Training Programmes for Professionals Dealing with Hoarding Situations

Hoarding is a complex issue that often intersects with other issues including mental and physical health problems. People supporting those who suffer from hoarding disorder require specialised training in order to support and help them effectively.

Hoarding is listed as a recognised mental health condition on the NHS website. It is thought to affect millions of people in the UK, with some estimates suggesting 2-5% of the population may be affected. Hoarders have a compulsion to keep items, collect large amounts of clutter and often store their items in their homes in a chaotic and haphazard way. This can lead to people living in extremely cluttered or even hazardous environments. 

Professionals dealing with hoarding situations may approach the situation from different angles; some professionals will be there to deal with the practical activities such as decluttering, organising and cleaning, whilst others may concentrate on the behavioural and psychological aspects of the disorder. 

Ultimately, for someone with hoarding disorder to receive effective intervention, they will require a mix of practical help and mental health support to ensure their living situation can be improved and that they are able to keep on top of things without falling back into poor habits and becoming overwhelmed once again.

Understanding Hoarding Disorder

There is a lot of misunderstanding and stigma attached to hoarding disorder. Hoarding is not the same as being untidy or unclean. Being a hoarder doesn’t mean that you hate housework or that you are a lazy person.

Hoarding is problematic because it can pose a hazard to people’s health from dust, bacteria and germs. When a significant amount of clutter builds up in a space, this can pose additional risks, including:

• Slips, trips and falls
• Items falling and hurting someone
• Fire risks

Hoarding is a leading cause of eviction for tenants according to the Chartered Institute for Housing (CIH), which can lead to housing instability and homelessness for vulnerable individuals, which in turn puts pressure on public services who may need to provide emergency accommodation. 

There is almost always a mental health cause for hoarding; however, studies also show that living in a cluttered environment also impacts our mental health negatively. Hoarding can therefore create a vicious cycle of poor mental health which leads to the hoarding of items which then, in turn, worsens mental health. 

Mental health conditions that are often associated with hoarding disorder include:

• Depression
• Anxiety
• Obsessive-compulsive disorder (OCD)

Hoarding can sometimes also be a sign of a degenerative condition such as dementia. 

Studies do not point towards a single root cause for hoarding, and it can start due to a single event, a number of factors or even due to a physical reason such as chronic pain or reduced mobility. Hoarding behaviours can also be triggered in response to trauma or grief. 

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 organisational skills

Hoarding disorder may be accompanied by signs of self-neglect, with the hoarder appearing dishevelled or unkempt. This can happen due to underlying mental health reasons or be due to the physical restrictions posed by their cluttered home (the bathtub being full of items, access to the washing machine being blocked or being unable to find clean clothes due to the volume of hoarded objects etc).

People with hoarding disorder hoard different types of items. Some people begin to obsessively collect items (for example collectable dolls), whereas others may struggle to throw anything away and may feel compelled to keep everything including rubbish, old packaging and, in extreme cases, their own waste. 

Hoarding can give hoarders a false sense of control:

• They feel that they cannot let items go because they have an emotional attachment to them
• The emotional attachment to their object seems irrational to outsiders but rational to the hoarder
• They have developed a fear that something bad will happen if they throw something away

Sometimes people will also hoard animals which they may struggle to house and care for appropriately.

NHS information suggests that 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

Data hoarding is a new phenomenon. It involves people storing and holding on to huge amounts of electronic data (such as emails) that they feel unable to delete. It can also refer to people acquiring stacks of electronic items that they hoard including old TVs and laptops, broken tablets etc.

