Case study: Providing live-in support for severe OCD and agoraphobia
Patient Background
A 35-year-old qualified lawyer sought help from Orchestrate Health to address severe Obsessive-Compulsive Disorder (OCD) and agoraphobia, conditions that had significantly impacted her life. Five years earlier, a traumatic incident ended up being the catalyst that led her to leave her high-pressure job and withdraw from professional and social life. Supported financially by her elderly middle-upper-class parents, she struggled with the ongoing strain her dependence placed on their relationship. Single and socially isolated, she faced cultural pressures of self-reliance and the stigma surrounding mental health, which made seeking help difficult.
Her medical history revealed a pattern of inconsistent treatment due to her agoraphobia – she had previously attempted therapy and medication but found it difficult to sustain progress. Alternative approaches, such as online therapy and mindfulness apps, had also failed to address the severity of her conditions.
Presenting Challenges
The client reached a crisis point where her OCD and anxiety became unmanageable, deeply affecting her own wellbeing, as well as her parents’. Her conditions included severe OCD with intrusive thoughts and excessive rituals, agoraphobia that prevented her from leaving home, as well as comorbid anxiety, depression, and PTSD. The loss of her professional identity and independence further compounded her struggles, and her social withdrawal made it difficult to maintain relationships or explore romantic connections. The client’s parents initiated contact with Orchestrate Health, seeking a comprehensive solution to alleviate the growing emotional and financial burden.
Given her severe agoraphobia, live-in care was essential to ensure immediate and consistent treatment. Orchestrate Health’s discreet and flexible at-home approach suited the client’s need for privacy and stability, allowing the team to integrate treatment seamlessly into her home environment without disrupting her fragile sense of stability.
Tailored Treatment Plan
The client’s goals were to achieve emotional stability, reduce the frequency and intensity of OCD rituals, and regain independence in daily tasks. She also aimed to rebuild her relationship with her parents and develop a sense of self-worth outside her condition. To meet these objectives, Orchestrate Health implemented a bespoke, whole-person treatment plan.
Treatment began with a comprehensive assessment conducted by a psychiatrist specialising in OCD and anxiety disorders. This included OCD severity scales, anxiety inventories, a full psychiatric evaluation, as well as medical input to assess stress-related conditions. Collaboration with the client’s private GP ensured a seamless partnership, with open communication reinforcing trust and maintaining the continuity of her care.
Key in this case was a registered nurse that provided 24/7 live-in wrapped around support, offering continuous care and monitoring to foster a sense of safety. A coaching psychologist visited regularly to implement therapy techniques such as Exposure and Response Prevention (ERP), which helped the client confront and manage her fears. The care team worked to create a structured daily routine that prioritised privacy and incorporated gradual desensitisation to social interactions.
Privacy and Discretion
Orchestrate Health ensured the client’s privacy and dignity were protected throughout her care. Clinicians blended seamlessly into her home environment, maintaining a low profile and minimising visibility to neighbours or visitors. Only her parents were aware of the treatment, ensuring no disruptions to her privacy.
Resolution and Progress
Over several months, the client experienced significant improvements in her mental health. Her OCD symptoms reduced substantially, with fewer compulsions and more effective coping mechanisms in place. Anxiety levels stabilised, allowing her to engage in daily activities with less fear. These changes enabled her to rebuild her relationship with her parents through family therapy and improved communication. She also began exploring hobbies at home, which fostered a renewed sense of purpose and confidence. Socially, she reconnected with friends through gradual home visits, eventually progressing to meeting them outside her home.
Family therapy played a key role in supporting her parents, helping them understand how to encourage her recovery without enabling compulsive behaviours. This collaborative approach strengthened the family dynamic, reducing the strain that her condition had previously caused.
Ongoing Care
The treatment plan was reviewed monthly, allowing for adjustments as the client’s independence grew. After the first eight weeks, the intensity of live-in care was reduced. The nurse transitioned to visiting three times per week, while the coaching psychologist continued weekly sessions. This stepped-care approach ensured that the client maintained her progress while gradually taking on more responsibility for her mental health. Periodic reviews and adjustments continue, with increased support provided during challenging periods, such as anniversaries or other emotional milestones, or even occasionally reducing sessions where appropriate.
Conclusion
Through Orchestrate Health’s live-in care model, the client was able to overcome the limitations of her severe OCD and agoraphobia. By addressing her needs in a discreet, supportive environment, she regained independence, rebuilt relationships, and found a renewed sense of self. The flexible and ongoing nature of her care ensures she can continue to navigate her journey toward lasting wellbeing with confidence and support.