Mental Health Needs Assessment - Epidemiology 2024

Unless specified, much of the demographic data in this report derives from Census 2021, run by the Office for National Statistics (ONS). Comparisons are made with the previous census from 2011. Dorset, and Bournemouth, Christchurch and Poole (BCP) are considered separately below, unless stated.

In the decade following the previous census, the population of England increased by 6.6% to 56,489,800. In the same period, the population of Dorset increased by 4.0% to 379,600 in 2021.

In Bournemouth, Christchurch and Poole, the population size increased by 5.7%, to approximately 400,300 in 2021. Both areas reported a proportionate increase below that of England, whilst the increase across the South West (7.8%) was greater than that of England.

The population densities of both areas contrast when listed in the South West's 30 local authority areas: Dorset is the ninth least densely populated area, whilst Bournemouth, Christchurch and Poole is the sixth most densely populated area in the South West.

Figure 1: Dorset population density map 2020

This image is of a map showing population density across Dorset, using shades of pink and purple to represent population density, the number of residents per square kilometre. Dark purple areas indicate the highest density (over 10,000 residents/km²), while lighter shades represent lower densities. 

The population has continued to age. across England, 18.4% of the population were aged 65 years and over in 2021 – the highest percentage recorded. On census day, (21st March 2021), the largest age group in England was those aged 30 to 34 years, whilst it was those aged 55 to 59 years in the South West.

The population pyramid of Dorset unitary authority area (UA) is given below. It comprises the former districts of East Dorset, North Dorset, Purbeck, West Dorset and Weymouth and Portland.

Figure 2: Dorset UA population pyramid

This image represents the population for Dorset in 2021, showing the distribution of males and females across age groups. Horizontal bars represent age ranges from 0 to 4 up to 90+, with male population on the right in blue and female population on the left in green. The pyramid shows larger populations in the 20 to 59 age range, with a gradual decline in older age groups.

There has been an increase of 24.8% in people aged 65 years and over, a decrease of 2.8% in people aged 15 to 64 years, and a decrease of 3.2% in children aged under 15 years (ONS). The median age of Dorset increased by 4 years, from 47 to 51 years.

The population pyramid of Bournemouth, Christchurch and Poole (UA) is below. Bournemouth, Christchurch and Poole UA comprise the former district of Christchurch and the former UAs of Bournemouth and Poole.

Figure 3: BCP population pyramid

This image represents the population for BCP in 2021, showing the distribution of males and females across age groups. Horizontal bars represent age ranges from 0 to 4 up to 90+, with male population on the right in blue and female population on the left in green. The pyramid shows larger populations in the 20 to 59 age range, with a gradual decline in older age groups.

This is how Bournemouth, Christchurch and Poole compares. There has been an increase of 12.7% in people aged 65 years and over, an increase of 3.1% in people aged 15 to 64 years, and an increase of 6.9% in children aged under 15 years (ONS).

The median age rose by one year to 42 years of age. This age is higher than that of England (40 years) but lower than the South West as a whole (44 years).

The Index of Multiple Deprivation (IMD) is a measure of relative deprivation for small areas (Lower Super Output Areas (LSOAs)) and is a useful tool for targeting services to help tackle deprivation. It comprises 37 indicators grouped into seven domains including income, employment, education, health, crime, barriers to housing, and living environment. Dorset Council’s 2019 IMD national ranking is copied below.

Figure 4: Dorset Council IMD map 2019

A map showing Dorset Council’s 2019 Index of Multiple Deprivation (IMD) national rankings. Areas are colour-coded by deprivation level: red indicates the 20% most deprived areas, blue indicates the 20% least deprived, and green, orange and yellow represents areas in between.

There are 11 areas in Dorset Council that are within the top 20% most deprived nationally for multiple deprivation: 10 of these are within Weymouth and Portland. Melcombe Regis Town Centre and Littlemoor West are the most deprived. Dorset saw the South West's third-largest percentage-point fall in the proportion of people aged 16 years and over (excluding full-time students) who were employed (from 54.7% in 2011 to 51.0% in 2021). The percentage of people who identified as being disabled and limited a lot in Dorset fell from 7.1% to 6.5%.

There are a small number of highly deprived area in the Bournemouth, Christchurch and Poole areas. Its high population results in a higher number of people who are income and employment deprived compared to other authorities. Cluster of deprived areas fall into two wards: Boscombe West and Kinson and are seen below.

