MAY 2021 / WRITTEN BY NORBERT MAGOS
HOARDING:
A REPORT INTO BEST PRACTICE
Improving outcomes for people living
with a hoarding condition is a core
aim of our 2021 workplan.
We want to see more multi-agency
protocols to support people living
with hoarding tendencies.
We want to increase the number
of RRO policies with dedicated
resources to hoarding.
Contact Us:
info@foundations.uk.com
www.foundations.uk.com
About Us
Foundations is the
National Body for Home
Improvement Agencies
in England. This means
that we’re contracted
to oversee a national
network of nearly 200
Home Improvement
Agencies (HIAs) and
handyperson providers
across the country.
It’s a role we’ve held since 2000, and since
2015 we’ve also been supporting local
authorities to improve how they deliver
Disabled Facilities Grants (DFGs) - whether
they use a HIA or not. Our vision is a thriving
range of Home Improvement Agencies –
supporting people to live safe, independent
and happy lives in the home of their choice.
Foundations’ role on informing policy and
design is twofold. On the one hand we advise
and support government in delivering on part
of its commitments to vulnerable older and
disabled people in their own home. At the
same time, we help local authorities to adopt
housing assistance policies and commission
services sensitive to local priorities and
needs.
FOUNDATIONS
Introduction 3
Executive Summary 4
1. Hoarding as a Condition 5
2. Why is Hoarding an Issue? 6
2.1 The Personal and the System Point of View
3. Methodology 7
4. An Overview of Existing Responses 8
4.1 Housing Assistance Policies
4.2 Survey Results
5. Case Studies 13
5.1 CaseStudy1:Suolk
5.2 Case Study 2: West Sussex
5.3 Case Study 3: East Cheshire
5.4 Case Study 4: Middlesbrough
5.5 Case Study 5: Leeds
5.6 Case Study 6: Lewisham
6. Discussion 23
7. Conclusion: A Comprehensive Response 25
8. Further Information 27
9. Appendix 29
CONTENTS
2
Introduction
Hoarding is a condition which is often
misunderstood and it is therefore often not fully
recognised. As a result, many local services fail
to provide an adequate response to people with
hoarding tendencies.
The impact of hoarding can however be
signicant and risks which are associated with
the condition may include:
Delays in hospital discharge and associated
additional costs of ‘bed-blocking’.
Fire hazards.
Poor physical and mental health and
possible safeguarding issues.
Costs to local services (health, housing and
social care), particularly where inappropriate
responses are used with associated risks
of a reoccurrence of the condition and/or
exacerbation of an existing situation.
It is important therefore both to understand
hoarding and to develop appropriate and
eective responses to meet the needs of people
with hoarding tendencies.
Report Aims
This report sets out to explore why hoarding
should be an issue for local authorities, how
they could respond to the needs of hoarders
and what these services look like in practice.
The purpose of the project is to improve the
understanding of hoarding as an issue, to
identify what services are currently delivered
and to support the development of good
practise in the delivery of housing-focused
services for people with a hoarding tendency.
Various terms are used with regard to hoarding.
In this report the term used is people with a
hoarding tendency.
Hoarding is an increasingly costly
and complex issue for local authorities
to deliver service solutions for. There is
currently little research and best practice
case studies available as resources.
Foundations commissioned this report to
research underlying issues and provide
a blueprint for a cohesive and integrated
service response to support people with
a hoarding tendency.”
Paul Smith
Director, Foundations
INTRODUCTION
3
EXECUTIVE SUMMARY
Executive Summary and
Recommendations
As this research demonstrates, hoarding is
a complex issue resulting from an underlying
mental health condition but with potentially
widespread impacts. A multi-agency, multi-level
response is therefore required to provide an
eective response.
Keyelementsofaneectivehoarding
service include:
A specialised hoarding service with a
dedicated caseworker coordinating the
approach.
Funding for decluttering, preferably
delivered by a specialised hoarding
company.
Ongoing support to prevent relapses,
for example the provision of CBT, group
therapy or peer support.
Established referral networks and well-
maintained partnerships.
Close cooperation with enforcement
services, the NHS, Fire Services.
A local hoarding protocol setting out the
steps of intervention and eligibility for
services.
Although the provision of such services is not
without cost, the risks and costs both to local
services and the individuals concerned may be
signicantly higher. The development of multi-
agency working and eective protocols together
with the provision of dedicated resources
should be seen as the essential elements in the
development of an eective local response to
the needs of people with a hoarding tendency.
Acknowledgments
I would like to express my appreciation
to Dave Eldridge for his valuable and
constructive suggestions during the planning
and development of this research work. His
willingness to give his time so generously has
been very much appreciated.
I would also like to thank the sta who
participated in the interviews and especially
Olive Quinton, CEO of Lofty Heights CIC,
whose contributions helped to inform the
project.
