Kim, there's a difference between a messy house and a dirty house.
If your bathtub is black, you got a layer of dust so thick on your furniture, you cannot see the woodwork under it and your kitchen counters are so cluttered with trash, dirty dishes and ickiness-there's no available space, then you've got a dirty house and yes, that would concern me as a housekeeper- let alone a mental health person.
If there are clothes drapped over a chair, the floor has a couple of loose pieces of lint on it, the kitchen has a couple of dirty dishes on the counter top and the bath sink has got some toothpaste film in it-then it's probably just a messy and not a big deal.