Social care practitioners have a role to play in supporting people who hoard, but where does that role begin and end, and what approaches and interventions are effective? Building on our Working with people who self-neglect: Practice tool, this hour-long webinar will explore the evidence around what works for people who hoard, considering the role of safeguarding adults, mental capacity assessments, multi-agency colleagues, the law and the person-centred, outcomes-focused framework that the Care Act 2014 provides. Aimed at: Frontline practitioners and managers.

1. 1
Working with people who hoard:
research messages webinar
Presenter Dr David Orr
Date 24th January 2017

2. Webinar objectives
› To outline the key challenges in addressing hoarding
› To explore the research evidence on engagement,
assessment and intervention with people who hoard
› To identify the policy and legal context for social
care with people who hoard
› To identify the roles of agencies and
practitioners who might become
involved with people who hoard
› To consider your own practice and
what you will start, keep or stop doing
when working with people who hoard
2

3. Questions: assessment in hoarding
3
› What is the difference between
collecting and hoarding? And between
cluttering and hoarding?
› Who decides in an individual
situation?
Shadwwulf at English Wikipedia, licensed
under a Creative Commons Atribution 3.0

4. Recent developments
› Hoarding disorder: included within
the 5th Edition of DSM
› Included in forms of abuse and
neglect in Care and Support
Statutory Guidance: “Self-neglect
covers a wide range of behaviour ...
and includes hoarding”
4

5. Collecting and Hoarding
Collecting Hoarding
Limited impact on life in general Interference with daily life (work,
home management, leisure, family
relationships)
Organised storage Clutter that impedes use of rooms
Less likely to have a mental health
diagnosis
More likely to have a mental
diagnosis
Selection: boundaries on what is
collected and each item chosen for
its unique properties
Less selective: may accumulate
multiple identical items; less
boundaried types
5

6. Safeguarding and Hoarding
› Section 9: Local
Authority duty to
assess care and
support needs where
it appears an
individual may have
needs for care and
support
› Section 42: Local
Authority duty to make
enquiries where (a) an
adult has care and
support needs, (b) is
experiencing or at risk
of abuse or neglect and
(c) as a result of their
care and support needs
is unable to protect
themselves
6
C
A
R
E
A
C
T

7. Empowerment
Support to make own
decisions
Prevention
Taking action before
harm occurs
Proportionality
Least restrictive
matched to risk
Protection
From abuse and
neglect
Partnership
Working together
Accountability
Clarity of role and
purpose
Safeguarding Principles

8. Hoarding and its dilemmas: finding
the right balance
8
Prioritising self-
determination:
‘hoarding as
lifestyle choice’?
Duty of care to
protect from harm:
‘hoarding as risk’?

9. Questions: finding the balance
9
In your experience:
› What problems arise when hoarding
is seen as a ‘lifestyle choice’ and
practitioners do not inquire further?
› What problems arise when hoarding
is seen as a source of risk that
automatically requires immediate
intervention?

10. Why do people hoard?
A cognitive-behavioural model
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› INFORMATION
› - memory
› - categorising
› - attention
EMOTIONS
- reaction to
loss
- positive
emotions
from new
possessions
BELIEFS
- anticipated
loss
- risks
- loss of
control

11. What reasons do people give for
hoarding?
› Sense of achievement and worth bound up in
possessions
› Early life experiences
› Environmental principles about waste
› Concern with needing things in future
› Not enough space
› Having different standards to others
› Things stand for or facilitate relationships
› ...
11

12. Example
› What are your thoughts on viewing this
video?
› How might you try to engage with this
person in your practitioner role?
https://vimeo.com/603058
(either 10:17 – 14:36 or 14:45 – 20:30)
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13. What people who hoard say about
getting engagement …
“It does not work
forcing things on
people. It made me
worse.”
“The social worker
said, ‘I can’t see
your toilet,your
bed’. […] That’s
further down the
line. But he was
doing things by the
book, which was
quite unnecessary
- had I been a
different person, I
would be in terror.”
“… they weren’t
helping, they were
just leaving it for me
to do.”
“people like me,
we’re not proud of
the state and he
came in and said,
‘you’ve got a lot of
stuff’ and of course
there was a lot of,
the stress levels
were very high.”
“She’s putting a lot
of pressure on me,
she knows I’ve got a
mental illness and
the root cause of
hoardism is anxiety
and … she just
makes mine worse.”

