11 - The time dimension: the process phase  pp. 129-140

The time dimension: the process phase

By Graham Thornicroft and Michele Tansella

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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.’ [1]

We define as process ‘those activities which take place in the delivery of mental health care’.

In relation to the theme of this book, the process phase therefore refers to a wide range of activities (clinical and non-clinical) which occur in the mental health system (seeTable 11.1).

These processes include direct interventions for people with mental illness (such as admissions to hospital, prescriptions of medications or the provision of psychological treatment) as well as non-clinical processes (such as administrative activities). Although our primary emphasis is upon outcomes (see Chapter 12), processes are important because they affect outcomes in important ways. For example, a staff decision of whether to admit a person to hospital or not, or a decision to take or not to take medication as prescribed, by a person with mental illness (two types of clinical process), may have serious implications for that person's treatment outcome. There may also be complex interactions between different processes. For example, increased individual satisfaction with services (perhaps because of better information provision) can improve consequent treatment adherence.

Process at the country/regional level

The many processes taking place within the whole mental health care system are largely invisible unless they are systematically described in ways that allow comparisons between places or across time.

Andrews G. Efficacy, effectiveness and efficiency in mental health service delivery. Aust. N. Z. J. Psychiatry 1999; 33(3): 316–322.
Becker T. Out-patient psychiatric services. In Thornicroft G and Szmukler G (Eds.). Textbook of Community Psychiatry. Oxford: Oxford University Press; 2001: 277–282.
Coop CF. Balancing the balanced scorecard for a New Zealand mental health service. Aust. Health Rev. 2006; 30(2): 174–180.
Dalton SO, Mellemkjaer L, Thomassen L, Mortensen PB and Johansen C. Risk for cancer in a cohort of patients hospitalized for schizophrenia in Denmark, 1969–1993. Schizophr. Res. 2005; 75(2–3): 315–324.
Erlangsen A, Mortensen PB, Vach W and Jeune B. Psychiatric hospitalisation and suicide among the very old in Denmark: population-based register study. Br. J. Psychiatry 2005; 187: 43–48.
Gater R, Amaddeo F, Tansella M, Jackson G and Goldberg D. A comparison of community-based care for schizophrenia in south Verona and south Manchester. Br. J. Psychiatry 1995; 166(3): 344–352.
Gilbody S, Bower P, Fletcher J, Richards D and Sutton AJ. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch. Intern. Med. 2006; 166(21): 2314–2321.
Gilbody S, Whitty P, Grimshaw J and Thomas R. Educational and organizational interventions to improve the management of depression in primary care: a systematic review. JAMA 2003; 289(23): 3145–3151.
Gilbody SM, Whitty PM, Grimshaw JM and Thomas RE. Improving the detection and management of depression in primary care. Qual. Saf. Health Care 2003; 12(2): 149–155.
Glover G, Arts G and Babu K S. Crisis resolution/home treatment teams and psychiatric admission rates in England. Br. J. Psychiatry 2006; 189(5): 441–445.
Goldberg D and Huxley P. Common Mental Disorders: A Bio-Social Model. London: Routledge; 1992.
Grimshaw J, Eccles M and Tetroe J. Implementing clinical guidelines: current evidence and future implications. J. Contin. Educ. Health Prof. 2004; 24 (Suppl 1): S31–S37.
Kessler RC, Demler O, Frank RG, et al. Prevalence and treatment of mental disorders, 1990 to 2003. N. Engl. J. Med. 2005; 352(24): 2515–2523.
Li J, Laursen TM, Precht DH, Olsen J and Mortensen PB. Hospitalization for mental illness among parents after the death of a child. N. Engl. J. Med. 2005; 352(12): 1190–1196.
Mainz J, Krog BR, Bjornshave B and Bartels P. Nationwide continuous quality improvement using clinical indicators: the Danish National Indicator Project. Int. J. Qual. Health Care 2004; 16 (Suppl 1): i45-i50.
Munk-Olsen T, Laursen TM, Videbech P, Rosenberg R and Mortensen PB. Electroconvulsive therapy: predictors and trends in utilization from 1976 to 2000. J. ECT 2006; 22(2): 127–132.
Perala J, Suvisaari J, Saarni SI, et al. Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch. Gen. Psychiatry 2007; 64(1): 19–28.
Ruggeri M, Leese M, Thornicroft G, Bisoffi G and Tansella M. Definition and prevalence of severe and persistent mental illness. Br. J. Psychiatry 2000; 177: 149–155.
Saxena S, Sharan P, Garrido M and Saraceno B. World Health Organization's Mental Health Atlas 2005: implications for policy development. World Psychiatry 2006; 5(3): 179–184.
Shield T, Campbell S, Rogers A, et al. Quality indicators for primary care mental health services. Qual. Saf. Health Care 2003; 12(2): 100–106.
Soanes C and Stevenson A. Concise Oxford English Dictionary, 11th edn. Oxford: Oxford University Press; 2003.
Thornicroft G and Tansella M. The components of a modern mental health service: a pragmatic balance of community and hospital care. Br. J. Psychiatry 2004; 185: 283–290.
Thornicroft G and Tansella M. The Mental Health Matrix: A Manual to Improve Services. Cambridge: Cambridge University Press; 1999.
Thornicroft G. Testing and retesting assertive community treatment. Psychiatr. Serv. 2000; 51(6): 703.
Van Herten LM and Gunning-Schepers LJ. Targets as a tool in health policy. Part I: Lessons learned. Health Policy 2000; 53(1): 1–11.
Van Herten LM and Gunning-Shepers LJ. Targets as a tool in health policy. Part II: Guidelines for application. Health Policy 2000; 53(1): 13–23.
Van Herten LM and Van de Water HP. New global Health for All targets. BMJ 1999; 319(7211): 700–703.
Von Korff M and Goldberg D. Improving outcomes in depression. The whole process of care needs to be enhanced. BMJ 2001;(323): 948–949.
World Health Organisation. Mental Health Atlas 2001. Geneva: World Health Organisation; 2001.
World Health Organisation. Mental Health Atlas 2005. Geneva: World Health Organisation; 2005.
World Health Organisation. World Health Organisation Assessment Instrument for Mental Health Systems (WHO-AIMS). Geneva: World Health Organisation; 2005.