01 August 2023

Dealing with hoarding on tv and in real life.

Since the 2008, tough reality TV shows like Hoarders: Buried Alive opened hoarding to public inspection. The weekly shows presented the clear problem that afflicted families, but hoarding was clearly a major public health issue, affecting c5% of the globe.   
                                       
Was this once the hoarder's bedroom, kitchen, loungeroom or study?
Is any object in the hoard worth keeping, donating or selling?

I watched the episodes with great interest until a middle-aged woman, living on a huge farm in 2017, was defecating on her floor and not worrying about hyg­iene or rat plagues. She abused animals and chained them to a wall, and caused the pre-teen grandchildren to live in dang­er and trauma. Chosen by God, she believed that hoarding in prepar­at­ion for the End Of Days was His command; discarding goods was Satanic! Examine the earlier discussion about hoarding being a type of obsessive-compulsive disorder.

In the NHS, council officers reported that hoarding accounted for a signif­icant proportion of bed-blocking, since hospitals couldn’t dis­ch­arge patients to unsafe homes. In one London borough, the av­e­rage cost servicing an individual hoarder for 4 years was £32,000: £10,000+ on forced clear­ances, £10,000+ on repairs and £10,000 on court costs. Hotel accommodation needed post-eviction was not even included.

Thousands of urine bottles in the basement
N.Y Post

But authorities intervened largely AFTER a hoarder was in crisis. But inter­vention involved dealing with the accum­ulated junk, rather than treating underlying problems. Hoarding was poorly un­­d­er­stood, seen as part of obsessive-compulsive disorders. Only re­cently was hoarding identified as a standalone psychological disord­er, leading to a grow­ing aware­ness of its ser­ious­ness. No medications exist specifically to treat HD. But a doctor may prescribe a selective serotonin reuptake inhibitor to help treat other mental health conditions. 

One council officer proposed a pilot programme to intervene early on, rather than waiting until crisis-point. Prev­ention meant growing a re­lationship with the hoarder, gaining trust and making slow, lasting progress.

2,000 rats infested a Sth California house, 
CBS

For the first time in 2013 the American Psychiatric Association pub­lished the Diagnostic & Stat­istical Manual of Mental Disorders, inc­l­uding hoarding. The NHS then es­tabl­ish­ed guide­lines for treatment and in 2018, WHO followed suit. But not all psych­iatrists were in fav­our of this change, being against nor­mal behaviours made path­olog­ical. 

Researchers agreed that hoarding often began as a reac­tion to trauma, but saw that other hoarders might have learned behav­iours or a genetic pred­is­position i.e a study found 50% of hoarders had a close hoarder relative. And there was overlap with other men­tal cond­it­ions eg severe depression or dem­entia. In the US alone, there were 100+ organ­is­at­ions dedicat­ed to tack­ling the crisis.

Even the gardens are hoarded
in Bondi, Sydney
ABC
 
Given that people had different tol­erance for junk, clinicians de­vel­oped a mea­s­uring tool called the Clutter Image Rating. Used by author­ities around the world, the tool con­sisted of photos of a kitchen, bed­room and living room. Their scale descr­ibed Level 1: the floor was clear with items on the surf­ac­es. Level 3: the rooms were messy and items strewn on the floor. Level 5: floors were almost obscured. Level 9: walls were invisible.

Some hoarders never faced intervention eg if a hoarder was happy in an extremely chaotic environment and there were no dangerous iss­ues. One hoarder owned 5 homes, but slept in his car as his houses were jam-packed. It was common for hoarders to sleep in chairs for years bec­ause their bedrooms were filled. Or to live in unheated homes or with­out running water, using plastic bags for a toilet. But when others were endangered, the authorities often moved in. When a home was Level 4+, clinicians and fire ser­vice declared it too risky. Hoar­ders had breached their tenancy agreement, Hous­ing Act and Public Health Act.

The 2014 Care Act overhauled social care for UK adults by class­ify­ing self-neglect as a safe­guarding issue, so councils had the resp­on­sib­il­ity to protect affected individuals. The cleaning company London Blitz Clean found an elderly resident who’d been living in the flat for de­cades, but was now in crisis housing after a hospital stay. The kitch­en was crowded out, the food was years old, weeks of water had leaked from pipes. A br­oken washer-dryer in the corridor blocked the bath­room and the bedroom had clothing piled to shoulder height. Family mem­bers worked nonstop, then London Blitz Clean finished the job.

London Blitz Clean started in 2015, working with London councils and NHS hospitals. Each job took 1-10 days and local authorities didn’t always pay; they might’ve comp­el­led hoarders to cov­er costs. Their em­ergency prior­ity was to make homes hygienic and safe, just a tempor­ary fix that only addressed hoarding sym­ptoms.