Figure 5: LSOAs in the BCP area within the most deprived 20% nationally

A map of Bournemouth, Christchurch and Poole (BCP) showing Lower Super Output Areas (LSOAs) that fall within the most deprived 20% nationally. Areas are colour-coded by deprivation type: red for entrenched, teal for escalating, orange for continuing, and purple for emerging. White indicate ward boundaries.

In Dorset households, 70.4% owned their own home. Under a sixth of households rented privately. The Pareto charts below illustrate the different accommodation categories ranked by number of households.

In BCP, the chart shows that flats are the most common type of accommodation after detached houses. In Dorset, semi-detached and terraced houses and both more popular than apartments. In BCP, 62.8% of households own their own home, and over a quarter of households rent privately.

Figure 6: Pareto chart - Dorset accommodation types

This chart shows the distribution of accommodation types in Dorset. Along the x axis are categories such as detached, flats or tenement, semi-detached, terraced, converted/shared, commercial building, converted building, and mobile/temporary. The y-axis is made up of observations ranging from 0 to 80,000 and percentages from 0% to 100%. The blue bars represent the number of properties in each category, with detached homes being the most common. An orange line shows the cumulative percentage across all categories.

Figure 7: Pareto chart - BCP accommodation types

This chart shows the distribution of accommodation types in BCP. Along the x axis are categories such as detached, flats or tenement, semi-detached, terraced, converted/shared, commercial building, converted building, and mobile/temporary. The y-axis is made up of observations ranging from 0 to 80,000 and percentages from 0% to 100%. The blue bars represent the number of properties in each category, with detached homes being the most common. An orange line shows the cumulative percentage across all categories.

The highest education level attained is similar in both areas and are combined in this section. The categories examined below are defined.

Table 1: Educational levels and descriptions

This table gives a description for each education level, this includes qualifications.

Level	Description
0	No qualifications
1	Level 1 and entry level qualifications: 1 to 4 GCSEs grade A* to C , Any GCSEs at other grades, O levels or CSEs (any grades), 1 AS level, NVQ level 1, Foundation GNVQ, Basic or Essential Skills
2	Level 2 qualifications: 5 or more GCSEs (A* to C or 9 to 4), O levels (passes), CSEs (grade 1), School Certification, 1 A level, 2 to 3 AS levels, VCEs, Intermediate or Higher Diploma, Welsh Baccalaureate Intermediate Diploma, NVQ level 2, Intermediate GNVQ, City and Guilds Craft, BTEC First or General Diploma, RSA Diploma
3	Apprenticeship
4	Level 3 qualifications: 2 or more A levels or VCEs, 4 or more AS levels, Higher School Certificate, Progression or Advanced Diploma, Welsh Baccalaureate Advance Diploma, NVQ level 3; Advanced GNVQ, City and Guilds Advanced Craft, ONC, OND, BTEC National, RSA Advanced Diploma
5	Level 4 qualifications and above: degree (BA, BSc), higher degree (MA, PhD, PGCE), NVQ level 4 to 5, HNC, HND, RSA Higher Diploma, BTEC Higher level, professional qualifications (for example, teaching, nursing, accountancy)
6	Other: vocational or work-related qualifications, other qualifications achieved in England or Wales, qualifications achieved outside England or Wales (equivalent not stated or unknown)

Figure 8: Dorset and BCP highest educational attainment

This chart shows the number of people in Dorset and BCP by highest level of educational attainment, from Level 0 to Level 6. The x axis shows the levels and y-axis shows the observations ranging from 0 to 250,000 and percentages from 0% to 100%. The blue bars represent the count of individuals at each level, with Level 5 having the highest count and Level 6 the lowest. An orange line overlays the chart, indicating the cumulative percentage of the population across education levels, rising steadily from Level 0 to Level 6.

The 80% cut-off comprises those with A-levels, degrees and higher or professional qualifications, or those with no qualifications. Most commonly, 31.8% of people have achieved a degree or higher, or professional qualification.

In Dorset, in 2021, 97.1% of people identify their ethic group as “White” and 1.1% identified their ethnic group within the "Asian, Asian British or Asian Welsh" category. 1.2% of Dorset residents identified their ethnic group within the "Mixed or Multiple" category.

