Hoarding

This page gives some guidance on hoarding, and what to do if you encounter it. If you meet someone who you feel is hoarding, or at risk of slipping into hoards, please

1. Read this page – to learn more about hoarding
2. Talk with the person – find out more about them, their reasons and what is a good approach for them
3. Get help – to enable the person to take steps with the support they need. You don’t need to feel alone; there is help to tackle it, and people who can support both you and the person in question.

Locally, we want:

• To help people start on their pathway out of hoarding.
• For the journey to be positive and long-lasting.
• To help partner organisations, individuals and family members find out how best to approach hoarding.

1. The amount of clutter

Hoarding can be defined as the “excessive collection and retention of any material to the point that it impedes day to day functioning” from Frost & Gross, 1993

It is essential to look at the reasons which lie behind the behaviour to best know how to support the individual.

• Hoarding disorder is distinct from the act of ‘collecting’ or keeping your home in a generally cluttered or messy state. Anything may be hoarded by the person at their home – inside or outside the property.
• Hoarding has no relation to gender, age, ethnicity, socio-economic status, educational or occupational history, or tenure type.

The clutter index

The clutter index provides a way to assess the extent of the collection, and gives a shared scale and language for everyone who is involved to use. It also helps see how things change over time:

These images are taken from Clutter-Image-Ratings.pdf

How the person feels

The guide below helps describe a person’s attitude towards their possessions. This is useful for describing the issue to other agencies and will help when creating an action plan.

1. Good or fair insight: The person recognises that hoarding-related beliefs (relating to difficulty discarding items, clutter or excessive acquisition) are problematic. The person recognises these as their own.
2. Poor insight: The person is mostly convinced that hoarding-related beliefs (relating to difficulty discarding items, clutter or excessive acquisition) are not problematic despite evidence to the contrary. The person might recognise a storage problem but has little self-recognition or acceptance of their own hoarding.
3. Absent (delusional) insight: The person is convinced that hoarding-related beliefs (relating to difficulty discarding items, clutter or excessive acquisition) are not problematic despite evidence to the contrary. The person is completely accepting of their living environment despite the various risks to safety and health.
4. Detached with assigned blame: The person has been away from their property for an extended period. The person has formed a detachment from the hoarded property and is now convinced a ‘third party’ is to blame for the condition of the property, for example a burglary has taken place, or it is the result of squatters or other household members.

2. Where to turn

The Hoarding Forum

The Hoarding Forum meets every 6 weeks for professionals who support people who hoard – to come together and seek advice, best practice and guidance from others. It is an open forum where everyone can present situations without revealing the person’s identity; all present are welcome to contribute. No notes are taken, it is down to the individual to take away their own conclusions on actions they will take. The multidisciplinary nature of the forum allows for a wide range of knowledge and experience.

If you want to come to a Hoarding Forum please email adult.earlyhelp@cambridgeshire.gov.uk and ask to be put in the invite list.

For the individual & their supporters

The MIND guide to hoarding is good for professionals and for individuals,  their friends and family. It includes good links including self-help ideas. Other agencies may be able to help, including the voluntary and community sector. Some are listed here with an outline of what they can do…

• The Fire Service can install smoke alarms in accessible rooms and give fire safety advice particularly on electrical, kitchen, candles, electric blankets, fires and heaters
• Social landlords can visit a person to inspect the property and assess support needs, possibly refer to the Floating Support service. They can make sure the person is maintaining tenancy conditions, fulfilling responsibilities, and can consider enforcement if needed.
• Private landlords: you can inform Housing Advice at Local Authority (see the Housing Guide to find each district’s housing advice team) if their tenant is displaying hoarding behaviour and the landlord is not aware. Housing Advice teams can challenge unlawful evictions that might result from hoarding and can act to prevent homelessness if it has gone that far (for any resident).
• GPs can carry out assessments and refer to appropriate mental health team, working with their social prescribers. This link takes you to an “ice breaker” to help start that conversation off.
• Psychological well-being service (also known as IAPT) aims to make psychological therapies more accessible to people experiencing common mental health problems such as depression and anxiety. They can be found here and people can refer themselves into the service.
• Environmental Health teams at the district council (see Housing Guide) will consider serving legal notices under various Acts, and if not complied with can consider ‘works in default’. Action mostly depends on complaints being received, or where the issue in one property affects other properties and people. For more detail please see the Hoarding Protocol.
• Voluntary agencies can offer advice, including debt advice, and support including for example gardening services, befriending, well-being activities and volunteering opportunities. In Cambridgeshire, Care Network’s Community Navigators can help people get in touch with the help they need, contact here.
• Animal welfare organisations and visit to do well being check of animals at the property and educate person on animal welfare if needed. They can provide advice / assistance on re-homing if needed, or consider removal of animals to a safe environment and even take legal action for animal cruelty if appropriate. Wood Green outreach services can support with animal welfare, including animal hoarding and helping if someone feels they can no longer care for an animal. Link here to the “pet promise” page on Wood Green’s website.
• Home Improvement Agencies can visit to assess suitability of accommodation, again please see the Housing Guide for contacts.
• Safeguarding: if you have concerns about abuse or neglect, you can make a safeguarding referral using this link.