There was often no passage within rooms or between rooms
IMDb

Hoarding-specific Cognitive Behavioural Therapy-CBT was not always  available on the NHS, and many hoarders reluctantly engaged with this treatment any­­­how. Worse, CBT typ­ic­­ally wasn’t very eff­ective. Ensuring accept­an­ce of professional help was a big hurdle. Vi­sits were arranged to discuss what they would like to achieve and once they reached a sh­ared aim, prof­ess­ional visits were org­an­ised. Such time-consuming, re­source-inten­sive tasks were prob­lematic for local authorities, but it was more effective than legal enf­or­cement, and hoarders rarely needed repeat visits.

Since Covid started, UK’s local authorities reported sharp in­cr­eases in hoarding. Along with reduced council budgets and decreased mental health funding, hoard­er-support was even harder to obtain. Yet the ex­perience for hoard­ers often felt brutal and int­r­usive. Since many also suffered from other mental health con­ditions, they’d av­oided let­t­ing outsiders in. And hoard­ing took endless time, plus much men­tal and physical energy for the sufferers. There were also health hazards eg toxic gases escaping from gar­bage, fire risks.

London fire brigades attended 1,036 hoarder fires in 2022, finding 186 injuries and 10 deaths! Now a Hoard­ing Panel meets month­ly to bring together senior fire­fighters, envir­on­mental health council officers, mental health workers and social housing workers. They discuss questions for specific cas­es eg man­dat­ory cleaning? eviction? They see hoarding as a complex condition needing targeted social policies and long-term management. Thanks Samira Shackle

Hoarders refer to their book piles as libraries
but they can still fall on hoarders' heads
N.Y Times


34 comments:

Deb said...

If we don't have any or many hoarders in Australia, it is probably because we can spend more time outside than colder climates can.

Rachel Phillips said...

Why are you writing about something in the UK that most people in the UK are not effected by and know nothing about? There's 66 million of us, clean and tidy.

jabblog said...

I didn't know hoarding had a specific name. I suspect many of us dance at the edges of hoarding, holding onto things that have just sentimental value, like birthday cards from years past, for example. Most of us manage to control the impulse to keep absolutely everything but there are some poor souls who become ill and whose ability to think objectively deserts them. It is largely hidden, of course, and is only revealed when external authorities, like pest control or ambulance, are involved.

Hels said...

Deb

if your mother told you that, she was wrong :) We have same rate of hoarding as do the other countries of the world that have done scientific research. The Australian National University Research School of Psychology said people with hoarding disorder are found each year to be 2-6% of our population.

Space Invaders was an Australian hoarders programme on the Nine Network for three seasons, 2021-3.

Hels said...

Rachel

According to Hoarding Disorders UK, between 2.5% and 6% of the UK population is affected by hoarding disorder. No worse, no better than any other First World nation, as far as I can find. The Hoarder Next Door was a sensitive British documentary series worth watching.

Contact https://hoardingdisordersuk.org/ They say they help and support people who are affected not only by hoarding but also chronic disorganisation. They work with the team around the person to create person-centre approaches to support the wellbeing of the individuals impacted by their environment. Their approach is non-judgemental, and trauma informed.

Parnassus said...

Hello Hels, Hoarding is a condition characterized by saving large amounts of (usually) useless junk or trash (think stacks of old newspapers or empty tuna fish cans), until one's safety is compromised. In this day of "minimalism" (which can be an equally crippling disease) hoarding is a label often thrown at maximalists or people who simply enjoy objects or "friendly" clutter. Those minimalists often show dire hoarding photos, such as the above, as the only (or inevitable) alternative to their bare lives. I vehemently disagree with these people.
.
You pointed out several times that one major dividing line is danger. That picture of the dangerously vertically stacked books called a "library" is a good example. Real libraries allow safe and organized access to books.
--Jim

Rachel Phillips said...

Hels, yes I remember watching one or two of the hoarding programmes when they first came out in the 90s. They were a bit of a novelty at the time. I was just surprised because when I started reading I assumed you were talking about your country and then suddenly the NHS came into it and I thought, are no, she's talking about us.

Hels said...

jabblog

hoarding is not having your wardrobe overflowing with your hippy clothes from 1968 or keeping EVERY since photo since your grandparents arrived from Greece. It only concerns the authorities if the house is rat infested, inescapable in event of fire, filled with animal faeces, high carbon dioxide readings from blocked vents and windows, no toilet or shower, and has mouldy food. Only after warnings and assessments will the local municipal council invoke its environmental and health laws.