People with a hoarding disorder do not always recognise that they have a problem. Signs of a hoarding disorder may include:

• People being reluctant to let go of items even when they are defunct, broken or useless
• Holding on to vast amounts of items that have little monetary value
• Becoming overly attached to items, refusing to loan them out or even let anyone touch them
• Problems with decision-making
• Struggles with general life such as paying bills, getting places on time and general organisation
• Problems finding things, organising them or categorising them
• Feeling overwhelmed by their home or household tasks

Hoarding can lead to loneliness and social isolation; hoarding often causes friction between hoarders and their friends or family who don’t understand the situation. Sometimes hoarders will feel embarrassed by the state of their home and will withdraw into themselves, not wanting anyone to see how they live. 

Hoarding may account for a significant number of ‘bed blocking’ cases where people are considered well enough to be discharged from NHS hospitals but are unable to return home due to unsafe conditions. 

Importance of Specialised Training

Knowledge Base

People who are assisting with hoarding situations need basic knowledge and insight into the causes and risk factors for hoarding disorder. This can help them to identify at-risk individuals, make informed decisions and create plans for effective interventions. 

Providing accurate information on the subject will also help to reduce the stigma attached to hoarding and help professionals to work more effectively alongside the hoarder, using compassion rather than judgement. 

The introductory part of any hoarding training should cover:

• What is hoarding?
• Potential causes and risk factors
• Types of things people may hoard
• Why is hoarding a problem?
• What does hoarding look like?

Once the individual grasps the foundations of hoarding, they can move on to learning about how best to assess, intervene and resolve the issue whilst keeping in mind ethical and legal considerations. 

To make effective interventions, an action plan should be drawn up to address hoarding. An example of this may look like:

• Identify the goals
• Assess the situation
• Identify the necessary strategies
• Set priorities
• Establish support

You may also want to make a plan for monitoring and review.

Effective Interventions

It is important that those working with people who have hoarding disorder take steps to foster trust and respect with the hoarder. This will make the process happen more smoothly and will encourage them to cooperate. 

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

• Empathetic
• Intuitive
• Emotionally intelligent

You will need to be able to assess cases on a case-by-case basis and decide how best to proceed. This will almost always involve a multi-disciplinary approach.

Some hoarders will have a better chance of recovery if they engage with the process and help with the clearing out of the house; others may be so overwhelmed and emotionally attached to the items they are hoarding that they will need to disengage from the process until the house is ready. This may require arranging alternative accommodation for them whilst the house is being tidied and cleaned. 

• As far as practicable, hoarders need to be involved in the decisions that affect them
• They should give consent as far as possible
• You should be open to working with the friends and family of the hoarder

It is important that anyone working with hoarders understands that dealing with the issue is complex and may require giving ongoing support. To deal with hoarding disorder, people need to be willing to confront their behaviour and recognise why it has happened, and be open to receiving mental health (such as counselling) and practical (clearing out and organising) support. 

Hoarders may need to be monitored for a period of time in case they start to struggle again in the future.

Legal and Ethical Considerations

When dealing with hoarding the health, safety and wellbeing of everyone involved in the project should be at the heart of any interventions. 

Legal and ethical considerations include:

• Health and safety considerations
• Use of PPE to protect from dust, dirt and other hazards
• COSSH
• Child and animal safety
• Issues around privacy and data sharing
• Safe disposal of waste items (including using licensed carriers to avoid fly-tipping)

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

• The hoarder lacks the mental capacity to make decisions
• The hoarder is having a mental health crisis that requires them to be detained
• The hoarding 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

Training on hoarding intervention should cover when it may be necessary to serve notices under any of the above Acts. 

Key Components of Training Programmes

Training programmes for professionals dealing with hoarding situations should begin with an overview of hoarding and then go into more detail about the different aspects of hoarding and how to best help someone with hoarding disorder. Effective training programmes will cover key components such as:

• Assessment techniques
• Intervention strategies
• Collaboration and referrals

Assessment Techniques

To teach professionals how best to assess hoarding situations they will need to look at different practical examples of hoarding disorder. This education may involve a mixture of: 

• Pictures
• Videos
• Written statements
• News items

It may help to encourage professionals to look at pictures of hoarding situations and rank them on a scale. This can provide some insight into how these situations escalate as well as at what point intervention is necessary. Professionals dealing with hoarding may be shocked by some of the sights they see; however, they will need to learn to tackle these situations head-on.