14. Questions: getting engagement
14
› What words and actions might I use
to build trust and find out about
people’s reasons for hoarding?
› What sorts of strengths might I be
able to acknowledge and work with?
› How do I address questions of risk
with the person?

15. Clutter Image Rating Scale
› Images from
International OCD
Foundation, at
http://hoardingdisor
dersuk.org/wp-
content/uploads/201
4/01/clutter-image-
ratings.pdf
15

16. Helpful approaches to intervention
› Relationship-based working
› Harm reduction
› Cognitive-behavioural therapy for
hoarding
› Motivational interviewing
techniques
› Signposting to support groups and
self-help resources
› Keeping the door open
16

17. Which agencies have you worked
with in cases of hoarding?
1. Local authority adult social care
services
2. Health: primary care
3. Health: secondary care (incl.
mental health)
4. Fire services
5. Police
6. Specialist clearance/cleaning
firms
17
7. Animal welfare
8. Voluntary sector
organisations
9. Professional de-
clutterers
10. Environmental health
11. Housing associations /
landlords
12. Safeguarding networks
What worked well? What challenges
were there?

18. Examples
› Hammersmith & Fulham identified
challenges of coordinating a personalised
response between multiple agencies
› Management support and direction to give
SWers time for effective work
› Cases of hoarding to be referred to ACSW:
− Clutter Scale 4-6: joint visit from SW + Fire
Service, EH and/or Housing Officer
− Clutter Scale 7-9: urgent multi-agency case
conference to develop action plan
› Local hoarding panel to advise on
challenging cases
18

19. Mental Capacity
› What common mistakes in capacity assessments in
hoarding have you come across, or do you know
about?
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20. Hoarding and Mental Capacity
20
Does the individual have an
impairment of, or disturbance in the
functioning of, the mind or brain
as a result of which they are unable
to make the specific decision at the
specific time, i.e. are unable to
understand, retain, or use and
weigh relevant information or to
communicate a decision (s.3)?

21. Housing
Housing Acts
1985, 1988
(amended
1996)
Building Act
1984
Housing Act
2004
Environmental
health
Public Health Acts
1936, 1961, 1984;
Prevention of Damage
by Pests Act 1949
Environmental
Protection Act
1990
Public Health
Act 1984,
amended by
HSCA 2008
Mental Health
Act 1983
- s. 2, s.3
admission
- s. 7
guardianship
PACE 1984
police powers of
entry
Animal Welfare
Act 2006
Other Relevant Legislation

22. Summary
› Effective work with hoarding requires:
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causes of hoarding, recognising
risk, interventions, legal options
and their limits
Knowledge
balancing autonomy with care,
working with the person, respectful
curiosity
Values
building a relationship, identifying
person’s goals, mediating,
coordinating multi-agency response
Practice
skills

23. Planning ahead
In my practice with hoarding, I will:
› Start
doing:
23
› Stop
doing:
› Keep
doing:

24. 24
Working with people
who hoard Frontline
Briefing:
available on the
RiPfA website now.

25. Further reading
› Orr D, Braye S & Preston-Shoot M
(2017) Research Briefing: Hoarding.
Dartington: RiPfA
› Holmes, S. (2015) A psychological
perspective on hoarding: DCP good
practice guidelines. Leicester: BPS.
http://www.bps.org.uk/system/files/P
ublic%20files/a_psychological_perspe
ctive_on_hoarding.pdf
› Steketee G and Frost R (2013)
Treatment for Hoarding Disorder.
Oxford: Oxford University Press 25

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