Defining the input phase

We define as inputs ‘the resources which are put into the mental health care system’

Defined in this way, inputs are those elements which are injected into the total mental health service system, and which need to be distinguished from the activities which take place within that system in providing mental health care,which we describe in the next chapter as the process phase.These resources enter the system at the three geographical levels, and may be further categorised as visible or invisible.

The visible inputs consist mainly of staff and facilities. In psychiatry, as compared with other medical specialities, a relatively small contribution towards visible inputs at present is expenditure on medication, supplies, equipment and investigations. Visible expenditure on staff includes the numbers, the mix of different disciplines (such as psychiatrists, psychologists and nurses) and their relative distribution across the service as a whole.

Often forgotten are the invisible inputs which activate the visible system inputs, and which potentiate the effective functioning of the service network.Without these invisible factors the visible inputs may be rendered largely ineffective. Indeed, the influence of these invisible inputs usually only becomes manifest when they are absent, unrecognised or disregarded. One example is the importance of establishing good working relationships between specialist and general health services, and between health and social services, for the joint care of people with long-term and severe mental illness.