Hoarding – when stuff overwhelms

By Susan Evans, Island Health

Jean Oliver is a recovering hoarder or "nester" as she likes to refer to herself. "I come from a long line of 'collectors' and grew up in a very full house," says Oliver. "Like my mother, I accumulated too much stuff through my good works. I did a lot of volunteering and with every opportunity came more and more paper. I believed every piece of paper was important and that I needed to keep it. I also used shopping as a way to deal with issues in my life. Within a few years, I was completely overwhelmed."

According to Dr. Eric Ochs, a Registered Psychologist with Island Health, between 1 and 5 per cent of the population suffer from Compulsive Hoarding (CH) disorder. "If we average that and estimate that 3 per cent of this region's population suffer from compulsive hoarding-that's 23,000 people. If we take that number and consider 5 per cent are a safety risk requiring an urgent response, that's an estimated 1150 severe cases of compulsive hoarding cases across the Island, potentially 550 of those cases in the Greater Victoria area."

Hoarding is a complex mental illness. Long thought to be an outcome of Obsessive Compulsive Disorder, hoarding was included as a diagnosable disorder in the 2013 Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. It is defined as "persistent difficulty discarding or parting with personal possessions, even those of apparently useless or limited value, due to strong urges to save items, distress and/or indecision associated with discarding."

Hoarding is characterized by the extensive clutter that fills up the occupant's living space and makes it impossible to use it for its intended purpose-for instance, not being able to use the kitchen for cooking or eating because it is too full of stuff. Exits might be blocked; it might be difficult to move through rooms or even use rooms because every inch of space is filled.

The "stuff" ranges from recyclables including magazines, newspapers and junk mail to containers, clothes, craft materials and castoffs picked up on the street. Hoarders want to keep stuff for a number of reasons--the most common reason being "I might need it later."  The second most common reason is the belief the information is important and they are afraid of losing it. They often keep newspapers and magazines because they believe they will read them "when they have time" and that the information in those publications might be valuable, or that old paperwork or letters will be needed later. Hoarders also keep things they believe to have sentimental value-in fact, many people keep mementoes and items with emotional meaning, just not to the same extent.

Hoarding is an issue, not only for the person affected, but also for the community around them. It can become a safety hazard when material blocks heating units or is stored too close to stovetops, creating a fire hazard-a fire that could spread to neighbouring homes. Collecting garbage and refuse and lack of cleanliness can lead to a public health hazard. Blocked entryways and lack of access can lead to tragic circumstances if first responders aren't able to gain entry to the home in an emergency.

As the clutter escalates, so do the safety concerns. Family or neighbours may become aware of the issue and call the authorities to investigate. In rental situations, a landlord might be forced to evict a tenant because of their overwhelming clutter.

Kate Scott-Moncrieff, Addictions Outreach Clinician with Island Health, works directly with people who have reached a hoarding crisis. "I'm often called in when the person is about to be evicted from their home, or when the fire department has deemed the home a public safety risk," she says.  Scott-Moncrieff works as part of the Hoarding, Education and Action Team (HEAT see information following).  "It's important to approach the client without judgement and not to be focused on the mess, but rather to see the suffering and provide support."

And it's not just a case of cleaning out all the junk and moving on. According to Ochs that can be counter-productive, "A forced clean-out may worsen the mental health issue. When that happens, often the same amount of clutter is back within a few months."

There is no cure for compulsive hoarding. However, for clients who are motivated, help can be found through cognitive behaviour therapy which can lead to a level of recovery.

For those who are not motivated to change their environment, safety is the goal. "You can't force people to clean out their home; in our society, people are still the king of their own castle," notes Ochs. "Once the fire hazard or public health issue has been dealt with, the goal is to check occasionally to make sure they continue to be safe."

If you or someone you know needs help with hoarding behaviour contact HEAT (see information following).

Hoarding Education & Action Team (HEAT)

HEAT was founded in 2012 and uses a collaborative approach to help hoarders in Greater Victoria. They also refer people outside Greater Victoria to local resources.

HEAT includes:

• fire departments,
• by-law enforcement,
• Island Health services,
• Island Health's environmental health department,
• SPCA,
• concerned non-profit groups,
• for-profit landlords,
• volunteers and
• de-cluttering services.

HEAT recognizes that hoarding exists in our communities and that it represents a significant health and safety risk for the hoarder, first responders and the community at large.