Written by Mark Sasvary, Chief Clinical Officer.
Hoarding is a serious problem and often goes unaddressed because people with hoarding disorder tend not to seek out services and services are often ineffective even when available. Hoarding is also associated with a myriad of other problems and is far more prevalent than is commonly known. A study conducted by researchers at Johns Hopkins University School of Medicine found that the overall prevalence of hoarding behavior is around 4%, but this number increases to over 6% for those age 55 and older 1.
Hoarding also has multiple intertwined factors associated with it including physical and mental health, housing, and clutter, all of which have serious ramifications. Clutter has been reported to increase risk of fire, falling, poor sanitation and health risks 2. A survey of health department officials indicated that hoarding was judged to pose a substantial health risk and in 6% of reported cases, hoarding was thought to contribute directly to the individual’s death in a house fire 3. The median number of repeat visits by the health department was 3 and ranged from 0 to 12 4. In addition to health departments, housing officials struggle with hoarding cases as well 5.
In the only published study on evictions and hoarding, data collected by researchers in 2010 found that 23% of residents seeking services from Eviction Intervention Services Housing Research Center (EIS) in New York City met criteria for hoarding. Of those, 32% were currently threatened with eviction and 44% had previously been threatened with eviction 6. Compulsive hoarding may also overlap with severe domestic squalor, creating additional public health concerns 7. Despite efforts to address these concerns these problems often persist. One small town health department spent most of their budget ($16,000) clearing out one house, only to face the same problem 18 months later 3.
A large majority (78%) was either overweight or obese according to current standards, and a majority (64%) reported at least one chronic and severe medical condition—markedly greater than the rates reported in the general population8. Hoarding is also associated with high rates of psychiatric comorbidity; in a study of 104 compulsive hoarding participants, 57% met diagnostic criteria for major depressive disorder, 29% for social phobia, and 28% for generalized anxiety disorder 9. Forty-five percent had received mental health services in the past year, a fivefold increase over the general population. Among those receiving such services, the amount of utilization was high (8 psychopharmacology visits, 19 outpatient therapy visits, and a remarkable 13 inpatient hospitalization days). It is noteworthy that 14% of hoarding participants report that their medical expenses were paid by public aid programs, suggesting that the cost to society is high 9.
Several cities in North America have developed inter-agency task forces to help them deal with individuals who hoard. Task forces are one of the most common methods to address hoarding. Generally, task forces focus on community education, case consultation, or a combination of both. Challenges that task forces face include long-term stability and sustainability. Funding concerns, changing membership, and the need for ongoing goal setting can contribute to the disbanding of task forces. Training in appropriate hoarding intervention is essential and is a necessary component of any hoarding taskforce.
Hoarding intervention training is the first step for many communities who seek a more effective response to hoarding behavior. Code enforcement officers, housing providers, social services, community-based organizations, health and behavioral health providers, and first responders all see the problem of hoarding through different lenses, so training needs to address different roles and ways to impact hoarding. Trainings allow multiple stakeholders to develop shared language, common assessment tools, and communication strategies to use during hoarding interventions. These trainings also help to increase the number of people trained to work directly with those who have hoarding behaviors to reduce the clutter in their homes.
While the provision of training in appropriate hoarding intervention techniques is an important step in better assisting residents with hoarding behavior, training alone is not enough. Intensive and targeted case management is also needed 10. Ongoing support for cities and towns is necessary to support the taskforces and case management. There is a need for ongoing training to develop the skills needed for hoarding intervention, regular case consultation, and supervision from those experienced in hoarding response. Additionally, there is a need for a shift in agency policies that would support staff to engage clients in sorting/discarding and other strategies to address hoarding behaviors. Hoarding can be successfully addressed by incorporate promising intervention practices in collaboration with case management work. Collaboration across governmental entities, social services, police and fire departments, health and behavioral health providers, and community-based organizations is also necessary as part of an effective hoarding task force.
1. Samuels, J. F., Bienvenu, O. J., Grados, M. A., Cullen, B., Riddle, M. A., Liang, K. Y., ... & Nestadt, G. (2008). Prevalence and correlates of hoarding behavior in a community-based sample. Behaviour research and therapy, 46(7), 836-844.
2. Kim, H. J., Steketee, G., & Frost, R. O. (2001). Hoarding by elderly people. Health & Social Work, 26(3), 176-184.
3. Frost, R. O., Steketee, G., & Williams, L. (2000). Hoarding: a community health problem. Health & social care in the community, 8(4), 229-234.
4. Frost, R. O., Steketee, G., Youngren, V. R., & Mallya, G. K. (1999). The threat of the housing inspector: A case of hoarding. Harvard review of psychiatry, 6(5), 270-278.
5. Frost, R. O., & Steketee, G. (2003). Community response to hoarding problems. In Annual Meeting of the Obsessive-Compulsive Foundation, Nashville, TN.
6. Rodriguez, C. et al. (2012). Prevalence of hoarding disorder in individuals at potential risk of eviction in New York City: a pilot study. J Nerv Ment Dis. 200(1), 91-4.
7. Snowdon, J., Shah, A., & Halliday, G. (2007). Severe domestic squalor: a review. International Psychogeriatrics, 19(1), 37-51.
8. Tolin, D. F., Frost, R. O., Steketee, G., Gray, K. D., & Fitch, K. E. (2008). The economic and social burden of compulsive hoarding. Psychiatry research, 160(2), 200–211. https://doi.org/10.1016/j.psychres.2007.08.008
9. Frost, R. O., Steketee, G., Tolin, D. F., & Brown, T. A. (2006, March). Comorbidity and diagnostic issues in compulsive hoarding. In Annual Meeting of the Anxiety Disorders Association of America.
10. Davis, T. H., & Edsell-Vetter, J. (2015). Rethinking Hoarding Intervention: MBHP’s analysis of the Hoarding Intervention and Tenancy Preservation Project. Metropolitan Boston Housing Partnership