Working with people who hoard: Frontline Briefing (2017)

Introduction

Hoarding has become increasingly acknowledged as a widespread challenge for practitioners in social care and allied sectors. Its consequences can include:

• severe emotional distress and/or relationship breakdown
• significantly restricted social and home living activities
• poor sanitation, with resulting health risks
• increased danger of fires
• the possibility of eviction.

While no comprehensive costs estimates are currently available, it is clear that the impact of these consequences on individuals, families and society is significant (Tolin et al, 2008). At the same time, people may hoard for many reasons, which sometimes include seeing it as useful, pleasurable or a way of coping. Therefore, they may or may not wish to make changes. Practitioners must find a balance between respecting the person’s choices and addressing the risks with them.

Work with hoarding has been affected by important changes to both policy and diagnostic guidance:

• Firstly, statutory guidance issued in support of the Care Act 2014 specifically refers to hoarding as one of the behaviours that can constitute self-neglect (Department of Health, 2016). Self-neglect, in turn, is listed as a form of abuse or neglect that may raise safeguarding concerns. Hoarding may therefore be referred to safeguarding where appropriate; otherwise it may be addressed through adult social care.
• Secondly, ‘hoarding disorder’ has been identified as a new psychiatric diagnosis in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, or DSM-5 (American Psychiatric Association, 2013), boosting its recognition as a mental health issue.

Both developments have implications for practitioners’ responsibilities. Hoarding challenges those involved to address risk while working with the person’s strengths, wishes, feelings and beliefs. Such an approach is in line with Care Act principles of wellbeing and Making Safeguarding Personal.

This briefing looks at:

• what hoarding is, and why people hoard
• assessment, intervention and risk- management in hoarding
• legislation and guidance relevant to hoarding
• coordinating multi-agency working in hoarding.