Hels said...

Parnassus

"useless junk" is such a personal concept. I have seen hoarders who think EVERY single item in their house has a value as Christmas presents for loved family members or to send to antique auctions for sale. The trouble is that the family members will never ever ever visit the hoarding parent's home, and the auction houses fear infections and bites. Even the rubbish-truck drivers insist on head to toe protective gear.

However if items are found that have special meaning for the hoarder and are not dangerous, they must of course be preserved and displayed.

Hels said...

Rachel

I did indeed make one Australian reference, a photo of the outside hoard in Bondi, Sydney. I hadn't seen outside hoards elsewhere and wanted to include it because 1] it _might_ keep the inside of the house halfway decent but 2] the local council will notice the disaster immediately. I would have thought that most hoarders would want to retain their privacy.

Luiz Gomes said...

Boa tarde. Acho que não existe nada mais atual do que o tema que você nos trouxe. Um excelente mês de agosto com muita paz e alegria.

Jo-Anne's Ramblings said...

This Aussie lives next door to a hoarder a really nice chap but you don't want to go into his house. Hoarder's are not dirty people as some would have one believe. My daughter's use to say I was a hoarder but after seeing the TV shows about hoarders changed their minds.

roentare said...

I did a training in the area of hoarding behaviour during fellowship training. It is controversial how to classify the condition whether it should be a type of cognitive impairment or a personality disorder.

hels said...

Jo-Anne
Your daughters must have thought that hoarders were people who tended not to throw out or give away old clothes, books, household appliances etc. Not at all. If there is no serious risk to the householder's physical health and safety, and mental health, then it isn't hoarding.

hels said...

roentare
I am impressed. You are the first person I have met who did proper training in the area of hoarding behaviour. I suspect that personality disorders were _very_ difficult to modify.

Andrew said...

In a previous job R came across a few hoarders. Without other interventions it was futile to clean out someone's home of 'rubbish'. It would not take long for the hoarder to begin to accumulate again.

hels said...

Andrew
Normally a team of 18 removalists, 6 dump truck drivers, all the hoarder's children and a psychologist can clear at least the ground floor of a home in the 3 days of a tv event. But experience shows that that if the hoarder does not commit to regular sessions with a flow up organiser and a follow up psychologist, the hoard will return within a few nonths.

You can tell straight away how sincere that follow up commitment is.

hels said...

Luiz
there have always been physical and mental conditions that threaten citizens' peace. But I am upset that the seriousness of hoarding has STILL not been tackled in most countries. Probably because sufferers are too humiliated to ask for help.

Andrew said...

Hels, you seem to have written a push button post. Further, I now remember a friend who lived in a rented flat in Punt Road Richmond. She fitted the definition of a hoarder as things were piling up on her floors. The separate toilet had books stacked around it to thigh height but it was still usable. She bought a flat in Murrumbeena and while she still bought useless 'stuff' along with lots of books, she did then keep things off the floor at least.

Hels said...

Andrew

I suppose we need to know what the event was.. that first promoted the hoarding addiction. For example God may have specifically instructed a person to prepare for the End of Days by putting away endless stacks of food. Then when all the shops closed, the hoarder could provide all his/her family with necessities for ever! But that sort of thinking was not readily open to "treatment".

Your friend who stacked up books in the hallways, toilets, bedrooms and lounge have to make a choice between 1] promoting her intellectual view of herself on one hand and 2] poverty and immobility in the flat on the other. I hope your friend is getting it under control in the new place.

Hilary Melton-Butcher said...

Hi Hels - I can't watch those sorts of programmes ... way too off-putting. Mine isn't perfect, but I've slowly eliminated some of the things - so it's not too awful! Only books do I hoard ... cheers Hilary

Hels said...

Hilary

no-one has a perfect home, and in any case, having too many books is FAR from hoarding. Hoarding is where it is too dangerous to walk on the ground, and too mouldy or infectious for people to live there.

But whether to watch a hoarding programme on tv or not is an interesting decision. I agree that sometimes it is so off-putting, the workers and even the tv viewers vomit from the faeces and rats on the floor. But I watch it because it gives me an understanding way beyond my normal daily experience.

mem said...

