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