There are some other teams and useful directories listed in the Housing Guide including money advice, help with energy efficiency and other services which may be useful to know about. Use the guide to look up the district and see housing-related services which might be able to help.

Where money is an issue

Some tips:

• Try to maximise the income of the individual through welfare benefit review, debt advice and support with utilities. Consider organisations that can help such as the Local Energy Advice Partnership (LEAP) at applyforleap.org.uk
• Get quotes, more than one to give a fair reflection, for help with cleaning or clearing as agreed. Encourage saving towards a solution.
• Consider if someone may need support with compulsive buying. There are lots of good online advice sights and apps. Cognitive behavioural therapy can also benefit.
• If applying for charitable funding ensure this part of a wider plan. Are underlying issues leading to the hoarding behaviour being supported? Is there an ongoing plan to sustain a cleaner environment such as support from a cleaner?
• Speak to landlords, both social and private. They may be willing to support with costs.
• Home Improvement Agencies may be able to support clearance costs, normally where there is a wider aim such as reducing the risk of trips and falls or hospital admission.
• Speak to local district councils, they may know local schemes and may also be able to involve their environmental health teams.
• If someone has a care and support plan through social care ask if the property condition has been considered in the assessment.

3. How to address the collection

It’s important to:

• Look at what someone is hoarding in a non-judgmental way.
• Show curiosity – ask what is collected and why.
• Use the same language as the person who is collecting – for example we’d suggest if the individual talks about their ‘treasures’, try to use the same term.
• Find out why the collection is important to the person, what value do they see in it?

Pointers for Clutter index: Level 1 to 3

• Listen to their story – why are these items important to them?
• Self-help may work best, we suggest following the approach in the MIND guide to hoarding. This level of clutter generally means the habit is less entrenched and there is less of a “habit”… as yet. It’s a great moment to stop the clutter increasing to a more serious level.
• Suggest taking regular photos to encourage a positive measure of progress using the clutter index.
• Involve others if needed, for example:
  • Professionals can attend a Hoarding Forum to get informal support and advice
  • Community and voluntary agencies may be able to help – have a look at Keep Your Head and How Are You web pages
  • Consider cleaners who support a positive response to hoarding. There are some cleaning services that work specifically with people who hoard, all are ‘paid for’ services.
• Enlist the person’s supporters to help prevent escalation.

Pointers for Clutter index: Level 4 to 6

• A habit has formed, possibly longstanding.
• This may need deeper exploration as to the reasons behind the collection. The person may well reveal a medical reason or a mental health issue which has led to the collection building in conversation.
• It’s important to both care and to confront – the “care-frontational” approach – listen carefully to the person’s feelings about their possessions (in a non-judgmental way) while guiding them to think about the risks and challenges a collection like this can bring.
• Some help from other people will probably be needed- consider the Hoarding Forum, attention to mental health and mental well-being, and talking with others who may already be aware, or may need to be drawn into the conversation. Forum members may suggest an inter-agency meeting if appropriate
• Offer advice about risks and safety, if it is a concern, consider asking Cambridgeshire Fire for a fire safety check (with the support of the person in question of course).

Pointers for Clutter Index: Level 7 to 9

• At this stage, everyone needs to work together to help the person plan their way out of this level of clutter. The Hoarding Forum is the best place to approach to get support on this and may recommend a multi agency meeting.
• It’s probably an epic and longstanding issue and almost certainly hints at underlying issues.
• There need to be persistent and consistent messages that this cannot continue, however in parallel with the need to tackle the level of possessions in a way that will not lead to additional trauma and mental health difficulties for the collector.
• This level of hoarding CANNOT be tackled by one person alone – it will need a number of partners to bring their influence to bear if the person is to make a change.
• At this stage, you may want to consider their mental capacity in order to understand the risks better.
• If this person has mental capacity but is not responding, consider raising your safeguarding concerns.