4
5
1 HOARDING
1. Hoarding as a condition
The word ‘hoarding’ was not used to describe
human behaviour until the 1960s. Since then
its denition has been changing signicantly
as the science on the subject has developed.
According to Frost and Steketee a hoarder
is a person who collects but fails to discard
possessions that appear to have little or no
value, whose living space becomes unt for
purpose and who experiences ‘distress or
impairment’ in functioning as a result of the
clutter.
2
For a long time, hoarding was not recognised
as a disorder but as one of the diagnostic
criteria for Obsessive-Compulsive Personality
Disorder. This only changed in 2013 when the
2 Steketee, Gail, and Randy Frost. Stu: Compulsive hoarding and the meaning of things. Houghton Miin Har-
court, 2010.
3 https://www.nhs.uk/conditions/hoarding-disorder/
Diagnostic and Statistical Manual of Mental
Disorders (DSM) changed its denition resulting
in the recognition of hoarding as a specic
mental health condition. (DSM is the standard
classication of mental disorders used by
mental health professionals in the United States
and elsewhere.) It’s thought that around 1 or
2 people in every 100 have a problem with
hoarding that seriously aects their life.
3
The latest research shows that hoarding is
often but not always present with Obsessive
Compulsive Disorder (OCD) and that almost
everyone with a hoarding tendency (92%) has
at least one additional mental health condition.
This is important because hoarding is one of
the more easily recognisable mental health
conditions.
Identifying people with a hoarding tendency
can help not only to deal with issues directly
related to the hoarding but other existing
conditions that would otherwise remain hidden.
An eective tool that can help the diagnosis of
hoarding is the Clutter Image Rating Scale, an
objective scale which can be useful not only to
the professionals but to the clients as well. This
tool dierentiates between 9 levels of clutter,
and it is generally recognised that above level 4
professional help is recommended.
4
2.1 The Personal and the
System Point of View
Hoarding is a condition that if left unchecked
can escalate to a level that can have a
signicant impact both to the individual and the
surrounding community.
From the person’s point of view, it can be
detrimental to the health of the individual
because of some of the conditions which are
associated with hoarding: poor sanitation and
cleanliness, poor nutrition from the inability to
cook safely, inability to use rooms as intended,
continuation or exacerbation of mental health
conditions, isolation and loneliness, pests and
vermin, potential fall hazards, smells, mould
and noxious fumes. Hoarding can also present
a risk to the property by increasing re risk and
by making repairs and maintenance impossible
4 https://hoardingdisordersuk.org/research-and-resources/clutter-image-ratings/
because of diculties in safely accessing the
property or particular rooms within it.
From the system’s point of view, hoarding
can become antisocial and expensive to both
the local community and the local authority. A
hoarded property can increase the risk of crime
due the property appearing to be unattended,
and an accumulation of clutter, especially
organic material, may create a nuisance and
potential hazard for neighbours and may attract
pests and vermin. An accumulation of material
may additionally pose a danger to people who
might be entering the building, which could
include relatives/friends and other people who
might need to visit i.e. from the local council and
emergency services.
In terms of costs, a poorly managed hoarding
case can create extra costs for statutory
services in terms of sta time, enforcement
action (including court hearings), cleaning,
repairs and costs of other associated issues
such as homelessness or ill health. A particular
concern for the Health Service is delayed
discharges of patients who have a hoarding
tendency and whose homes may not be
suitable for a patient to be discharged to. This
can result in increased costs for health services
and may block access to hospital beds for other
patients.
2 WHY IS HOARDING AN ISSUE?
6
7
3 METHODOLOGY
3. Methodology
In order to identify best practise the project
used four sources of data. First, a survey was
sent out to local councils that Foundations
already had an established relationship with. In
this survey, respondents were asked a series
of questions on what services they provide for
people with a hoarding tendency. Respondents
were then asked to rate these responses in
accordance with their perceived eectiveness
on a scale from 1 to 5. This survey also
included some general questions about the
number of hoarding cases which were dealt
with each year and whether there were ecient
referral services across local agencies.
The second element was a semi-structured
interview that was conducted with some of
the survey respondents to follow up on their
answers and also with other leading experts
working in the eld of hoarding. These
interviews were recorded and transcribed
before the relevant information was extracted.
Finally, to provide additional data the project
looked at publicly available housing assistance
policies and at academic research.
As with most mental illnesses,
thereisno‘onesizetsall’
approach to hoarding. Some
instances require a practical,
hands-on approach – particularly
dicultiftheindividualhoards
animals and the property is a
classiedbio-hazard.Othersneed
time to be taken to talk things
through, before they will even
contemplate moving items.”
