Mary Hatcher hadn't left her Arlington rambler for years. She was severely depressed and anxious, and she wasn't sleeping or eating much either. She had lost a lot of weight, and most of her days were spent in bed. 

Hatcher had been receiving services from Arlington after breaking a shoulder when a county nurse decided the 83-year-old could benefit from the county's unusual homebound program for seniors with mental health issues. The nurse referred her to the program, and a geriatric psychiatrist and a psychotherapist soon began visiting Hatcher at home. 

Four years, many medications and much therapy later, Hatcher is back doing what she enjoys -- cooking, reading and puttering around her house. She also goes out at least once a week, to get her hair done, buy groceries or visit CVS. 
"I didn't think I'd ever feel this good again," Hatcher said. "I look forward to getting up in the morning now. Before I couldn't get out of bed." 

Hatcher is one of 35 Arlington residents 65 and older who are under the care of geriatric psychiatrist Larry Spoont and psychotherapist Catherine Harrison as part of the homebound program, a division of Arlington's Senior Adult Mental Health Program. Spoont and Harrison make house calls so their patients don't have to trek to a doctor's office. 

The Senior Adult Mental Health Program serves about 220 clients a year. It seeks to reach seniors in need of assistance before they require institutionalization in a psychiatric hospital or nursing home, officials said. 
Hatcher, who never married and lives alone, has some extended family in the area. A niece in Rockville comes for dinner once a week and a nephew in Purcellville is on call in case of an emergency, she said. But all the neighbors she used to visit with on her street have died or moved away, she said. It makes for a lonely existence. 

"Dr. Spoont must be the only doctor who makes house calls anymore," Hatcher said last week during one of the doctor's regular visits. "He saved my life." 

Arlington is the only jurisdiction in the Washington region that sends a county psychiatrist on house calls for ongoing treatment, said Henriette Kellum, supervisor of the Senior Adult Mental Health Program. Kellum said the program, which won a 2006 Best Practices Award by the Commonwealth Council on Aging, provides a model for how mental health services can be delivered to a rapidly aging population. She said the homebound program played a big part in the award. 

"We saw that some clients were not able to go out and get services, so it was decided to bring the services to them," Harrison said. "The goal is to keep people happy and healthy in their own homes." 

Demographics show there will be a growing need for senior services such as the homebound program. The population of Virginians 65 and older is projected to increase by 106,679, or 65.4 percent, from 2005 to 2020, according to the Northern Virginia Regional Strategic Planning Project. In Arlington, that population numbered 17,762 in the 2000 Census and is projected to double to more than 35,000 by 2030, according to the county's demographer. 

Harrison said the homebound program's clients are 66 to 97 years old, with most in their 80s. They suffer from such illnesses as schizophrenia, bipolar disorder, major depressive disorder, obsessive compulsive disorder, anxiety disorder and dementia. 

About half the patients live alone; seven live in Culpepper Garden, a nonprofit facility on North Pershing Drive for lower-income seniors. The overwhelming majority of clients are referred. Medicare covers the cost of most services. 
The program, which started in 2003, has allowed the county to reach an unserved population and continue to serve clients who become homebound after they have initiated treatment at the office, Kellum said. It also has allowed the county to reach seniors fearful of or resistant to mental health services, which was Hatcher's situation. 

I knew I wasn't well, but I was too timid, too shy to ask for help," said Hatcher, who graduated from James Madison University in 1945 and worked as a teacher in Maryland for a while. 

In addition to Spoont and Harrison, a county aide visits Hatcher twice a week to help her bathe. Another aide comes once a week to help her do laundry and housecleaning. A handyman friend helps maintain her yard. 

"Seeing a person in their home environment gives the clinician much more information about how the person is functioning than you will ever see if that person comes to your office," Kellum said. 

In Hatcher's case, Harrison said seeing her at home -- and discussing her anxieties there -- led to two small, but important, changes that have gone a long way toward easing Hatcher's worries. 

One reason Hatcher wasn't leaving the house, Harrison said, was that she was worried about construction vehicles blocking her gate; over the past few years, several houses have been built on her tiny Arlington street. The county erected signs prohibiting parking in front of her house, solving the problem. 

Hatcher, who had fallen and broken her shoulder, was also concerned about falling again and having no one to help her. So Harrison got her an emergency communication device connected to Virginia Hospital Center. Hatcher wears the device around her neck and can use it if she needs help. 

"Those two things made a big difference to her," Harrison said. "She didn't feel trapped in the house anymore." 

Spoont initially prescribed an antidepressant, an anti-anxiety drug, a mood stabilizer and a sleep medication for Hatcher. She began to feel better after about four months, he said. Last year, there was a recurrence of her severe depression and the medications were changed, he said. After a few months on the new medications, she recovered again. 

Spoont visits Hatcher every two to three months, more if necessary. For instance, when Hatcher suffered her relapse, he visited once a week for a time. Harrison visits every one to two weeks and sometimes also drops by on her way to work. If she sees anything amiss, she lets Spoont know. 

Harrison said her job with the elderly often involves validating them. 
"A lot of people are very isolated," she said. "They have nobody to tell their stories to. They just want to feel that they matter, that their life matters. A lot of the work I do is validating their lives and reminiscing with them." 

Spoont, 76, qualified as a geriatric psychiatrist in the mid-1990s after retiring as chairman of psychiatry at Franklin Square Hospital Center in Baltimore. He said he thinks it is easier for elderly patients to relate to him "because I'm older, too." 

"And it's easier for me to understand their problems because I'm also aging," he said. 

Spoont said one of the signs he looks for in Hatcher during his visits is whether she's cooking, because it is an activity she always enjoys when she is well. 
"I may make up some pie crust for a chocolate pie," she said when asked by a visitor what she was planning on doing after Spoont's visit. Spoont smiled. 
"Depression is not a normal part of aging," Spoont said. "We really want people to understand that." 

"Life doesn't stop when you're 80," Harrison said. "There are plenty of 80-year-olds who have no depression, no dementia. They drive, they have sex, they have relationships." 

Spoont and Harrison said there is room for more clients in the homebound program. Anyone who knows a senior in need of psychiatric help should call Arlington's Aging and Disability Services at 703-228-1700.