Introducing an important new Echo series on mental health provision in Dorset

ONE in four people is likely to suffer a mental illness during their lives. Around 10 per cent of the population are suffering from depression at any one time and by 2020 it is expected to be the second largest cause of health problems in the world.

An estimated 700,000 people in the UK and nearly 18 million people worldwide - most of them elderly - suffer from dementia, of which Alzheimer's is the most common form.

Other mental illnesses that can have a serious effect on people's lives include anxiety states, bipolar condition (manic depression) and schizophrenia.

Many people will remember the large Victorian asylums, such as Herrison Hospital near Dorchester, where sufferers could be sent for months if not years. But care and treatment has been changing dramatically in recent decades as developments in West Dorset show.

The responsibility for providing NHS services for people with mental illness in the area rests with the North Dorset Primary Care Trust. Based at Forston Clinic near Dorchester, the trust covers an area including Blandford, Shaftesbury and Lyme Regis.

In a series of occasional articles, Theresa Newton looks at the mental health and other services they provide, beginning with spending plans for the current year.

NEARLY £11.5 million is being spent in West Dorset during this financial year to provide treatment and care for people with a mental illness, an increase of more than £400,000 on last year.

Developments include a new purpose-built day unit at Bridport Community Hospital for elderly people with dementia, depression and schizophrenia which opened in October.

The unit is being shared by North Dorset Primary Care Trust (NDPCT), which looks after more seriously-ill patients, and the Bridport Branch of the Alzheimer's Society, which provides social day care.

A six-bedded in-patient unit at Cornwall Road in Dorchester for mentally-ill adults is being upgraded and an additional psychiatrist appointed, based in Weymouth.

The developments are part of a programme by NDPCT which is responsible for NHS mental health services in the area, to make them more accessible to patients and their families.

"We want to provide services as close to people's homes as possible and in the least restrictive and safest environment possible," said Tim Archer, the Trust's Director of Mental Health Services.

Until relatively recently, mentally-ill patients who needed to go into hospital were admitted to the Forston Clinic near Dorchester.

But gradually, the number of beds there has been reduced and replaced by new ones in five different areas in West Dorset - Weymouth and Portland; Dorchester and Sherborne; North Dorset; Blandford and Bridport and Lyme Regis. Now only the most acutely-ill, disturbed or needy patients are admitted to the intensive care unit at Forston.

Most will have been detained under the Mental Health Act because they are thought to be a risk to themselves or others.

But long gone are the days when being admitted to hospital with a mental illness could mean staying there for months, or even years.

Now, the average stay at Forston is three or four weeks until patients are stabilised, when they can go back to be cared for in one of the mental health units which cater for people with less-serious illness and are closer to their homes and families.

In Weymouth and Portland that could be at the 16-bedded Linden Unit for adults in Radipole Lane, which opened two years ago.

Weymouth Community Hospital provides inpatient beds for elderly people with dementia and has the Melcombe Day Hospital in its grounds to provide day care for people with similar problems.

In Bridport the two-year-old Hughes Unit at Bridport Community Hospital provides the focal point for mental health ser-vices in the town and outlying areas including Lyme Regis. And in Dorchester, patients can be admitted to the unit in Cornwall Road.

Each locality not only provides inpatient care but also day care, an assertive outreach team - whose members go out to severely-ill people in the community - outpatients' clinics, out-of-hours support for patients and a community mental health team.

"Members of the mental health teams have a wide range of skills between them," said Tim. "They include not only medical staff like psychologists, psychiatrists, nurses and occupational therapists, but social workers, housing experts and representatives from voluntary organisations.

"Anyone - including relatives, neighbours and friends - can refer someone they are worried about to the community mental health team for help," he added.

In a nine-month period last year, more than 450 people were referred to the Weymouth team, just over 200 to the Bridport team and just over 150 to the Dorchester team.

The NDPCT and Dorset Social Services work far more closely together now.

"Many people with mental health problems will need both health and social care," said Tim. "By working together we can be more responsive and flexible and cut down on bureaucracy. The patient then gets a whole package of care."

Caring at home for someone who is mentally ill can be difficult.

"A person with manic depression can be quite aggressive towards their carer," said Tim. "And if you are looking after someone with dementia, it is a commitment for the rest of that person's life.

"It can be very distressing to see a loved one who has a mental illness. So every year, we carry out an assessment of the carer's needs to make sure that they are being met too," he added.

For the future, the Trust is looking at how best to provide a seven-day-a-week service for people facing a mental health crisis.

It will also be working with people like GPs, health visitors and district nurses - who work in the community - to help them spot mental illness at an early stage.

The NDPCT has joined forces with the Dorset County Hospital to care for people admitted for other reasons who also have mental health problems - thought to be between 30 and 65 per cent of hospital patients.