1
8
4 AN OVERVIEW OF EXISTING RESPONSES
4. An Overview of Existing
Responses
4.1 Housing Assistance
Policies
The screening of housing assistance policies
showed that relatively few councils have
specic policies for hoarding. Examples of
initiatives focused on people with a hoarding
tendency include:
West Sussex County Council has a ’deep
clean and clearing service’ for residents with
a disability in cases where the costs are not
expected to be over £2500;
Watford Borough Council has a similar
policy but dierentiates between dierent
levels of hoarding. Interventions take place
in cases where the hoarding is level three
or level two (as measured by the Clutter
Image Rating scale) when there are children
involved as well. Having such criteria can be
eective at directing the available resources
to those who need it the most.
South Gloucestershire Council’s policy notes
that housing sta will work with colleagues
from the Anti-Social Behaviour and
Community Safety Team on cross-cutting
cases where housing conditions and tenant
and/or landlord behaviour negatively impact
on the community.
North Lincolnshire Council has a loan
available for removing hazards in homes
in order to prevent avoidable emergency
admissions.
Guildford Borough Council has a grant
available to remove hoarded materials from
homes in situations where this is necessary
4 AN OVERVIEW OF EXISTING RESPONSES
9
to enable a hospital discharge.
Gravesham Borough Council has a more
general grant available for people with
hoarding tendencies that can be quickly
accessed through a handyperson service
after a referral from a health professional.
Whilst many councils do not mention hoarding
in their housing assistance policies that does
not necessarily mean that they do not have a
policy in place. Often these policies/guidelines
can be found in local self-neglect and hoarding
protocols instead. Having such a protocol is
essential for enabling an eective multi-agency
response to hoarding and helping frontline
sta.
It is estimated that between 2
and 5% of the population hoard.
This equates to at least 1.2
million households across the
UK.
It is estimated that only 5% of
hoarders come to the attention
of statutory agencies.
Hoarding cases can cost
anywhere from £1,000 to £60,000
to resolve.
2
10
4.2 Survey Results
The survey was sent out to a number of local councils that Foundations had an established
relationship with, primarily in London and the South East. The response rate was 16.2%.
Figure1Source:Foundations’surveywithstafrom12localcouncilsinLondonandthe
south east of England
4 AN OVERVIEW OF EXISTING RESPONSES
Figure2Source:Foundations’surveywithstafrom12localcouncilsinLondonandthe
south east of England
4 AN OVERVIEW OF EXISTING RESPONSES
11
Figure 1 shows that the most common service
for hoarders was repair and home maintenance
with 9 councils out of 12 oering it. This involves
arranging essential works such as the repair of
faulty heating or a leaking roof for people who
could not otherwise meet the necessary cost.
The eectiveness of this service was rated to be
2.7 which is on the lower end of the surveyed
services. Three services are oered in 8 out of
the 12 surveyed councils: Fire Safety Checks,
one-o deep clean of the property and provision
of specialist support. Of these, re safety
checks were rated to be the most eective with
an average score of 3.3. One-o deep cleaning
received a rating of 3.1, whereas specialist
support received 3.0.
These numbers indicate that there is not
one specic service that is overwhelmingly
considered to be more eective than others.
It is rather a package of interventions which
together can provide eective help for people
with a hoarding tendency. A similar conclusion
can be drawn from the interviews conducted
with experts and service providers.
The intervention that received the highest
eectiveness rating was “A dedicated service
to people with hoarding tendencies” with an
average score of 4.5. The reason for this high
rating can be found in the comment made by
Lewisham’s Hoarding Development Ocer
who noted that authorities often try to address
only one aspect of the hoarding behaviour, for
example the re risk, without responding to the
underlying issues, such as the psychological
issues associated with hoarding. Moreover,
such responses, if not combined and led by
a specialist team, may exacerbate the issues
leading to further occurrences and a higher
cost to the local authority and may also result in
the alienation of the client from the authorities
or trauma resulting from poorly managed
decluttering.
4 AN OVERVIEW OF EXISTING RESPONSES
Many people have heard of hoarding,
but this doesn’t mean that they
understand it. Misconceptions about
hoarding can sometimes come from
the media, including TV shows – which
often fail to show how varied people’s
experiences of hoarding can be or how
they might feel.”
3
© Mind. This information is
published in full at mind.org.uk
12
5 CASE STUDIES
5. Case Studies
The use of in-depth interviews with service
providers gave the opportunity to explore what
responses are most eective when dealing
with hoarding. Each interview used the same
structure of questions but there was always
space for the conversation to develop into other
directions where an additional question seemed
relevant. This section provides some examples
of hoarding services and considers some of the
practical issues which were identied during the
discussions.
5.1 CaseStudy1:Suolk
The interview was conducted with Olive
Quinton, CEO and founder of Lofty Heights
CIC, a social enterprise that originally began
as a loft emptying service and now provides
a hospital discharge service and a general
decluttering service.