People undertaking training will also need to learn to make clear plans on how to tackle the situations they are going to face. At the core of hoarding is disorganisation on a grand scale, therefore taking a methodical and highly organised approach to dealing with the situation is key to dealing with these situations.
Professionals dealing with hoarding will need to be able to assess:

• How severe is the hoarding situation? Is it an extreme case? Where is it on the scale?
• What type of hoard is it (general, object, collection, animal etc)?
• What immediate risks are present? Are there vermin/pests or the presence of body waste? Are there any toxic or very hazardous items?
• How can the risks be controlled?
• Are there any special circumstances that need to be considered (entry/access issues, children or animals present in the home, safety of the general area)?
• If children or animals are present, what condition are they in?
• What other services or third-party contractors will need to be involved? What services are already involved?
• Does the hoarder have adequate emotional and physical support? How safe do they feel in the property?

People who work with hoarders need to make a commitment to collaborate with others in an ethical way that complies with privacy laws and puts the hoarder at the heart of decision-making as far as possible. 

Intervention Strategies

Hoarders often have a complex relationship with all of the items they have accumulated and may not be willing to engage with professionals or make any efforts to change their situation.

Hoarding interventions may include:

• Having the hoarder assessed by a GP or doctor
• Prescribing medication (such as antidepressants) or therapy (such as CBT) to help the hoarder better deal with their issues

Once a property visit has been carried out, it may be necessary for practical interventions to be carried out by trained professionals. This may necessitate:

• Categorising, organising and removing items
• Throwing out rubbish
• Cleaning the area thoroughly
• Deciding what is to be kept and returned to the property
• Deciding where the hoarder will live during and after the decluttering is done. Is it safe for them to return and what ongoing support will they need?

Hoarders may be very resistant to anyone entering or assessing their home. Any exchanges should be kept respectful, compassionate and professional. Hoarders should be encouraged to understand that some of the barriers to them enjoying their home will disappear once the hoarded items go, such as:

• Reduced feelings of stress and shame
• A cleaner and healthier environment to live in
• Guests will be able to visit the home once again
• Safer environment for everyone (including children and animals)
• Reduced tension with friends and family
• Reduced feelings of stress and overwhelm

Additional interventions may need to be made for people who are hoarding and are at risk of serious safeguarding issues, such as there being violence in the home, the hoarder being disabled, having addiction issues or being at risk of homelessness.

Collaboration and Referrals

Professionals who assist people dealing with hoarding disorder may also be required to collaborate with or work alongside other organisations or services to provide the full range of care that the hoarder needs to maintain their wellbeing. This includes:

• Mental health teams or GPs
• Social services
• Letting agents and property managers
• Environmental health inspectors
• Housing teams
• Local authorities
• Animal rescue teams
• Specialist cleaning services

Professionals who deal with hoarding may work in teams with different people, each bringing a different skill set. Some may be able to offer empathy and support to the hoarder, engage with them and work alongside them to make a plan to get their space cleared out and organised. Others will be able to address the root cause of the issue and suggest treatment options such as therapy or medication. 

Once professionals are in place to deal with the emotional and mental health side of hoarding and provide ongoing support, it is important to consider how to hire for other, more practical roles. A decision will also need to be made about who is going to pay for services that may be required, such as:

• Specialist cleaners
• General cleaners
• Furniture movers
• Upholstery cleaners
• Pest control
• Painters or decorators
• Skip hire
• Waste removal

If everyone dealing with hoarders is well trained and educated on the subject they will be better equipped to work with other professionals and/or make appropriate referrals. 

Effective solutions will only be reached using a multidisciplinary approach to hoarding – hiring a skip and a cleaning company may provide a short-term solution but it will not get to the root cause of the issue or help with long-term recovery or prevent relapse.

