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.
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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.
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.
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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