Through their loft emptying service Lofty
Heights started to encounter excessively
cluttered and hoarded homes and saw the
negative impact that this had on the lives of
individuals and the demands hoarding placed
on local housing, social care, re services and
the NHS. This led to the development of the
Homeward Bound Hospital Discharge Service
which is designed to reduce delays in hospital
discharges and prevent readmissions. This
service is commissioned by two NHS Clinical
Commissioning Groups. Suolk County Council
itself has a self-neglect and hoarding policy and
has established a Multi-Agency Safeguarding
Hub (MASH) through which people can be
referred to the relevant services. This helps to
13
ensure that hoarding cases are picked up by
social services.
Lofty Heights receives referrals from a wide
range of organisations including social services,
housing providers, local and district councils
and the voluntary sector on a spot purchase
basis. GPs and local social prescribing
schemes also make referrals but usually there
is no funding to support these referrals so it is
dicult for help to be provided.
Lofty Heights believes multi-agency and
partnership working is key to achieving
long-term sustainable outcomes and works
closely with other partner agencies, regularly
signposting clients (with their consent) to other
services as appropriate.
The team at Lofty Heights have received
training from the local Fire Service and when
in properties test that smoke detectors are in
working order and if not replace them. They
also look for re safety risks, such as blocked
exists, overloaded sockets or wires chewed by
rats and report issues to the Fire Service for
follow-up by Fire Prevention Ocers. Similarly,
if the Fire Service nds someone who hoards
they will refer them to Lofty Heights.
Experience has shown that a one-o
decluttering exercise does not have a lasting
eect and in almost every case the problem will
recur. In order to avoid this, Lofty Heights aims
to provide longer term support to people who
hoard, to gain a better understanding of what
has led to the individuals hoarding behaviour
and to identify the support required in order help
break the cycle of hoarding.
A key aim of the service is to reduce risks of
homelessness and to remove the immediate
threat of enforcement action by Environmental
Health. Although Lofty Heights does not
currently have a dedicated mental health
worker, they have found that it is essential to
engage with the client in order to eectively
address their hoarding tendencies. Such an
approach can help to avoid any kind of trauma
arising from the decluttering since the client
is involved in the decision-making about what
stays and what goes. This person-centred
approach is the key to achieving sustainable
behavioural change. An important aspect of
the decluttering service is a close working
relationship with local charities and recycling
organisations. The client can be sure that
decluttered items will be used for a good
purpose, which is very important as this can be
a signicant step towards getting the client’s
consent and engagement in the process.
There may also be wider benets from
supporting people with hoarding tendencies.
For example, Lofty Heights has helped family
5 CASE STUDIES
14
5 CASE STUDIES
relationships to be re-established, enabling
grandchildren to safely visit their grandparent
once the home has been cleared. In other
cases, Lofty Heights has been able to prevent
an eviction by supporting their client at a court
hearing.
Lofty Heights aims to get involved at an early
stage to avoid enforcement or the threat of
enforcement action, as a result of which this
occurs in only about 10% of cases. A person-
centred approach is very important as clients
“are often quite ashamed and embarrassed to
let anybody in and they can be quite fearful and
defensive of authorities.”
If the client is not yet convinced that a lifestyle
change is required then the team explains in
an honest, reliable and trustworthy manner
what might happen if they do not change their
behaviour. Decluttering may be carried out in
a single day if the job is straightforward, but in
some cases, it may take place over many days
or be spread over weeks so the client does not
get overwhelmed.
Lofty Heights’ teams are made up of two people
because whilst the client may be comfortable
with two people they may become suspicious if
there are more team members involved since
it becomes more dicult for them to keep track
of what everyone is doing in the home. Lofty
Heights may also occasionally arrange one
to one work with clients who present as being
extremely anxious.
15
5.2 Case Study 2: West
Sussex
The interview was conducted with West Sussex
County Adaptations Manager. In West Sussex,
there is a deep clean and clearing service
available for people with disabilities who cannot
remain or return home due to the condition of
their properties, which includes those who have
hoarding tendencies. The service is funded by
all 7 of the districts and boroughs from a top-
slice of their Disabled Facilities Grants money,
with the service commissioned by the county
council via a cleaning company.
As in Suolk the original idea behind the
provision of such a service was that the NHS
could not send people home if their home
was in a very poor state of cleanliness and/
or hoarded. With an NHS bedspace costing
approximately £400 a day the deep cleaning
and property clearing service is seen as a
cost-eective way to enable patients to be
promptly and safely discharged from hospital.
The service is widely available to people with
disabilities and a wide range of professionals
can make a referral. Referrals are passed to
one central point where the Contract Delivery
Manager, assisted by the County Adaptations
Manager, will assess if the person is eligible.
Eligibility is dependent on certain conditions
including whether the person has a disability
or if they had used the service in a previous
year. The County Adaptations Manager noted
that although the service could be advertised
more widely this has not been done as further
funding is not guaranteed beyond the pilot
project period. The project has demonstrated
that waste disposal is expensive, especially
if it is contaminated with human or pest
waste, requires skips and skip licences or is a
controlled waste and it is therefore desirable to
deal with problems as early as possible.