Its interesting how a lot of hoarding starts after trauma and also with advancing age . I work in the health industry and its actually rare to see it young people . Apparently it was also more common in people who survived the war and the great depression . Personally I think it has a lot to do with fear and feelings of insecurity . Its an expression of the world not being a safe predictable place . I have many refugee clients who NEVER throw anything out .
When my aunt died they found hundreds of packs of socks in her cupboards . When my MIL died it was dozens of bottles of expensive perfume . I wondered if she had forgotten that she had bought them and bought more . They turned out to be great lucky door prizes at pre Covid Christmas lunches held for clients:)

Hels said...

mem

I can understand why advancing age would bring about all sorts of physical and mental difficulties that families were previously not familiar with. If an older person lives alone in a hoarded mess, nobody else will care very much. But if the children and grandchildren are too scared to enter grandpa or grandma's hoarded house, then they are much more likely to offer help many times, and eventually to call in the authorities.

Insecurity is terrible for everyone and lasts forever. When my in laws survived the Holocaust, they kept wrapping bread pieces in silver foil and burying them around their Sydney flat. So I understand your refugee clients totally!

mem said...

How very sad . I am sorry

bazza said...

I have often wondered if passionate collecting is somewhere on the same spectrum as hoarding. Sometimes, when watching an auction, I have been curious as to why someone might want to pay a vast sum of money for a stamp that had been misprinted. Of course, Hoarding Disorder is symptomatic of other, inner, disorders: OCD, depression & anxiety for example.
CLICK HERE for Bazza’s fairly fallacious Blog ‘To Discover Ice’

Hels said...

mem

Insecurity can come from anything, whether we understand the hoarder's mind or not. His/her brain, linked to uncertainty about self and others, seems to be linked to seeking support from objects.

As silly as this sounds, the hoarder may not have certainty in their spouse, parents, neighbours, children or bosses, but they can totally trust the 27 junked cars in the back yard. It doesn't have to be rational... but it does have to be certain.

Hels said...

bazza

the items that are collected by the hoarder have to be important to him/her, either valuable financially or emotionally. It doesn't matter that the collector's items are considered stinky rubbish by the auction houses; as long as the hoarder thinks his/her items are valuable. Thus when the hoarders are interviewed on tv, most prefer to be known as collectors, which is respectable, rather than hoarders, which is sleazy.

Some hoarders owe many thousands of pounds to their local council, and plan sell their collection at a top class auction house to pay off the debts. Even if their treasures are worth a total of £27!

My name is Erika. said...

I swear I only get links to some of your posts Hels. So let me apologize for missing so many. This post is sad and disturbing. Except for maybe the books. Yes it's hoarding and that is extreme. But something about having books around can be comforting. So when does hoarding start and a big collection end? Happy weekend. Off to check out your other posts.

Hels said...

Erika

Sadly I am technologically dim witted and can't even guess what is wrong with the links. I wonder if anyone else has the same issue.

Watch the tv series called "Hoarders" and you will see what I have been thinking about. The original American programme was on A&E and then newer sessions appeared under the titles "Hoarders: Where Are They Now?", "Hoarders: Then & Now" or "Hoarders: Overload". It is never an issue of collecting, or even over-collecting. It only becomes hoarding when the Health Dept or local Council say the environment is too life-threatening to live in eg mould, rats, using plastic bags for faeces because there is no toilet or running water, infected old food on the floors etc.

River said...

My older sister is a hoarder. She is mentally challenged since birth and has it in her head that you don't throw (or give) away your things, which means that anything she has ever owned, whether bought herself and had given to her, is still with her. She has the clothes she wore to primary school and all her school books from then too. She also has piles of rubbish which doesn't get thrown out, something she once said to me was she didn't want the neighbours to see, maybe she thought they would check her bin each week and laugh at her? Anyway, I remember one time she had to move house into a housing trust place and she boxed and bagged everything including the rubbish then counted all the boxes and bags to be sure they all arrived at her new home. More recently a house inspection had Housing insist that she move all her stuff out of the house as it was a fire/health hazard. Of course they meant she should throw things away, but she simply cannnot throw away a single thing, "they're my things" so a large shed was provided and she moved all the boxes into it. I suspect that more has now accumulated in the house, but when we visit we never go inside, she doesn't allow people in.

Hels said...

River

Thanks for a very honest response. Your sister is a sad story that I have heard many times, but that never makes it easier for the family of the hoarder. I am assuming that a housing trust place means social housing of a _confirmed standard_; that a person simply cannot live in dangerous, squalid conditions, even if they choose to.

But she will never change if the hoarding is meeting a real need (in her mind, at least). The people who help her clean out the dangerous, unhealthy space must find out what caused the mental pathology in the first place and deal with it directly, not via hoarding objects. Otherwise she will return to the hoarding as soon as the authorities leave.

I wish your family all the best.

hasan said...
This comment has been removed by a blog administrator.
Hels said...

hasan
I am pleased you enjoyed the post, but no advertising please.