Bournemouth, Christchurch and Poole report greater ethnic diversity with 2.8% identifying within the "Mixed or Multiple" category; a jump of 1% from 2011. 91.3% of people in BCP identified their ethnic group within the "White" category. 3.4% identified their ethnic group within the "Asian, Asian British or Asian Welsh" category.

Almost half of the people in Dorset and BCP (49%, 383,125 people) are affiliated with Christianity in the 2012 census. 41% replied that they had no religion, and 6.7% did not answer the question. All of the other religions account for fewer than 3% of the population. A third of these identify as Muslim, but this figure includes Buddhists, Hindus, Jews, Sikhs and other religions. This question is voluntary and has variable response rates.

Key points from the previous sections are:

• population growth (Comparison of Census 2021 to Census 2011): Dorset's population grew at a lesser rate than that of the population of England. Dorset's population rose by 4% to 379,600 and Bournemouth, Christchurch, and Poole (BCP) increased by 5.7% to 400,300 residents
• population densities: within the South West's 30 local authority areas, Dorset ranks as the ninth least densely populated area, and BCP is the sixth most densely populated area in the South West
• if the current trend is maintained, population growth will result in an overall increase in need and demand for further support and services
• age profile: on 21 March 2021, the largest age group in England consisted of individuals aged 30 to 34 years, and 18.4% of England’s population were aged 65 years and over
• Dorset unitary authority (UA) area saw a 24.8% increase in people aged 65 years and over. There were approximately 3% decreases in people aged 15 to 64 years, and in children aged under 15 years
• the median age of Dorset rose by 4 years, from 47 to 51 years
• Bournemouth, Christchurch, and Poole (UA) recorded a 12.7% increase in people aged 65 years and over. There was a 3.1% increase in people aged 15 to 64 years and 6.9% increase in children aged under 15 years
• the median age rose by one year, reaching 42 years
• absolute numbers of at-risk groups will also grow e.g. middle-aged men or young people, leading to a greater demand for services. An aging population could result in more individuals experiencing risk factors related to poorer mental health including social isolation
• Index of Multiple Deprivation (IMD): Weymouth and Portland account for 10 of Dorset Council's 11 areas that fall within the top 20% most deprived nationally. The most deprived areas are Melcombe Regis Town Centre and Littlemoor West
• employment decreased from 54.7% in 2011 to 51.0% in 2021
• the percentage of people in Dorset identifying as disabled and significantly limited declined from 7.1% to 6.5%
• within BCP, clusters of deprived areas are found in the wards of Boscombe West and Kinson
• living in deprived areas is associated with worse mental health outcomes and negatively impacts health-risk behaviour, such as smoking, drugs, poor diet and physical inactivity. Alcohol use remains a problem across the population
• housing: 70.4% households owned their own home in Dorset with a sixth of household rented, compared with 62.8% homeowners in BCP, and a quarter renting privately
• in BCP, flats are the most common type of accommodation after detached houses, whilst in Dorset semi-detached and terraced houses and both more popular than apartments
• education: this is less discerning as a factor: whilst 32% of the Dorset and BCP population have achieved a degree or higher, the values of the other groups decline more gradually e.g. 18% have achieved two or more A levels (or equivalent) but 15% report no qualifications
• ethnicity: 97.1% of people in Dorset and 91.3% of people in BCP identify their ethic group as “White”
• in BCP, 3.4% identified their ethnic group within the "Asian, Asian British or Asian Welsh" category, and 2.8% identify as "Mixed or Multiple"
• religion: almost half of the people in Dorset and BCP (49%, 383,125 people) are affiliated with Christianity, but 41% replied that they have no religion
• all other religions accounts for fewer than 3% of the population, with a third of these identifying as Muslim

This section reviews data provided by the Office for Health Improvement and Disparities (OHID) via Fingertips. The mental health intelligence profiles collate many mental health and dementia data arranged in 7 themes, and aim to support commissioning, planning, and local services planning. Where available, the values for Dorset and Bournemouth, Christchurch and Poole have been compared to the national figures for England.

The suicide rate in BCP (14.2 per 100,000 for 2020-22) is higher than the national rate (10.3 per 100,000), and also of that in the South West region (11.9 per 100,000). The increases seen in Dorset are non-significant: 11.1 per 100,000. These rates increased to above that of England from the 2013 to 2015 recording period. The trends in both councils can be seen in the graphs below. 