On one occasion the service has managed to
prevent the eviction of a household with two
children, avoiding the need for rehousing and
the additional costs of this. However, there is
limited ongoing support for clients who have
underlying mental health problems and as
a result the service is regularly dealing with
situations where the same problems have
recurred within the space of a few months.
The service is being undertaken as a two-year
pilot project which started in February 2019.
The initial budget of £300,000 (which also funds
the minor adaptations and repairs service) was
fully committed as the demands on the service
grew. A further £300,000 was provided from
the 7 districts and boroughs of West Sussex
to allow the scheme to continue until the end
of the pilot project. The service is focused on
disabled people and people with mental ill-
health issues.
5 CASE STUDIES
16
[Hoarding is a]
multifaceted condition
[that] needs a multifaceted
approach. It requires that
multi-agency work be
meaningful, not just another
buzzword…. The common
goal [of multi-agency work]
is to provide a coordinated
and managed response
to support hoarding
behaviours”
4
Mental Health Today Dec
2019
5.3 Case Study 3: East
Cheshire
The interview was conducted with the manager
of Housing Standards and Adaptations within
which the local Home Improvement Agency is
located.
The service for people with a hoarding
tendency was developed because there were
an increasing number of cases where the HIA
was not able to carry out home adaptations
due to clutter which prevented the work being
carried out. The service aims to initially focus on
short-term solutions including, for example, the
installation of smoke detectors as a short-term
preventative action. In some cases, the service
engages with clients to help them identify ways
to reduce their hoarding tendencies with weekly
visits from a caseworker to provide motivation
to the client.
The service provided depends on the
circumstances of the individual and their level
of hoarding. Convincing the client to give items
away to charity or recycling rather than simply
disposing of them has proved to be an eective
approach for clients who have strong emotional
links to the items being hoarded. A referral form
has been developed for all referring agencies,
with organisations working together to try to
stop evictions occurring as a result of a client’s
hoarding tendencies.
Experience has shown that de-cluttering alone
does not work in the long-term, even if there is
accompanying emotional support and the client
has consented. Accordingly, where there may
be an underlying trauma, such as bereavement,
clients are referred to mental health services.
Support can be provided by a mental health
reablement service that oers six-week
treatment of Cognitive Behaviour Therapy and
which can also oer group therapy. In cases
where the need for psychological treatment
may not be required the service has found
it important to keep in touch with clients by
5 CASE STUDIES
17
providing informal emotional support such as
popping in for a cup of tea.
The approach in East Cheshire is modelled on
the service provided by Clouds End, a social
enterprise that specialises in providing support
groups and individual support for people with
hoarding tendencies. Experience has shown
that people may develop a hoarding tendency
for many dierent reasons not necessarily
linked to OCD or trauma. For example, in one
case a client had over a lengthy period of time
‘unlearned’ the ability to dispose of rubbish.
To support her to ‘relearn’ how to dispose of
rubbish the case worker put a list on the fridge
that explained to her what to do with food
packages. The caseworker had to initially go
through the process with her and then simply
needed to remind her to do the job on her own.
As this case shows, it is particularly important
to identify the underlying reasons for hoarding
behaviour before coming up with any kind of
solution.
Over the years the service has also learned
to develop realistic outcomes for people who
collect objects obsessively. The service focuses
on managing such tendencies since it is often
impossible to stop such behaviour completely.
Another learning point which has emerged
is the importance of working collaboratively
with Environmental Health Ocers and
Planning Enforcement teams. This is essential
because their involvement can sometimes be
traumatising their clients, and this may undo the
work put in by the specialist service. As a result,
Environmental Health only become involved
if properties are verminous and not in general
cases. In cases of animal hoarding, the team
work with the RSPCA. The service has also
developed a Self-Neglect and Hoarding policy
that front line workers use as a toolkit.
The council has a very limited capacity to nd
those in need of help, and usually the only way
to identify people with a hoarding tendency is
when a visit is made to the person’s house.
For example, the Fire Brigade has an eective
programme in Cheshire of making home visits.
This way hoarded homes are often revealed,
although visits are only focused on people
whose homes may be at the greatest risk of re.
5.4 Case Study 4:
Middlesbrough
The interview was conducted with the Staying
Put Agency’s Business Development Ocer.
The service for people with a hoarding tendency
is delivered by Mental Health Matters who
work in partnership with the HIA. The service
provides a one to one, person-centred support
service with two members of sta who have
5 CASE STUDIES
18
5 CASE STUDIES
19
experience in supporting those with poor
mental health using CBT techniques and have
experience and training around supporting
individuals with a hoarding disorder. The service
can include coaching, professional decluttering
or home organisational skills depending on the
individual needs of the client. Since clients are
not usually very keen on change, a step by step
approach is recognised as the best approach to
take.
