What is hoarding?

Hoarding is now recognised as a mental illness known as Hoarding Disorder. It is a complex interplay between social, psychological, and environmental factors.

A person who hoards may:

  • become extremely attached to items and experience great difficulty in getting rid of possessions
  • experience problems in social, occupational, or daily living activities
  • experience distress and have difficulty making decisions
  • fill area with clutter so it can no longer be used as intended
  • find it hard to organise or categorise items
  • find relationships with family and friends are affected
  • keep or collect items of no monetary value
  • present a risk to personal safety and that of others due to hoarding
  • struggle to manage everyday tasks such as cooking cleaning or paying bills

People often do not have the energy to sort thing out and the task becomes overwhelming. Feelings of guilt or shame may prevent people from seeking help or allowing access to their home.

Research with people who hoard has shown that hoarding may be a linked to specific traumatic life events or could be symptoms of another condition such as obsessive-compulsive disorder, acquired brain injury, dementia, depression, or autistic spectrum disorder.

People who hoard often have logical reasons why they hoard e.g., throwing things away is wasteful, or harms the environment or the item is unique or special or holds special memories or ‘it makes me happy’.

Hoarding may develop over a period of time due to declining health both physically and mentally. Therefore, building relations as early as possible to offer help and support and minimise the hoarding is important.

How can we help and support someone who hoards?

It is important to challenge our own prejudices and assumptions. Everyone is different and we cannot fully understand why an individual hoards. The situation can be frustrating, worrying and difficult. Often, the individual does not want or feel they need help. The following suggestions might help.

  • Educate yourself about hoarding disorder first – it’s a complex condition with no quick solutions.
  • Always use respectful language – don’t refer to things as junk or clutter. The item may hold a special meaning for the person. Use the same language as they do about their possessions.
  • Don’t tell the person what to discard or touch their possessions without consent.
  • Be gentle – you cannot force someone to change their behaviour. Any attempts to do so will make matters worse and is likely to cause distress.
  • Build trust and be patient – this is a slow process and may take many months. Once someone acknowledge they need help it can take a long time before they are ready to make changes. Let them know you are there and are not judging them.
  • Don’t pressure them to let you into their space – as you build a relationship it may help to consider other places you could meet.
  • Help them celebrate small successes  – try celebrating after they clear a small area. The whole task maybe overwhelming so reassure and help them to take things one step at a time.
  • Focus on aspects of safety and well-being – talk about how you can work together to reduce the risk of accidents or eliminate things that could cause harm. This can often start the process off.
  • Do not consider forced clean-ups – focus on a ‘harm reduction strategy’.
  • Don’t make decisions for the person – encourage them to make achievable goals no matter how small.
  • Help them to seek treatment and support – help them know you will support them to seek help when they are ready.
  • Listen to what they want.
  • Always include the person in decisions to call the authorities and explain why this is necessary – they may be reluctant but if you have built a trusting relationship and have focused on safety and well-being this will help.
  • Do not let professionals make surprise visits.
  • With the person’s consent, try to engage family or a friend to give additional support.
  • Record your interventions to enable statutory organisations to have a clear picture of actions taken so far.

What professional help is available?

The person’s General Practitioner can be of help with diagnosis and linking you to other statutory services.

A multi-agency approach is the best way to work with people who hoard. Social services and mental health services can carry out risk assessments and develop risk management plans. They can use the care planning process, or the care programmed approach to try and ‘mitigate the risk of serious self-neglect that can result in significant harm’. Do ask to be included in multiagency meeting or at least send a report on the situation and what action you have taken so far. They can carry out a Mental Capacity Assessment which may help determine if the Court of Protection has the powers to make an order regarding a decision on behalf of an individual. However, application of the Mental Capacity Act can be very complex in relation to self-neglect. Hoarding is a complex issue and often the statutory authorities do not legally have the powers to intervene.

Relevant legislation

  • The Care Act 92014) Statutory Guidance- self neglect is included as a category under adult safeguarding.
  • Mental Health Act (2007)- If a person is believed to have a mental disorder and they are living alone and are unable to care for themselves a magistrate’s court can authorise entry to remove them to a place of safety.
  • Mental Capacity Act (2005) s16(2)(a)- the court of protection has the power to make an order regarding a decision on behalf of an individual. The court’s decision about welfare of an individual who is self-neglecting may include access to assess capacity.
  • Public Health Act (1984) s 31-32- local authority environmental health could use powers to clean and disinfect premiss but only for the prevention of infectious diseases
  • The Housing Act 1988-a landlord may have grounds to evict a tenant due to breaches of the tenancy agreement
  • Article 8 of the Human Rights Act – gives us a right to respect for private and family life. However, this is not an absolute right and there may be justification to override it, for example, protection of health, prevention of crime, protection of the rights and freedom of others.

Thanks to Helen Boyd for providing the above information

posted 24 May 2023