disciplines to participate in a structured Delphi process, a well-established method for building consensus in areas where evidence is broad and multidisciplinary (Iasiello et al., 2026).

The outcome was a taxonomy. Unlike a theory, which explains why something happens, a taxonomy is a classification system that organizes complex concepts into agreed categories using common terminology.

Importantly, the research team adopted the same broad understanding of positive mental health reflected in the WHO definition. Rather than focusing on a single theoretical tradition, they first examined measures spanning well-being, quality of life, resilience, and coping to capture the breadth of the associated concepts (Iasiello et al., 2024).

The Delphi study was therefore not the starting point of the project. It built on an earlier umbrella review and concept map in which the same research team systematically examined 155 measures of the construct.

That review identified 410 original dimensions, which were synthesized into 21 preliminary themes, forming the starting point for expert refinement during the Delphi process (Iasiello et al., 2024).

In three rounds, participants rated the importance of candidate dimensions, proposed refinements, and worked toward a consensus on what should be considered essential for positive mental health.

In the end, 19 dimensions reached at least 75% agreement, creating the first internationally agreed-upon taxonomy of positive mental health. Additionally, the researchers explored whether experts perceived each dimension as functioning primarily as a driver, an outcome, or both.

This staged approach adds important methodological rigor. The initial umbrella review ensured that the candidate dimensions reflected the breadth of existing mental health theories and measures, while the Delphi study provided an independent process for evaluating and refining those dimensions through interdisciplinary expert consensus.

Together, these two studies combined evidence from the published literature with expert judgment rather than relying on either source alone.

The Six Dimensions With the Strongest Expert Agreement

The image below shows the 19 dimensions of the taxonomy. While all 19 dimensions reached consensus, these six received the highest consensus with more than 90% agreement among experts.

1. Meaning and purpose
   The perception that life is guided, your daily activities are linked to personal goals, and you can make decisions about your life to reach those goals
2. Life satisfaction
   A cognitive assessment that life is going well overall
3. Self-acceptance
   Recognizing and accepting yourself, including strengths, limitations, and life experiences
4. Connection
   Having close, supportive relationships
5. Autonomy
   Living according to your own values and making individual choices
6. Happiness
   Good feelings and enjoyment in life

The other 13 dimensions (shown below) were found to have 75% to 89% of the overall consensus.

Taken together, these dimensions provide the most comprehensive interdisciplinary picture of positive mental health developed to date. Importantly, the taxonomy is intended as a shared classification system rather than a final statement, and future versions may add, merge, or refine dimensions as the evidence base develops.

It’s also worth noting that, rather than requiring everyone to achieve high scores across all of these dimensions, the taxonomy acknowledges that positive mental health is a multidimensional construct. People may flourish in different ways based on their values, life status, development, and culture.

This shifts assessment from a question of “Is this client happy?” to a much richer exploration of which dimensions are already strengths and which may benefit from further development.

Driver vs. Outcome: A More Precise Approach to Thinking About Intervention

While the taxonomy itself provides a common language for describing positive mental health, one potentially valuable addition is the distinction between dimensions that experts perceived as acting more as drivers or outcomes.

During the last Delphi round, experts were asked to evaluate whether each dimension primarily functions as a driver of a psychological resource contributing to flourishing or as an outcome of improved mental well-being.

Autonomy and sense of safety were viewed as tending toward driver dimensions, whereas happiness and life satisfaction were viewed more as outcomes. Rather than leading to good mental health, the latter two are more likely to occur when psychological resources are already in place. Most other dimensions fell somewhere between the two.

This is in line with what people actually experience every day. Clients don’t get happier as they pursue happiness. Instead, happiness is better understood as the result of making decisions aligned with your values, building important relationships, feeling more independent, developing competence, or reconnecting with meaningful goals.

In the same way, life satisfaction is never determined by someone’s decision of, “I feel more satisfied.” It tends to increase after significant progress in multiple areas of life.

This reflects a familiar principle within behavior change science. Sustainable outcomes are often achieved by changing upstream processes rather than pursuing downstream results directly. The taxonomy simply provides practitioners with a clearer map of the upstream processes.

Although this distinction remains exploratory rather than definitive, it offers a useful way for practitioners to think about assessment, case formulation, and intervention planning.

Measuring Positive Mental Health: The Taxonomy and MHC-SF.

While the new taxonomy offers practitioners a common framework for understanding flourishing, it is not a measurement instrument. Clinicians still need reliable, scientific tools to assess their patients in practice.