The service has found that supporting hoarders
is complex and often linked to long-term mental
health issues. Experience shows that whilst
great changes can be made to the person’s
home, wellbeing and lifestyle, it is very dicult
to eliminate the person’s need to hoard. Many
people continue to live with a hoarding disorder
but can be supported to manage the condition.
In order to achieve this the service oers
an approach which helps the individual to
recognise the problem, slowly declutter the
home and helps them to reconnect with family,
friends and the local community. Finding an
alternative to hoarding can often prevent
a relapse back into old ways. Clients are
encouraged to get involved in a peer support
group because people who have a hoarding
tendency often nd it helpful to be around other
people similar to them and the peer support
group can help to prevent people reverting
to their hoarding tendencies. The service
also supports clients to participate in other
community-based activities such as work or
leisure activities through working in partnership
with other services, with around 80% of the
clients happy to take part. The peer support
group provides a form of group therapy but the
term hoarding is avoided, instead describing it
as a social get- together to enable friendships to
form and to create social opportunities.
The service has found that the Clutter Image
Ratings Tool is very useful to help people face
5 CASE STUDIES
The British Red Cross Assisted
Hospital Discharge Service estimate
that up to 30% of service users
live in cluttered or unclean home
environments, display hoarding
behaviours, or are at risk of self-
neglect. This can be triggered by, or is
exacerbated by stressful life events,
such as bereavement, illness, mental
health issues and/or dementia.
British Red Cross
20
the reality of being a hoarder and they also use
it to identify people that need to be referred
to this service. People’s perception of what
it means to have a cluttered home can vary
greatly. Middlesbrough use the Clutter Image
Rating tool to make sure they get an accurate
sense of a clutter problem. In general, the
service supports individuals whose clutter has
reached a level 4 or higher, as it is at this point
the clutter is starting to have a serious impact
on the individual’s life. This also enables the
service to ensure that they are focused on
those who are most in need.
The HIA is part of Adult Social Care services
which has helped to establish the necessary
partnerships with other relevant agencies.
Learning from the service includes the need
for a destigmatising campaign to help others
understand the seriousness of the condition,
as well as making the service more widely
known to people, as currently the number of
cases known to them is a very small portion of
potential numbers. Middlesbrough’s approach
is based on the concept of Making Every
Contact Count (MECC) which means ensuring
all agencies are aware of the needs of people
with hoarding tendencies, working alongside
appropriate local services and programmes,
with a multi-disciplinary work plan looking
holistically at each individual case and focusing
on the lifestyle issues that, when addressed,
can make great dierences to an individual’s
health and wellbeing.
5.5 Case Study 5: Leeds
The interview was conducted with caseworkers
from Care & Repair Leeds, an independent
home improvement agency.
In some cases, they had found it dicult to
deliver home improvements because of the
level of hoarding, which was blocking access
to rooms, which has led to the development of
a multi-agency approach. In one case which
concerned a family with three children the city
council provided funding to help to declutter the
home because the caseworker was concerned
about state of hygiene in the house. The
agency worked with the cleaners to enable the
necessary work to the house to be completed.
They have also put the family in touch with a
local neighbourhood network team.
On another occasion, another neighbourhood
network team put together a team of volunteers
and social workers to help another person with
a hoarding tendency. As a result, the home is
now warm and tidy and the householder is able
to safely pursue his interest in writing. In some
cases, a relatively small intervention can help.
In one case a client was keeping old clothes
that had accumulated in her home and she also
had a lot of rubbish in the property because
she did not have a bin. The agency bought her
a bin and some bags to put the clothes in for
transportation to a charity shop explaining that
they could make good use of them. Once she
was convinced that they would go to a good
place she agreed to the process and lled nine
bags.
5.6 Case Study 6: Lewisham
The interview was conducted with Lewisham’s
Hoarding Development Ocer.
Lewisham has a CCG funded project that
started in 2019. Initially the project contracted
with a clearance company to deal with hoarding
but subsequently found it was better to work
with a specialist company and they now work
with Clouds End. After an initial conversation
with the client an assessment is made
regarding how long the work is going to take
place, which could take up to ten sessions.
They also use self-help resources, for example,
the clutter image ratings which helps the person
understand if they have a hoarding tendency.
Sometimes Clouds End will also arrange small
repairs as part of their work with the client.
Although adult social care services had a
special cleaning unit, they were unable to
do large jobs which Clouds End is able to
5 CASE STUDIES
21
5 CASE STUDIES
undertake. Lewisham also tries to ensure that
an ongoing maintenance support program
is provided for people who hoard. Once the
property has been decluttered, domestic
support may be commissioned as part of a care
package. In addition, Clouds End can provide
ongoing support to help to keep the house tidy.
The project only uses enforcement action as a
last resort when everything else has been tried
and the client is not engaging with the service.
