The Government is setting up pilot centres to treat a potentially dangerous form of metal illness. Barry Nelson visited a North-East hospital which is preparing to tackle the problem of personality disorder.

FOR someone who has been asked to treat some of the UK's most problematic mental patients, Professor Don Grubin looks remarkably cheerful. "It's grasping the nettle, this is something that needed to be done," says Prof Grubin, a senior psychiatrist at the sprawling St Nicholas mental hospital in Newcastle.

The hospital is to become the site of one of only three treatment centres in the country for patients with personality disorders.

Most people have never heard of personality disorder, a type of mental illness which affects between one and ten per cent of the population. But most people will have heard of Michael Stone, the mental patient diagnosed with a severe personality disorder years before he murdered Lin Russell and her six-year-old daughter, Megan, but who was allowed to remain at large in the community.

Only last year, a Darlington man, 27-year-old Robert Sowden, who was suffering from severe personality disorder, was ordered to be sent to a secure mental hospital after a judge described him as "a great danger to the public."

Sowden bit off his girlfriend's ear after stalking her and ripped a chunk out of a policemen's leg as he was arrested.

Such high-profile cases, and the fact that some psychiatrists believe that personality disorder cannot be treated in the same way as conventional mental illness, caused something of a panic in recent years.

Since the Michael Stone case, the Government has been looking at ways to be seen to be doing something about personality disorder. But last year's proposals to change the law so personality disorder patients could be detained indefinitely in the interests of public safety was so strongly criticised by mental health and civil liberty groups that the Government has backed off and is trying a different approach.

"The Government seems to be saying we are not talking about locking people up... we are talking about treatment and that has to be welcomed," says Prof Grubin, who has a chair in psychiatry at Newcastle University.

He explains that this involves a twin track approach, setting up specialist treatment units in high security prisons and secure mental hospitals for patients diagnosed as having dangerous and serious personality disorder (DSPD) and establishing new medium secure hospital units to tackle personality disorder patients who have demonstrated that they could be a risk to the public.

The flamboyant New Jersey-born psychiatrist, who has been based in Newcastle for nine years, is delighted that the Government is setting up the new treatment units.

He suspects the new urgency attached to the problem of "PD" patients may have helped the regional hospital secure millions of pounds of funding to carry out a complete revamp of acute mental health services, which will include the new 16-bed PD unit.

"We were desperate to see our facilities modernised, now PD is part of the redevelopment of this unit," he says.

Prof Grubin has no doubt that PD can be treated and is looking forward to getting the resources and special facilities to deal with this long-neglected area of mental illness.

But he acknowledges that it is no easy task.

"To some extent treatability is in the eye of the beholder. Many doctors don't want to treat PD people or don't know how to treat them. Treatment is certainly difficult but we have had some success stories in this area. One of the problems with PD is that your successes are invisible. It is only when something goes wrong that you get publicity," he says.

While there have been successes, Prof Grubin remains cautious about the long-term outlook. "Personality disorder is an enduring condition and we are never going to competely remove risk."

So far no one has come up with any treatment alternatives to the time tested mixture of medication, psychotherapy and counselling.

While most people with personality disorders have difficulty relating to other people and getting on in life, some of them are by no means lacking in intelligence, says Prof Grubin. "I have known PD patients who are fairly bright, they may have got as far as university," he says.

So what causes personality disorder?

According to Mind, the mental health charity, many people with PD will have experienced poor parenting, rejection, lack of love or even abuse when they were children. Mind also reports that there may be a genetic link between mental health problems and personality disorders.

Prof Grubin agrees with much of this: "There is certainly a genetic component along with a lot of parenting and environmental factors. Someone who has been neglected during childhood may go on to develop PD."

What is baffling to non-specialists is that PD can take as many as ten different forms, ranging from paranoid personality disorder (an unwarranted distrust of other people) to obsessive-compulsive personality disorder (a preoccupation with orderliness and control).

But the most worrying manifestation of the condition is APD (antisocial personality disorder).

According to Mind, APD people with this condition "consistently disregard and violate other people's rights. They may appear superficially charming, but are callous and self-serving and lacking in empathy".

APD sufferers are often incapable of consistent employment or maintaining a long-term relationship, Mind adds. They often behave impulsively without considering the consequences - behaviour often linked with criminal offences, particularly violence crime.

Mind says research points to people with APD having a higher rate of alcoholism and substance abuse than the general population.

The new medium secure PD unit at St Nicholas' is not expected to open until 2005 but Prof Grubin will continue to treat personality disorder patients with the resources he has.

One development which is happening almost immediately is the setting up of a specialist team to help moderate PD patients living in the community. An important part of this team's function will be to provide what is known as crisis intervention.

"The community pilot scheme actually started this month and we are taking our first patients," Prof Grubin adds.

While services are expanding, he would also like to see more resources for another group of PD patients. "We need to develop services for people who harm themselves, that is the group at the other end of the spectrum from the people who harm others," he says.

Much attention has been focused on the specialist PD treatment units being set up in high security prisons - such as Frankland Prison in Durham - but Prof Grubin says people should try to put things in context.

"People with personality disorders are just like people with other mental health problems: in reality it is only a very small percentage who are dangerous."