In 2022, the number of suicides recorded was 67 in BCP and 35 in Dorset. In 2021, 43 suicides were recorded in BCP and 45 were registered in Dorset.

This is due to an increased rate recorded in males, as that of females is not higher than the national rate. The national suicide rate for men for 2020 to 2022 was 15.8 per 100,000. Dorset and the South West both reported rates of 17.7 per 100,000 and BCP recorded a male suicide rate of 23.3 per 100,000.

Figure 9: Suicide rate (persons) for Bournemouth, Christchurch and Poole

This line graph shows suicide rates per 100,000 people in Bournemouth, Christchurch and Poole compared to England from 2001 to 2019. The graph includes a blue line for the local area and a black line for England, with the local line showing more fluctuation and a noticeable rise in recent years. Coloured markers highlight specific data points, including red for higher rates and yellow for lower rates. The x-axis shows the year ranging from 2001/03 to 2017/19 and the y-axis covers the per 100,000.

Figure 10: Suicide rate (persons) for Dorset

This line graph shows suicide rates per 100,000 people in Dorset compared to England from 2001 to 2019. The graph includes a blue line for the local area and a black line for England, with the local line showing more fluctuation and a noticeable decrease in recent years. Coloured markers highlight specific data points, including red for higher rates and yellow for lower rates. The x-axis shows the year ranging from 2001/03 to 2017/19 and the y-axis covers the per 100,000.

Increased rates of self-harm feature prominently in the local area mental health data, highlighting the prevalence of mental health issues in children and young people. Both Dorset and BCP have higher than national rates of hospital admissions due to self-harm in each age group between 10 and 24 years old. In both councils, the highest rate is seen in 15 to 19 age group: that of BCP is almost twice that of the national rate (1179.5 per 100,000 in BCP, and 947.2 per 100,000 in Dorset). Self-harm also reflects through high rates of inpatient stays in secondary mental health services: this is significantly higher than the national rate in BCP (75 per 100,000).

Many factors also contribute to the mental wellbeing of children and young people. Such factors may be protective: providing free school meals helps qualifying children achieve a “good level” of achievement at the end of Reception. However, the percentage of children with free school meal status in Dorset achieving a good level of development at the end of Reception lags behind the national rate in this measure: 46.2% compared to 51.6% in England. Dorset had a slightly higher than national rate of pupil absence in 2021/22 (8.2%), whilst BCP recorded a higher rate of first-time entrants to the youth justice system (289.4 per 100,000 in Dorset).

A number of domains are collated within this theme:

• severe mental illness (patients with a diagnosis of schizophrenia, bipolar affective disorder and other psychoses) - the proportion of patients in BCP is slightly higher than the rate in England
• housing and employment - home ownership is less affordable in both BCP and Dorset. This metric is calculated by the ratio of median house price to median gross annual residence-based earnings
• crime, safety and violence - in 2022, BCP recorded a higher rate of first time offenders, and also a greater proportion of offenders who reoffend (26.3%)
• alcohol, drugs and tobacco - in 2018/19, BCP had higher than national rates of admission episodes for alcohol-related conditions (2,578 per 100,000 in BCP compared to 2,367 per 100,000 in England). The rate is higher in both males and females, separately. BCP also has a higher rate of admission episodes for mental and behavioural disorders due to use of alcohol (139.9 per 100,000)
• social relationships - social isolation is a factor for adult social care users in Dorset: Just 35.3% claim to have as much social contact as they would like compared with 40.6% in England
• mental health related care - in 2021, BCP is less successful in completing drug treatment in opiate users (2.4% vs 5.0%), in non-opiate users (26.6% vs 34.3%), and alcohol treatment (31.2% vs 36.6%)
• also recorded in the above category is: domestic abuse related incidents and crimes. The 2021/22 crude rate is 32.2 per 1,000 in BCP and Dorset, compared to 30.7 per 1,000 in England
• severe mental illness - both BCP (36%) and Dorset (37%) perform worse than England (58%) and the South West (53%) for adults in contact with secondary mental health services who live in stable and appropriate accommodation (2021). These values are very similar for both males and females

Two key indicators highlight differences in local performance compared to regional and national figures in 2021/22:

• general fertility rate - in 2021, rates are lower in the South West generally by comparison with England (51.8 per 100,000 in the South West vs 54.3 per 100,000 in England). The rate is 48.2 in BCP and 51.6 per 100,000 in Dorset
• proportion of new birth visits (NBVs) completed within 14 days – in 2021/22, 64.4% of NBVs were completed in BCP, lower than the proportion in England of 82.7% For the 12-month review, both BCP (75.4%) and Dorset (78.0%) lag behind England (82.0%). Results are comparable for the 6-to-8-week review figures

The Fingertips data lists a variety of population subgroups in Dorset County performing worse than the England average across a range of mental health and wellbeing categories. Additionally, considering the demographics of Dorset may highlight areas to focus on initially.