Eligibility for this service is assessed by the
Hoarding Development Ocer, who carries
out a risk assessment based on the service’s
eligibility criteria. Older people who are socially
isolated are referred to AgeUK who can
provide either access to community activities
or a befriending service. This can especially
help people who are purchasing objects
because they are in need of human contact.
Approximately 70 cases were dealt with during
the rst year.
It is intended to develop the project further, for
example, working with Mental Health Services
to provide a specialised service to hoarders, but
so far this has not been possible because of a
lack of resources. The Hoarding Development
Ocer is also working to make the hoarding
and self-neglect framework of the council more
user friendly so it can serve as an easy guide
for all service providers.
The three main learning points from Lewisham’s
service are:
Having a framework for people to refer to.
Contracting a professional decluttering
company instead of a standard clearance
company.
Having an aftercare service, for example,
a hoarding support group or input from the
mental health service to prevent relapsing.
Hoarding is one of the
leading causes of eviction
in social housing (Brown,
F. & Pain, A. 2014).
It frequently prevents
hospitals from making
safe discharges and the
emotional and physical
impacts on the individual
and their families are
extensive. In addition to re
risks and pest infestation,
suerers can become
increasingly isolated and
at signicantly higher risk
of developing co-morbid
mental illnesses (Frost,
RO. & Steketee G, Tolin
DF. 2011).”
Mental Health Today
22
6 DISCUSSION
23
6. Discussion
The previous section has shown that hoarding
is addressed very dierently in dierent areas.
In some areas, it is the council providing a
service, in some, it is the NHS or the HIA,
in some it is a social enterprise. All these
organisations use dierent interventions
depending on the level of resources available
and the scope of their expertise.
The biggest problems arise if the provided
service is not a comprehensive solution but
rather a response to a specic symptom. If a
service provider has a decluttering service,
for example, but does not address the
psychological needs of the client then the
hoarding will almost certainly recur. If there is
an enforcement issue which is addressed too
early, then that may unnecessarily traumatise
the client. If there are no enforcement tools
available to the council then it may prove to
be increasingly dicult to convince people to
accept help with their condition. If there is a
social enterprise willing to work with the patient
on a long term basis but there is no funding
for decluttering the client will not receive the
required help.
Even if a comprehensive service is oered there
can be other obstacles to success. Where there
is no suitable hoarding protocol and eective
referral routes for additional support the person
needing help may only receive some or none
of those available services. Most councils have
diculties in identifying people with a hoarding
tendency who may need support, which is
often due to the lack of personal contact with
residents. Initiatives such as Make every
Contact Count are invaluable in responding
to the needs of all people who hoard and in
identifying people who might not otherwise be
known to the council.
There can many other pitfalls too. It is important
that these schemes are nancially viable and
it is therefore crucial to get eligibility criteria
right and make sure that cases are assessed
on an individual basis to avoid the provision
of unnecessary services. As the interviews
highlighted, every hoarding case is dierent:
some can be solved by a sticker on a fridge
while others will require ongoing support from
specialist sta.
6 DISCUSSION
24
7 CONCLUSION
25
7. Conclusion: A
Comprehensive Response
In order to avoid the problems outlined above
and to reduce the risk of adverse social
outcomes aecting both the individual and the
system, a comprehensive response at the local
level is required.
An eective service for people with a hoarding
tendency requires:
A specialised hoarding service with a
dedicated caseworker coordinating the
approach.
Funding for decluttering, preferably
delivered by a specialised hoarding
company.
Ongoing support to prevent relapses,
for example the provision of CBT, group
therapy or peer support.
Established referral networks and well-
maintained partnerships
Close cooperation with enforcement
services, the NHS, Fire Services.
A local hoarding protocol setting out the
steps of intervention and eligibility for
services.
Other elements which are also desirable
include:
Social inclusion activities at a community
centre.
A range of interventions including
the ‘Shoebox method’ (a less radical
intervention of decluttering bit by bit).
Self-help resources (such as Fire Safety
tips, books, videos, contact details of
specialist organisations).
Access to repairs, home maintenance and
a regular cleaning servicem to help manage
the situation and prevent it from getting
worse.
Advice and support when at the risk of
eviction.
Fire safety check and the installation of
smoke detectors.
Financial advice.
Strategies that may help with individual cases:
Explaining to the client the possible
implications of not changing their behaviour.
Oering to donate valued objects to charity
or recycling.
A recognition that people are often more
willing to accept help from the third sector
than from statutory services.
Decluttering with small teams (2-3 people)
so the client can feel in charge.
Decluttering over multiple days so the client
does not feel overwhelmed.