One of the best-known measures is the Keyes’ Mental Health Continuum-Short Form (MHC-SF; Lamers et al., 2011). The 14-item questionnaire assesses three broad domains of positive mental health:

• Emotional well-being (happiness and life satisfaction)
• Psychological well-being (personal growth, purpose, and self-acceptance)
• Social well-being (social contributions, integration, and connection).

The MHC-SF allows practitioners to estimate where a client is on the mental health continuum (from languishing through to flourishing) while also complementing a patient’s traditional symptom score.

The new taxonomy serves to supplement rather than replace this model. Think of the MHC-SF as a dashboard that gives you a general picture of good mental health. The taxonomy then helps to explain why those scores look so good on the surface by identifying the issues that may need to be probed further.

For example, two clients may have similar overall MHC-SF scores, but their underlying profiles might look very different.

One might derive their positive mental health from a strong sense of autonomy and purpose while experiencing weaker social connection and belonging. The other could feel deeply connected and embedded in community but perceive less autonomy and purpose.

Both appear to be flourishing the same based on their MHC-SF scores. However, it’s only when applying the taxonomy that practitioners can identify their client’s strengths and vulnerabilities to explore further. The resulting interventions for both clients will consequently look very different.

Applying the Taxonomy: A Clinical Scenario

Perhaps the biggest contribution of the taxonomy is not that it changes what practitioners do; it clarifies why they do it.

Most clinicians already help clients build stronger relationships, develop a sense of purpose, increase autonomy, grow self-acceptance, and establish meaningful goals. The taxonomy provides a common language for managing these intervention objectives within a coherent framework.

Instead of asking only if a client is improving, practitioners can ask broader mental health questions:

• What elements of positive mental health are already strengths?
• Which dimensions seem most underdeveloped? Are these driver dimensions or outcome dimensions?
• Which driver dimensions are most likely to produce meaningful downstream improvements?

These questions encourage a strengths-informed formulation without losing sight of presenting difficulties.

A clinical example

Imagine Sophie, a 38-year-old marketing executive who is looking for help because she feels “stuck.” She has no symptoms of a diagnosable mental disorder and says she does well at work and is physically healthy. She thinks she is doing a good job and considers herself happy.

Yet, according to Sophie, something is missing, and she feels directionless about how to identify it. Sophie scores in the moderate range on the MHC-SF, but when the taxonomy is used to guide assessment, the picture is a bit more nuanced.

Her strengths are competence, achievement, activities, and functioning. But she also reports low self-confidence, limited autonomy, and ‌few meaningful social connections outside work.

Rather than treating her reduced happiness and life satisfaction as the focus of her treatment plan, the taxonomy suggests these are likely downstream effects of weaker driver dimensions.

Sophie and her coach focus more on autonomy and on how much of her lifestyle aligns with her own values rather than on what people think of her. They also find a way for her to reconnect with meaningful relationships and mental health activities that matter to her personally.

Six months later, Sophie feels more robust, more satisfied with life, and more positive. These improvements followed increases in the underlying driver dimensions.

Building Positive Mental Health With Taxonomy Insights

The publication of the 2026 taxonomy does not require practitioners to abandon their current practice. Instead, it offers a framework for connecting them.

A cognitive behavioral therapist could continue to use behavioral activation while recognizing that these interventions are likely to enhance autonomy, competence, and engagement.

An acceptance and commitment therapy practitioner might view the interventions as increasing psychological flexibility and self-congruence, as well as meaning and purpose.

And positive psychology practitioners can still implement evidence-based interventions such as strengths-building, gratitude practices, acts of kindness, or values clarification, and be more specific about which aspects of positive mental health those interventions address.

One of the taxonomy’s greatest potential benefits is the common language among therapeutic orientations that is likely used to inform assessment, set goals to support assessment, and follow up on the progress of interventions across all therapeutic perspectives.

This common language can improve communication among researchers, clinicians, educators, and policymakers when research is ongoing and evidence is translated into practice.

A Take-Home Message

For decades, practitioners have recognized that reducing symptoms is only one part of helping with mental health. The challenge has been defining what we are trying to build once the distress fades.

The taxonomy finally gives practitioners a shared language for describing what flourishing actually looks like.

As ‌science continues to evolve, the taxonomy should be viewed as the beginning rather than the endpoint of a shared scientific language.

Positive mental health is not something to measure after therapy has been successful; it is something that can be assessed, cultivated, and purposefully developed at any stage in life.

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