Co-ordinated approach to engaging people with hoarding tendencies

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The context

US research suggests that people with hoarding disorders are over-represented in homeless shelters and eviction prevention services. UK research also highlights the role hoarding plays in evictions and in preventing prompt hospital discharges.

Though national statistics in Scotland cannot tell us how prevalent the issue of hoarding is as a direct cause of, or contributor to, homelessness, the link between hoarding and potential housing crisis for individuals is well understood by public services. But effective interventions in respect of this notoriously complex issue have been in short supply. London Borough of Lewisham is aiming to implement a more consistent, sustainable way of working with people who hoard.

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The intervention

Local evidence suggested hoarding affected a high number of households in Lewisham. In 2019, the Adult Safeguarding Board piloted a comprehensive, cross-tenure approach, appointing a Hoarding and Self Neglect Specialist Officer to research best practice, coordinate multi-agency input and source suitable support resources across Lewisham. The role was funded by the NHS and based in the adult social work team. Referrals can be made by the fire brigade, hospitals, GPs, housing, environmental health, family or friends, as well as by individuals who have a hoarding tendency and want help (though this is rare).

The officer visits a referred household, jointly with other agencies if appropriate, to carry out a welfare check and an assessment. They take time to understand underlying reasons for the issue, as there is no one reason why people hoard. People are offered help from Clouds End, a specialist social enterprise that supports and negotiates with householders to gradually declutter. They use the clutter image rating tool to develop realistic goals, and also offer a small repairs service. Environmental health only become involved if a home is verminous. Its input is carefully coordinated, so as to maintain trust.

As a hoarding tendency can rarely be entirely curbed, the officer aims to ensure ongoing support for each person once a home is decluttered, based on their own situation and needs. This could be a befriending service or access to community activities from Age UK, for example if an elderly person has started to hoard due to social isolation. It could be domestic support as part of a care package, or access to peer support groups in the local area. Enforcement action is only taken as a last resort. Lewisham’s dedicated officer has also developed training and a comprehensive toolkit for other agencies.

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The outcome

Approximately 70 households were referred to Lewisham’s dedicated officer in year one. A high proportion engaged with the service, once it was explained decluttering support would take a gradual, tailored approach, with the person at the centre, rather than a standard, one-off ‘clear and clean’. Persistence is sometimes needed to gain trust in the first place, with some people taking many months to open the door. Only a minority of cases, which were of a particularly complex nature, proceeded to enforcement action.

Whilst challenging to evidence directly, it’s possible households could potentially become homeless without this multi-agency, trauma-informed service. Its value has been recognised by the social work department, which is now continuing to fund the officer. This marks a sea-change from the past, when the issue was regarded as ‘too difficult’, passed between departments and invariably dealt with by a one-off clearance.

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Key insights

• a specialist decluttering service, rather than a one-off clearance company, can engender greater trust from households, increase understanding of causal issues and reduce potential for re-occurrence
• hoarding is not an issue subject to a ‘quick fix’ and will often be costly to address. An aftercare offer (such as a support group) is vital to reducing potential for hoarding problems to reach crisis point again
• a dedicated officer able to coordinate, educate and assign tasks to the right agencies prevents the complex, expensive issue of hoarding being passed round departments and inconsistently addressed

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Find out more…

Jennifer Greaux, Hoarding and Self Neglect Specialist Officer, London Borough of Lewisham
jennifer.greaux@lewisham.gov.uk