Hoarding: Best Practices for Safe and Respectful Intervention

Hoarding disorder is thought to affect millions of people in the UK, with some estimates suggesting 2-5% of the population may be affected. Hoarding is considered a recognised mental health condition by the NHS. 

Hoarding situations should be approached with sensitivity and respect, using a mixture of practical techniques and mental health support. This allows for collaboration between hoarders, families and professionals and promotes safe, effective and respectful intervention.

Understanding Hoarding 

Hoarders have a compulsion to keep items, collect large amounts of clutter and will usually store their items in their homes in a disordered and haphazard way. This can lead to people living in extremely cluttered or even hazardous environments. There is usually chaos in hoarding and an underlying mental health reason – this is how it can be differentiated from extreme collecting. 

Hoarding disorder manifests as the compulsive collecting of items and objects. People can develop an emotional connection to their hoarded items and will feel unable to part with them or throw them away, even if they appear to be of low value, broken or useless.

According to NHS information, common items that are hoarded include:

• Newspapers and magazines
• Books
• Clothes
• Leaflets and letters (including junk mail)
• Bills and receipts
• Containers, including plastic bags and cardboard boxes
• Household supplies

In extreme cases, hoarders will keep household rubbish and even their own waste in their home. 

A recent phenomenon is data hoarding. Data hoarders will store and hold on to massive amounts of electronic data (such as emails) that they feel unable to delete. Some data hoarders acquire stacks of electronic items that they hoard, for example old TVs and laptops, broken tablets etc.

Some people hoard animals, which they often struggle to house and look after.

Hoarding disorder is often associated with certain mental health conditions such as:

• Depression
• Anxiety
• Obsessive compulsive disorder (OCD)

It may also be a sign of a degenerative condition such as dementia. 

Hoarding can affect anyone of any age or gender, although hoarders may be more likely to:

• Live alone
• Not be married
• Have suffered from deprivation as a child
• Have a family history of hoarding
• Have grown up in a cluttered home where they failed to learn key organisation skills
• Be overweight

Studies do not point towards a single root cause for hoarding and it can start due to a single event or a number of factors such as:

• Poor mental health
• A physical reason (such as chronic pain or reduced mobility)
• A response to trauma
• Grief

Having a cluttered and disorganised home can pose a health hazard for slips, trips and falls. An unclean, messy and disordered living space can also attract other hazards such as dust, flies, vermin and bacteria. According to the Chartered Institute for Housing (CIH), hoarding is amongst the leading causes of eviction for tenants from rental properties.

Hoarding disorder may be accompanied by signs of self-neglect, with the hoarder appearing dishevelled or unkempt. This can be a symptom of poor mental health or due to the physical restrictions that living in a cluttered home creates, for example clutter may prevent someone from accessing washing facilities or finding clean clothes to wear. 

Hoarders will often struggle to do basic housework (e.g. washing up, wiping surfaces, dusting and vacuuming) due to their hoarded items, making it hard to move around and lack of access to surfaces and carpets. They may also struggle to locate important items in their home and will find it hard to organise themselves, pay bills and get to appointments or engagements on time.

Hoarding can also leave people feeling socially isolated due to shame, stigma or other reasons:

• They may not want to invite anyone into their home due to embarrassment about how their home looks or smells
• Hoarding can cause problems between hoarders and their families who struggle to understand the way their family member is living
• Hoarders may struggle to find necessary items (clean clothes, mobile phone, keys, bag etc) and may find it easier to stay at home rather than make plans that mean they have to get ready to go out
• Poor mental health, such as depression and anxiety, may make hoarders withdraw from society

Hoarders sometimes struggle to recognise that they have a problem and may be extremely reluctant to engage with services that want to help them. 

Best Practices for Intervention 

Interventions for hoarding disorder need to focus on both the practical and emotional aspects of the situation. This includes taking steps to ensure everyone’s safety as well as to establish trust and rapport between all parties involved.

Health and safety considerations 

Ensuring everyone’s safety is fundamental when dealing with a space that is cluttered, chaotic and potentially hazardous. 

Important safety considerations for dealing with hoarding situations include:

• Assessing the structural safety of buildings
• Fire safety considerations (including access, emergency exits, fire extinguishers)
• Assessing hazardous substances that may be present
• Understanding COSHH guidelines
• Use of PPE (masks, gloves, protective suits etc) to protect people from hazards such as bacteria, dust, chemicals or bodily fluids
• Removing or containing any animals that are present

Communication and building trust 

To work effectively with a hoarder, you will need to be:

• Empathetic
• Intuitive
• Emotionally intelligent

Strategies to build trust between intervention services and hoarders:

• Use good communication skills and active listening techniques
• Approach individuals with empathy and understanding
• Promote engagement and collaboration rather than judgement
• Involve the hoarder in decision-making, as far as practicable
• Acknowledge the emotional and psychological effects of their hoarding

Collaborative Approaches

A coordinated effort between different services is necessary for safe and respectful intervention in hoarding cases. This will vary on a case-by-case basis but will often involve a collaborative approach between:

• Mental health professionals
• Social workers
• Community support groups
• Housing and property management professionals
• Fire service

Family members, friends and caregivers may be able to play a role in supporting hoarders to deal with their situation. This should always be done in a caring and empathetic way so as not to fuel any existing tensions between hoarders and their loved ones.

