Home Visits

The majority of clients suffering mental illness are successfully treated as outpatients with medication or therapy delivered by psychiatrists, therapists or GPs. Response to medication and therapy varies but in uncomplicated episodes, an initial improvement is usually observed within 3-4 weeks.

Progress, however, can be slow in a significant proportion of clients with certain types of mental illness leading to significant consequences; in a smaller proportion of cases, medication or therapy will only achieve a certain level of improvement in severe symptoms or everyday function:

• 20% of clients with depression experience degrees of treatment-resistance to adequate trials of 2 or more medications; 10% suffer chronic refractory depression with non-response to multiple treatments, including augmentation & Electro-Convulsive Therapy (ECT), with depression lasting more than 2 years.
• In generalised anxiety disorder, only 18-35% are in full remission over a 5yr period; 30% with obsessive compulsive disorder will not respond to combinations of medication and therapy; a minority of clients with post-traumatic stress disorder remain unwell for years; social anxiety can be difficult to treat in 15% clients.
• Approximately 30% clients with schizophrenia suffer continuous difficulties with symptoms affecting thoughts, concentration and memory, and everyday function, with a further 30% experience a relapsing and remitting course of illness with multiple episodes in their lifetime.

The role of our clinical staff under these circumstances is to help clients accomplish further improvements through integrated care, regular home visits, and support of clients and their relatives to manage mental illness more effectively.

A significant proportion of clients who have suffered an episode of mental illness will continue to experience some residual consequences of severe symptoms for weeks or months after overcoming the ‘acute’ phase.

Thus, approximately 30% of clients suffering schizophrenia will experience blunted affect, conceptual disorganisation, passive or apathetic social withdrawal, emotional withdrawal, lack of judgment and insight, poor attention, somatic concern, difficulty with abstract thinking, anxiety and poor rapport.

Approximately 50% of clients with depression will suffer 2 or more residual symptoms even after successful treatment with medication or therapy. Among the most frequent residual symptoms of depression are ongoing low mood, guilt, insomnia, anxiety, impaired work, loss of interest, irritability, fatigue, lowered libido, and a range of somatic or physical symptoms, including backache, muscle ache, stomach aches and joint pain. In addition to physical and emotional residual symptoms, cognitive deficits may remain in clients who otherwise appear to have reached remission, such as impaired memory processes and decreased cognitive reactivity. Residual symptoms are a predictor of relapse regardless of whether the client was treated with medications or with psychotherapy: 76% of clients with residual symptoms of depression will relapse within a year of remission from previous episode compared to 25% of clients without residual symptoms on remission.

Claimont staff will support clients during an episode of mental illness and who continue to suffer residual symptoms of mental illness. In addition to helping clients to manage their mental health, home visits help clients to address broader rehabilitation goals, pacing their recovery to reduce the risk of clients over-exerting themselves or stagnating, and aiming to restore everyday function over a period of time.

Clients who have suffered an episode of mental illness are very likely to suffer future episodes or to experience residual consequences. Some of the reasons for clients relapsing are:

• natural course of the mental illness, which manifests in multiple episodes;
• possible ‘kindling effect’ where the more relapses, the greater the risk of further episodes;
• non-compliance with medication;
• biological triggers such as misuse of substances or lack of sleep;
• social triggers such as work, relationship or family stress.

Thus:

• 50-70% of clients suffering schizophrenia will have further acute episodes or experience continuous cognitive and functional problems;
• 70-80% who have suffered depression will have a further episode and 10-20% will endure longer-term dysfunction;
• approximately 50% of clients with bipolar affective disorder will continue to have symptoms 5 years post diagnosis;
• anxiety disorders persist for many years in clients and may result in similar or more severe consequences than mental illnesses often assumed to cause greater difficulties, such as schizophrenia or bipolar affective disorder.

Home visits by Claimont clinical staff allow monitoring and review of clients with longstanding or recurring serious mental illnesses, supporting their mental health and rehabilitation, and reducing the risk of acute relapses, lack of progress and hospital admissions.