Defining the process phase

The Concise Oxford Dictionary defines process as ‘a course of action or proceeding, especially a series of stages in manufacture or some other operation’ or as ‘ the progress or course of something.’

We define as process ‘those activities which take place to deliver mental health services’.

In relation to the theme of this book, the process phase therefore refers to a wide range of clinically related procedures which occur in the mental health service system. In fact, we consider the process of care as the shell within which the active ingredients of treatment (inputs) are delivered to patients.

The distinction between inputs and processes is important but is often not clear cut. On one hand, it should be recognised that these processes are the vehicle for the delivery of care, and are not the substance of the treatment itself (Shepherd & Sartorius, 1989). On the other hand, these processes (non-specific contextual factors) also contribute indirectly towards patient outcomes, through many psychological mechanisms. For example, increased patient satisfaction with services may improve consequent treatment adherence. We therefore see the content of specific treatments (inputs) as of primary importance, and the process of care as a second order issue. The balance between these two sets of factors will vary. In situations where there is a limited knowledge base about what are the effective treatments for a particular clinical condition, or where known effective treatments are simply not available in a given local area, then process issues tend to assume greater relative importance.