Tips

• The level of insight the person has about their own behaviour will affect your approach. People who are at the first two stages on the “insight” scale will be much easier to work with then those who have much less insight, or are delusional. The less insight a person shows,the more you will need to involve other agencies to ensure there is a clear and consistent message about the possessions.
• The earlier we can get alongside a person who hoards, the more likely we are to reach a good outcome for all concerned, in a way which helps in the long term – not just treating the symptoms.
• Bearing in mind the complexity of hoarding behavior, especially the fact that it tends to be rooted in anxiety disorders, it is important that we take a sympathetic approach.
• The person with hoarding behavior may well not respond favorably to a simple clearance of their property. In fact,this is likely to be extremely upsetting and will almost certainly exacerbate any mental ill health and add to their stress.
• Clearance is also unlikely to be a solution in the longer term, as it often leads to trauma followed by a continued need to gather items, if the root cause(s) have not been explored.
• Once some cleaning has been completed in cooperation with the resident, consider what might help them maintain their new habits and ensure they do not “slip back”. One idea is for a cleaner to visit regularly but not too frequently, to help keep things tidy and to keep an eye on bad habits returning.
• Just to be certain – cleaning includes wiping surfaces, removing cobwebs and emptying bins. Any collection of items in the property might be boxed up or put to one side while an areas is cleaned, but the possessions are NOT removed.
• Clearance is removing possessions to go to the tip or in a skip. you do not want to confuse the two terms because it will have a profound effect if someone is expecting a tidy up and wipe of surfaces, but finds their possessions have all been removed instead.
• In some situations, the property needs a deep clean. In others, there also needs to be a clearance – often one area at a time. It is VERY IMPORTANT that if you are considering arranging either cleaning or clearance, the person in question understands the terms you are using, and they agree to whichever action they are happy with.
• A more specific situation is where there is a squalid collection of items associate with drug or alcohol misuse – of no sentimental or significant value and may be a direct risk to health for example contaminated needles. In this case, it is best to approach the agencies which support people with substance misuse issues. The web page for Cambridgeshire is here and for Peterborough is here.

Risk

• Depending on the extent, there may be a risk to the resident, and to neighbours, when hoarding occurs.
• This includes increased risk of fire, due to storage of flammable materials particularly if they are kept close to heat sources such as cookers or fires. Also risk of getting trapped or crushed, should a pile of good fall onto the person, and the risk of fire crews and ambulance teams being unable to access the property if access routes are blocked.
• This is why the Hoarding Protocol outlines a ‘care-frontational’ approach – balancing care for the individual against concern for their safety, and that of neighbours and visitors.
• Individual organisations which get involved will have ways to assess risk and guidelines on how they will do that assessment. The Hoarding Protocol also includes a helpful risk assessment tool.
• If you are helping someone who is hoarding, we’d suggest that in conversation with the person, you balance a caring and inquiring approach with outlining some of the the risks posed, to encourage them towards taking action and/or seeking help. We are not suggesting that individuals and family members who are trying to help, need to undertake a formal risk assessment themselves.

Avoiding some pitfalls

Please click here, or on the thumbnail image,  to open hoarding: myths and truths.

4. Example situations & conversations

There are as many reasons to hoard as there are people who hoard, so here are some examples…

A person with long standing trauma, for example someone who was in care themselves, or have had a child taken into care, can lead that person to collect things by way of replacing something that’s missing.

There are also conditions where people cannot process cause and effect (some personality disorders fit here), where the individual cannot see that their actions have led to what they see. They presume some other reason for the collection

A case study

Here are some headlines of a case study which P3 helped to support as part of a pilot project in 2021…

• A female was referred to P3 from Cambridgeshire Fire Service. Her bedroom was inaccessible and she was sleeping on a mattress on the floor downstairs. She was experiencing poor mental health, social exclusion and isolation and difficulty in coping.
• She was in the financial position to order a skip, easing clearance of the bedroom. At this stage, practical support could be provided by P3, so a full day with P3 hoarding specialists was undertaken to ensure maximum impact.
• A reduced clutter rating has been achieved, with a dramatic change in the condition, safety and presentation of her home. She felt her well being had improved and she was feeling more motivated. The bedroom is now accessible.
• She had coping mechanisms and tools in place, and now has tools, techniques, and routines to make sure this can be maintained independently.

This is a great example of the help needed to reduce the clutter and stick to the new routine. However please note, this was a pilot scheme, which ended in 2021.

We are keen to work together to secure support for people who hoard, and the P3 pilot has helped prove the difference such support can make. We will update on our progress on this page. Click here to open the End of Hoarding Service Report.

5. Our local protocol

Find out more in the hoarding protocol, agreed by partners across Cambridgeshire and Peterborough.

Multi-agency training on safeguarding adults at risk and hoarding is available for anyone in Cambridgeshire or Peterborough who works with adults at risk and their families, and can be accessed using this link.

6. Feedback & comments

If you have feedback on this page or want to suggest improvements, please contact sue.beecroft@cambridge.gov.uk