Case Studies and Practical Examples

1. Hoarding Panel

In 2022, Greater London Fire Brigade attended 1,036 hoarding-related fires which led to 186 injuries and 10 deaths. As a result, a database of ‘known hoarders’ has been created which logs their details so fire stations can make informed decisions and send extra firefighters if a fire is reported in relation to one of these properties. 

A ‘hoarding panel’ has been created in East London. Their monthly meeting brings together:

• Senior firefighters
• Mental health workers
• Landlords of social housing properties
• Housing officers
• Environmental health council officers

They meet to discuss interventions for specific cases and to strengthen their general collaborative skills, for example:

• Firefighters attending to install or check smoke alarms or provide flame retardant bedding
• Whether the landlord could instruct forcible cleaning or commence eviction proceedings
• What support or training programmes the hoarder could be referred for

The existence of such a panel suggests a shift in the way hoarding is seen – as a long-term problem with serious short-term risks (most notably fire risks) and complex, underlying mental health causes. 

2. Specialist Cleaning Services

Elsewhere in London, seeing a gap in the market that was in need of attention, former care worker Damian Simon started the cleaning company Blitz Clean. He had seen first-hand the relationship between NHS bed blocking and people not having clean, safe accommodation to return to. The cleaning company have specially trained staff to deal with hoarding situations. As specialists in ‘Hoarder cleaning and Blitz cleaning’ the company advertises:

• Experienced, trained, sensitive staff, who can help discern what items should remain and be disposed of
• Discreet service with unmarked tipper trucks
• Responsibly disposing of junk and cleaning the homes of people who hoard, live in excessive clutter and struggle to maintain a suitable environment

Specialist cleaning services like Blitz Clean offer a short-term solution to people struggling with hoarding. It is then necessary that other organisations step in to ensure that adequate interventions are offered to prevent such services from being required again for the same individual in the future.

3. Hoarding on Stage 

Laura Horton’s play Breathless sensitively depicts the personal struggles that hoarders face, as well as the complex relationships we can develop with inanimate objects. Obsessed with clothes and seeing each outfit she buys as a new version of her, the protagonist slowly begins to evolve from fashionista to hoarder. Her struggles are brought into sharp focus when she begins dating a minimalist and is forced to confront her addiction. 

Informed by her own personal experiences with hoarding, the writer wanted to create a piece of media that would open up difficult conversations about this complex mental illness. It is what also inspired her to start the Hidden by Things campaign where people were inspired to donate clothes with a label attached telling their story. The aim was to encourage people to let things go, knowing their stories are not lost and can live on with a new owner.

Training Resources and Organisations

There are a number of training courses available that provide valuable education and training to people wanting to learn more about hoarding disorder. You can sign up to our CPD-certified Hoarding Awareness course here.

Other courses to consider once you have completed our awareness course include:

• Courses run by HoardingUK including full day courses, half-day courses, individual courses, group courses and online courses
• Virtual Hoarding Awareness Training – Stage 1 by Hoarding Disorders UK CIC
• Trauma Informed Approaches to Hoarding Disorder online course provided by the Chartered Institute of Housing (CIH)

A number of books have been written by people who have a keen understanding of hoarding disorder, such as:

• 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

There are several podcasts available that discuss 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, a condition that affects up to a million people in the UK. Information about hoarding and OCD can be found on the OCD UK website.  

Conclusion

It is vital that all services involved in the support of people who are hoarding have had adequate training and education on the subject in order to create positive outcomes. 

Professionals who work with hoarders should understand how to collaborate with other organisations. Training should ensure that all service providers know how to act within a legal and regulatory framework regarding issues such as consent, information sharing and health and safety. 

Effective training programmes for professionals dealing with hoarding disorder will reduce stigma and increase empathy and understanding of the issue, which can help to inform more effective interventions and find long-term solutions to the problem.