Practical Intervention Strategies 

Key practical intervention strategies for dealing with hoarding include:

• Assessing the situation
• Developing a plan
• Organising the space
• Providing support and resources

Assessing the situation

In order to make a clear plan, it is first necessary to assess how severe a hoarding situation is. During training, professionals who deal with hoarding are often taught to think of it on a scale from 1 to 10, with 1 being an acceptable home and 10 representing an extreme hazard. 

Next it is important to establish what kind of hoard you are dealing with, for example general, object, collection, animal etc. This will determine which other services need to be involved and how items will be disposed of, and will inform parts of your risk assessment.

It is important to conduct a risk assessment when dealing with a potentially hazardous workspace. A sample framework for the risk assessment may include:

• What immediate risks are present? (Are there vermin/pests or the presence of body waste? Are there any toxic or very hazardous items)
• Who may be harmed and how?
• How can the risks be controlled? (PPE, specialist equipment, outsourcing tasks to specially trained professionals etc)
• Recording and reviewing your findings

There may be other special circumstances that need to be taken into consideration, for example entry or access issues, the presence of children or animals in the home and the general safety of the area.

Developing a plan

Your risk assessment will help to inform your intervention plan in terms of keeping everyone safe and involving the correct agencies. The plan will need to be specific, well organised and shared with everyone involved. 

The plan will need to be clear and strategic. It will also need to be decided:

• What other services or third-party contractors will need to be involved?
• What services are already involved?
• How will organisations and services be contacted and who will pay for it?
• Does the hoarder have adequate emotional and physical support?
• Where will the hoarder live during and after the decluttering is done?
• Is it safe for the hoarder to return to their home once the job is complete and what ongoing support will they need?
• Who will provide ongoing support and follow-up services?

It is important to set realistic goals and expectations, including a time frame for the work to be done. This should be communicated to all services involved to ensure everyone is on the same page.

Practical support for dealing with hoarding may include the services of multiple organisations and businesses, depending on how severe the situation is, for example:

• Cleaning companies
• Pest control
• Skip hire companies
• Waste removal services

Organising the space

After a risk assessment has been conducted and a plan written up, the practical work will need to begin to tackle the hoard so the living space can become safe, organised and clean once again.

Organising the space will necessitate:

• Categorising and organising items in groups
• Removing items from the property for cleaning and temporary storage
• Throwing out rubbish
• Deciding what is to be kept and returned to the property (where possible, the hoarder should be involved in this process)

Cleaning and sanitising the space means:

• Cleaning the home thoroughly, room by room
• Working methodically, e.g. starting in one corner of a room and working your way around before moving on to the next
• Different types of cleaning techniques such as wiping down, dusting, vacuuming, de-cobwebbing, mopping etc
• Cleaning areas down with soap and water prior to disinfecting/sanitising
• Ventilating the space with fresh air by opening windows
• Safe use of appropriate chemicals and equipment

Heavily soiled soft furnishings, such as carpets, may need to be ripped up and removed completely.

Some cleaning companies offer specialised hoarding services and have trained professionals on hand who understand best practices for safe and respectful intervention.

Providing support and resources 

Many hoarders are resistant to assessment and intervention for their hoarding. They may be reluctant to recognise that they have an issue and unwilling to engage with treatment. As a result, without ongoing support, hoarders will often quickly lapse back into old habits. To combat this, hoarders should be given access to ongoing support, such as therapy or community resources. They may also require resources to deal with emotional, physical or practical issues they are facing, both during and after the intervention. This may include:

• Mental health support (including therapy and medication)
• Support from occupational therapists to help adapt the living space or provide mobility aids
• Support with daily tasks, such as housework

Legal and Ethical Considerations 

When dealing with hoarding the health, safety and wellbeing of everyone involved in the project should underpin any safe and respectful interventions. 