7 CONCLUSION
26
27
8. Further Information
Useful sources of information
Foundations - Hoarding Behaviour and
Cluttered Homes
National Housing Federation - Hoarding: Key
considerations and examples of best practice
NHS Choices - Hoarding Disorder
People, Place & Policy Online: Issue 1:
Treasures, trash and tenure: hoarding and
housing risk
Royal College of Psychiatrists - Hoarding
Suolk - Self-Neglect and Hoarding Protocol
Multi-Agency Hoarding Framework: Guidance
for Practitioners in Nottingham City and
Nottinghamshire
London Borough of Merton - Multi-Agency
Hoarding Protocol
Specialist Companies
providing support for people
with a hoarding tendency
Clouds End
Enabling Spaces
Hoarding Disorders UK
Hoarding UK
Lofty Heights
8 FURTHER INFORMATION
28
8 FURTHER INFORMATION
Discretionary Housing
Assistance Policies
The following local authorities have included
support for people with a hoarding tendency in
their discretionary housing assistance policy.
This list is not exhaustive. Foundations has
details of 293 discretionary housing assistance
policies some of which may also include similar
elements.
West Sussex County Council (Adur-worthing.
gov.uk; arun.gov.uk; chichester.gov.uk; crawley.
gov.uk; horsham.gov.uk; mid-sussex.gov.uk)
Watford Borough Council
South Gloucestershire Council
North Lincolnshire Council
Guildford Borough Council
Gravesham Borough Council
9 APPENDIX
29
9. Appendix
9.1 Interview Questions
The structure of the interviews was the
following:
1. Why should hoarding be an issue to
adaptation services?
2. Please describe the services you provide
for people with hoarding tendencies.
3. How do you identify people with hoarding
tendencies who might need help and support?
4. Are there eective referral opportunities
across organisations?
5. How should adaptation services respond
to the needs of hoarders? In your experience
what other agencies can also assist hoarders
e.g. Fire and Rescue, NHS? Where more than
one agency is involved how is support best
coordinated/delivered?
6. Can you identify any factors which can
help the development of eective services for
hoarders?
7. Can you identify any factors that might
limit the development of services for hoarders?
8. Is the respondent aware of existing good
practice at other local councils?
9. Is the respondent aware of any stories
of success where an intervention had lasting
results?
10. What other resources would you advise
to be considered for the report?
9 APPENDIX
30
9.2 Case Study: Peabody
Peabody delivers Home improvement Agency services in Kent and East Sussex. The
organisation also provides Home Straight, a service for people with a hoarding tendency funded
by four councils in Kent. This meets the cost of employing a dedicated worker in each area
(either full-time or part-time) and demand for the service is growing. The case study below
illustrates the work of the service.
Client circumstances:
Property hoarded and a re risk.
Property needs to be decluttered for customer and other residents safety.
Customer has health issues such as diabetes he also has disabilities (curvature of the spine).
Summary of service delivered:
Built trust with customer to encourage to declutter.
Arranged a declutter with our handyperson service including skip hire.
Provided safe pathways.
Supported customer during the declutter and worked with him to encourage to throw things
away or give to charity.
Encouraged to sort through paperwork.
Outcomes:
Property now decluttered.
Customer continues to sort paperwork.
Continuing to support and encourage to further get rid of things that customer does not need/
use.
9 APPENDIX
31
9.3 Images
With special thanks to Peabody and Clouds
End CIC.
Cover: Credit to photographer Waranont
(Joe)
Inlay: Credit to photographer Jay Mullings
p.5: Credit to photographer Volkan Olmez
p.7: Credit to photographer Kate Buckson,
La Grange Park Public Library
p.8: Credit to photographer coofdy “Fill to
top only” licensed under CC BY-NC-SA 2.0
p.9: Credit to photographer Sharon
McCutcheon
p.12: Credit to photographer Don Harkins
licenced under CC 2.0
p.13: Credit to photographer Dimitri
Houttema
p.15: Credit to photographer Mark Epstein
licensed under CC BY-ND 4.0
https://creativecommons.org/licenses/by-
nd/4.0/
p.23: Credit to photographer Rick Mason
p.25: Credit to photographer Hanson Lu
p.19; p.27: Credit to Clouds End CIC
p.29: Credit to photographer Belinda
Fewings
p.20; p.30: Credit to Peabody
Back: Credit to photographer Lukas Skoe
Endnotes
1 Mental Health Today, Aug 2018
2 Nottingham City and Nottinghamshire
Multi-Agency Hoarding Framework https://www.
nottinghamshire.gov.uk/media/132451/notting-
hamnottinghamshirehoardingframework.pdf
3 © Mind. This information is published in
full at mind.org.uk https://www.mind.org.uk/in-
formation-support/types-of-mental-health-prob-
lems/hoarding/about-hoarding/
4 Mental Health Today, Dec 2019
Trading as Foundations
Collective Enterprises Limited
Company no:02131825
Astral PS Limited
Company no:07818356
22 Norfolk Street
Glossop
Derbyshire, SK13 8BS
0300 124 0315
info@foundations.uk.com
info@lt.org.uk ©Foundations, May 2021