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Well-being is a central dimension of recovery in severe mental disorders (SMD), underscoring that mental health extends beyond the absence of illness. However, well-being may not hold the same meaning for patients, relatives, and professionals, raising key questions about its assessment in clinical practice. Moreover, the perception of well-being is a decisive outcome that can guide clinical decision-making, reinforcing its role as a critical indicator in psychiatric care.

This sequential mixed-methods study examined agreement between 186 patients with SMD (self-informants) and 186 external informants (family, friends, or therapists) on the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Quantitative analyses assessed concordance and tested whether age, gender, relationship type, or relationship duration predicted discrepancies. Complementary qualitative interviews explored how each group conceptualizes well-being.

Quantitative analyses showed moderate concordance between self- and external informants (70%), with professionals tending to rate well-being higher than relatives and patients. Relationship type explained only a small proportion of variance. Qualitative findings indicated that patients primarily linked well-being to experiential recovery processes such as empowerment, freedom, and acceptance, whereas external informants, particularly professionals, focused on observable and behavioral aspects, including self-efficacy and help-seeking.

Well-being is understood differently by stakeholders. Patients emphasize internal, subjective dimensions, while relatives and professionals prioritize behavioral indicators. These complementary but divergent perspectives highlight that self-reports capture unique aspects of well-being not reflected in proxy assessments. Clarifying what well-being means for each agent is essential for individualized rehabilitation planning and ensuring clinical decisions align with patients' recovery goals.