Suicide

We have seen in the evidence reviews how demographic risk factors increase the suicide risk of a whole population across its lifetime, but do not predict suicide in an individual at a single time-point. Suicide is a national concern, but the OHID data demonstrates how the BCP rate is higher than the national and South West rate and that is primarily due to a higher rate in men. Middle-aged men have been identified as a priority by the RCPsych's Suicide Prevention Programme as a group with the highest suicide rate in the UK, and examples of how to tackle this feature in evidence review.

Population growth between censuses has increased the number of susceptible, high-risk individuals and the increased demand in these groups including middle-aged men, children and young people and the elderly will have to be met and increased capacity put in place in advance. This may include increased capacity, awareness campaigns or training opportunities.

Population

Key population trends are influencing mental health and wellbeing needs, including:

• both populations saw a rise in the median age driven by a marked increase in people aged 65 and over
• BCP also recorded a smaller percentage increase in younger age groups - see below for children and young people
• older adults are at risk of developing mental health conditions such as depression or anxiety, as well as other long-term physical conditions and experience loneliness
• an increase in demand is expected likely to be associated with more individuals with mental health and wellbeing needs. An aging population has specific issues to contend with e.g. loneliness, and social isolation. An increase in available resources may also help tackle these issues through peer-to-peer projects

Children and young people

BCP reported a 7% proportional increase in children aged under 15 years.

Several metrics refer specifically to children and young people:

• self-harm: hospital admissions are significantly higher than the national average at all age groups between the ages of 10 and 24
• BCP had a significantly higher rate of inpatient stays due to self harm in people under 18 years of age
• Dorset had a slightly higher than the national rate of pupil absence
• BCP reported a higher rate of first time entrants into the youth justice system
• focusing on the mental health and wellbeing of children and young people is of immediate importance. This would likely have a beneficial effect on the rates of self-harm, but this is a specific issue that must be tackled without delay by understanding and addressing the related risk factors

Perinatal mental health - including risk factors

Key indicators for perinatal mental health and risks in Dorset and BCP:

• in 2021/22, BCP recorded a lower rate of new birth visits completed within 14 days
• Dorset and BCP both have lower rates of completed 12-month reviews compared with the rate in England
• the rate of domestic abuse related incidents and crimes in Dorset and BCP are higher than the national rate. Multi-partner working and surveillance together with possible changes to criminal response and making it easier to obtain support should be employed to reduce the number of incidents
• if the trend is unaddressed and health visitor capacity remains low, the lower rates of new birth visits risks missing nascent mental health issues in the newborn and postpartum depression and related conditions (as well as physical and other child-rearing problems). Many mental health conditions start early and tackling them at the earliest opportunity reduces the risk of their manifesting at a later date. Home visits are hugely important as one of the rare occasions where the newborn, mother and family can be assessed in their home environment

Index of Multiple Deprivation (IMD)

The domains that make up the IMD score are reflected in several of the categories addressed, with the most deprived areas in Dorset and BCP identified above as potential targets. There is an association between living in deprived areas and engaging in risky behaviours, which highlights where targeted support may be most needed:

• the proportion of the population in employment decreased in Dorset between the last two censuses. The resultant stress is associated with depression, anxiety and lower self-esteem
• housing: a greater proportion of homeowners live in Dorset than BCP
• detached houses are the most common owned dwelling; flats are the second most common in BCP
• both Dorset and BCP have less affordable home ownership when compared to England
• crime: BCP has a higher than national rate of first-time offenders and (all ages), first time entrants to the youth justice system, and reoffending levels
• alcohol-related conditions: BCP records higher rates of admissions due to alcohol
• risk factors for poor mental health are associated with areas of greater deprivation and therefore offer opportunities to target interventions which could help address inequalities of access to services