Legal, ethical and safety considerations include:

• Health and safety considerations (including fire safety)
• Use of PPE to protect from dust, dirt and other hazards
• COSHH regulations
• Child and animal safety
• Understanding legislation relating to privacy and data sharing
• Safe disposal of waste items (including using licensed carriers to avoid fly-tipping)
• Respecting the autonomy and dignity of the hoarder

In extreme cases, hoarding may be so bad that it is covered by legislation, for example:

• The hoarder lacks mental capacity to make decisions
• The hoarder is having a mental health crisis that requires them to be detained under the Mental Health Act
• The hoarding is so bad it qualifies as a public nuisance or poses a public health risk

Legislation relevant to cases of hoarding disorder may include some of the following:

• The Care Act
• Mental Capacity Act 2005
• Mental Health Act 1983
• Public Health Act 1936
• Prevention of Damage by Pests Act 1949
• Environmental Protection Act 1990
• Anti-Social Behaviour, Crime and Policing Act

Professionals dealing with hoarding intervention should understand when it may be necessary to serve notices under any of the above Acts. The serving of any notices should be done in addition to offering support and other intervention strategies. 

A Real-World Example

In the book Dirty Secret: A Daughter Comes Clean About Her Mother’s Compulsive Hoarding, New York City writer Jessie Scholl tells the true story of returning to Minneapolis to help her mother prepare for surgery and get her affairs in order after a cancer diagnosis. What complicates matters is that her mother’s home is drowning in a lifetime of collected items and as the writer tries to declutter and organise the space, she is forced to confront the truth behind her mother’s pathological behaviour. 

In the book, Scholl balances the practicalities of the quest – the removal of the “broken appliances, mouldy cowboy boots, twenty identical pairs of sneakers, abandoned arts and crafts, newspapers, magazines, a dresser drawer crammed with discarded eyeglasses, shovelfuls of junk mail” with the personal ramifications of a lifetime of compulsive hoarding. 

She reflects on her childhood and begins making connections with her mother’s hoarding and other classic signs of the disorder. She talks of her mother’s chronic disorganisation to the point she once forgot to collect Scholl from kindergarten as she was too busy thrift store shopping. Ultimately, she traces the downward spiral in her mother’s behaviour to the death of a long-term boyfriend.

Scholl’s story, although a personal one, is a tale that connects with so many others affected by hoarding: the underlying risk factors (chronic disorganisation, poor timekeeping etc) met with a traumatic event (death of her boyfriend) to create a perfect storm of compulsive hoarding, resulting in a strain on their mother/daughter relationship. She interweaves statistics about hoarding in the book, such as the number of Americans who hoard and some of their shared traits. 

Dirty Secret: A Daughter Comes Clean About Her Mother’s Compulsive Hoarding is a fascinating real-world example of the implications of hoarding and the damage it can do to relationships, told by someone who grew up with a hoarder and was then forced to relive their childhood experiences as they tried to help their mother in later life.

Resources and Support

Hoarding is a complex issue that extends far beyond the removal, organisation and cleaning up of the hoarded items. Hoarders will require the support of different services, depending on their individual needs, for example their age, mobility, financial circumstances and the root cause of their hoarding disorder. 

Support may be available from:

• Local authorities
• Adult social services
• Charities such as hoardinguk or Hoarding Disorders UK CIC

Resources and support for hoarders may include ongoing mental health support, such as:

• Therapy (e.g. cognitive behavioural therapy (CBT)
• Medication (such as antidepressants)

A number of books have been written by people who have a keen understanding of hoarding disorder, which may be of interest to anyone involved with hoarding:

• Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding
  By David F. Tolin, Randy O. Frost and Gail Steketee
• Overcoming Hoarding: A Self-Help Guide Using Cognitive Behavioural Techniques
  By Satwant Singh, Margaret Hooper, Colin Jones
• Stuff: Compulsive Hoarding and the Meaning of Things
  By Randy Frost and Gail Steketee

If you prefer listening to podcasts there are a few available that focus specifically on hoarding. Some are recorded from the perspective of the hoarder and others feature interviews with experts, therapists, academics, influencers, children of hoarders and professionals who work with individuals who suffer from hoarding disorder. 

Notable podcasts that discuss hoarding include:

• That Hoarder: Overcome Compulsive Hoarding
• The Hoarding Solution Podcast
• Hidden by Things
• Hoardganize

There is also an episode of the hit iHeartPodcasts show Stuff You Should Know that deep dives into the phenomenon of hoarding from a cultural and scientific perspective. 

Hoarding is sometimes associated with obsessive compulsive disorder (OCD), a condition that affects up to one million people in the UK. Information about the relationship between hoarding and OCD can be found on the OCD UK website.

Conclusion

Hoarding is a complex issue that has practical, emotional and psychological implications. Hoarders often struggle to confront their behaviour and refuse to engage with services that want to help them. To encourage engagement and collaboration, it is essential that strategies for safe and respectful intervention are practised by all of the support services and organisations involved.