More mentally-ill patients are to be treated in their own homes because of the stigma attached to “walking up the hill” to the Mid-Atlantic Wellness Institute.A new team of staff has been set up with the sole responsibility of carrying out home visits in the hope that being in familiar surroundings will speed up a patient’s recovery.The workers are currently seeing about 40 patients in homes across the Island many of these are “too embarrassed” to be seen in the Devon Springs Road neighbourhood.The programme was launched as part of the Mental Health Act’s aim to work towards community rather than institutional rehabilitation.Chantelle Simmons, MWI’s chief of psychiatry, said: “Some service-users have sat in my office and said they didn’t want to walk into the building.“They ask to be seen at a different location as they are too embarrassed to be seen here.“There are many concerns about being seen at MWI. Sometimes people feel uncomfortable just walking towards the building, they don’t even need to have opened the door and walked inside.“One man said he’d struggled with depression for years because he just couldn’t bring himself to walk up the hill. It’s that walk where everyone assumes where you are going.”The three staff who make up the new ‘intensive case management team’ visit patients on a daily, weekly and monthly basis, depending on individual needs.They carry out initial assessments of new patients and dispense medications, but most of their work is follow-up visits included in a patient’s treatment programme.Dr Simmons said the team’s work was already proving to be “invaluable” in preventing admissions to MWI’s residential units.She said: “Our care is very much becoming community-based and recovery-orientated. We are considering the most appropriate and therapeutic treatments.“It is for this reason we are getting out in the community and seeing more people in their own homes.“We can better serve people wherever they are and are more likely to have positive outcomes.“If someone wakes up feeling depressed, the last thing they feel like doing is getting out of bed, getting washed, making breakfast and walking to the bus stop.“If we visit them, it takes less effort, there’s no stigma attached to being seen and they remain in familiar and comfortable surroundings.”Dr Simmons said her first three months in the top MWI job had been “a really exciting time” but she recognises that they are “still lots of initiatives we are trying to put in place”. She took over from Michael Radford, who returned to England on September 1.She said: “I understand there’s a lot of work to be done. It’s a challenge and very much a work in progress.”The Mental Health Plan, which was passed by the House of Assembly in 2009, also recommends home treatment, establishing outreach teams and relocating community rehabilitation services from MWI to Hamilton. It is hoped that more patients can live among our communities in group homes and with the support of caregiversDr Simmons says she is also “very supportive” of long-standing calls to introduce a Mental Health Court in Bermuda so judges can work with health experts to review cases and make recommendations.A Government task force was set up in 2003 to plan a Mental Health Court, as part of a PLP election pledge. Government was then said to be planning such a court as part of a pledge made during the 2007 Throne Speech. But as yet, no such court has been implemented and there was no mention of a Mental Health Court in the Mental Health Plan.But Dr Simmons said she was the psychiatrist for a drug court programme while working in Atlanta and witnessed first-hand the benefits of judges discussing available treatments. She said: “It often felt more like a therapy session than a court of law.”She added: “It positively affects outcomes when you have all the key players round the table. It really is quite beneficial to people’s medical needs.“Judges need to be understanding of the recovery process and people’s medical needs.”There has also been much talk about making better use of MWI’s partnership with a medium-secure unit in Birmingham, England, so that those with the most severe mental health issues can be transferred.Dr Simmons said she couldn’t discuss this any further because Health Minister Zane DeSilva “hasn’t officially signed [the agreement] yet.”It was an uphill battle trying to change people’s mindset and make them understand that not all mentally-ill patients need to be locked up, she added.It comes just days after residents voiced their concerns to The Royal Gazette about schizophrenic Shiloh Payne roaming the streets unsupervised about two months after he was sentenced to an indefinite hospital care order for stabbing his neighbour. Payne has been spotted in the MWI neighbourhood after the Supreme Court heard he was “a very dangerous person” who had “a real likelihood” of committing serious offences.Dr Simmons said: “People need to understand that most people with mental illnesses are not violent and are not a risk to the public.“I certainly understand people’s concerns when court cases put things in the public eye and yes, there have been some unfortunate situations.“But I’d encourage people to think about the reality of how often these things happen.”She added: “Mental illness is a chronic illness. One day you could be diagnosed with diabetes or a mental illness, you just don’t know.”MWI’s programmes are currently used by about 600 patients and it is estimated that about one in four people in Bermuda has suffered a mental illness, although many do not seek help.MWI’s workload is varied but it is “very common” for staff to treat people who are “having suicidal thoughts after fighting with loved ones”. They typically need a few days in a supportive environment to “get back to their normal mental status”.Patients with schizophrenia, those who are bipolar and those with depression require long-term stays of several months or even years as they suffer relapses.These are the patients who have to be reintegrated into society “on a step-by-step basis” before they are allowed to be discharged. Dr Simmons said this starts with a walk around the MWI property with a staff member, then an unsupervised walk before progressing to overnight then weekend stays with their families.