FEATURE: How we supported a customer with hoarding disorder

By Sandra Stride, Mental Health Liaison Officer at SNG

Hoarding can have a severe impact on a person's physical, emotional and social well-being. It carries risks to health which include fire hazards, structural damage to homes, pest infestations, poor sanitation, accidents, and injuries.

If items start to accumulate, especially flammable ones, then this can significantly increase the risk of a fire. Escape routes maybe blocked, making evacuation difficult in an emergency. It can also put other customers at risk if a fire were to break out.

When we approach a customer about hoarding, especially when their tenancy is at risk, we aim to show sensitive and respect. It also requires some careful planning!

Hoarding is often linked to mental health conditions, it’s not just about clutter but involves deep emotional attachment to possessions. A customer might feel embarrassed, anxious, or defensive about their hoarding behaviour. Showing empathy is key and gently explaining to them the condition of the home may be putting their tenancy at risk. It's important for us to emphasise that we want to help them to avoid eviction or other legal issues.

I've found that giving a customer the chance to speak, acknowledging that it’s a difficult situation for them and sharing their perspective can help them reveal important details about the situation, such as personal struggles and fears. Here is the story of one customer who I worked with recently to confront and resolve the hoarding in his flat. He gave us his consent for this to be shared.

Sandra Stride, Mental Health Liaison Officer

Jacob's story

I became aware of Jacob following an inspection from our Fire Safety team who said it was one of the worst cases of hoarding they had seen.

Jacob is a 55-year-old man who lives with paranoid schizophrenia and is supported by the community Mental Health team. Jacob's flat is a ground floor bedsit in a block with 13 other bedsits and he has lived there for over 20 years. He likes to keep himself to himself and only really goes out to collect his medication once a month and to do his shopping. Jacob used to be visited by his sister and mother but over time, he had cancelled visits and they had not been in the flat for a few years.

He’s a heavy smoker; his curtains and windows had not been opened for years. The thickness of the smoke hit you as soon as you walked in and PPE was required for the cleaners who eventually helped clear the flat. The walls were stained yellow and thick cobwebs would hang from ceiling to the floor. The bathroom was unusable, and it was clear Jacob had no washing space. The kitchen sides were completely covered, and the sink and drainer were stacked so high with items that looked like they had been there for some months. Jacob was living off snack type foods that required no cooking.

Jacob's Neighbourhood Officer sent a referral to my team and after a joint home visit, it was clear to see that the risks to him and his neighbours were also putting his tenancy at risk. We had a conversation with Jacob regarding the safety concerns. It was clear that he was not able to see what we could and did not recognise the dangers his home was posing. On the first visit, Jacob told us he would clear this himself, we just needed to give him the opportunity to do so and we advised that we'd return in a couple of weeks to check on his progress.

When we returned, there was no change, Jacob said he would start it in the spring. During this visit, we had the Fire Safety Officer with us to explain again why we needed to make a start on helping him clear his home. With Jacob being under secondary care services, we were able to work with them too. They completed an assessment with Jacob and were then able to choose a specialised local hoarding cleaning service through their service finder.

Every visit, my colleague and I would attend together. Jacob was familiar with our faces, and we had built a good relationship with him. We introduced the cleaning staff that would be spending a lot of time in his home over the next few weeks as we know that having strangers inside his home would impact on his mental wellbeing. We had a discussion with him on the items he wanted to keep and the items that would be thrown away. We needed to set boundaries at the same time, and we spoke with Jacob that items that were 10 years out of date would need to be removed. We bought plastic containers for the items Jacob was able to keep, so it could be stored neatly in the corner.

The agreement was the cleaners would attend three times a week spending three hours at a time. We were hesitant that it would get started, but to our surprise Jacob allowed them in to begin the mammoth task. It was nice to see Jacob getting involved and he himself had started to remove the paper on the walls. By the end of the first week, you could see Jacob was accepting of the cleaners in his home.

By the end of week three, it was clear to see how much this had taken out of Jacob, who was feeling exhausted and looked tired. Unless you live with a mental illness, I don’t think you can ever understand how a task like this can impact on you. You can see a photo of the amount of items removed from the flat on the right.

It was also so lovely to see Jacob smile and want to show us his home, and how far he had come. The windows were open and the curtains and been washed, we offered to get Jacob a new bed and bedding through our Charitable Fund for all his hard work and commitment he had shown. He declined this offer but instead went and bought himself some new bedding. The sides in the kitchen were clean and he was not only washing up, he was putting the dishes away in the cupboards.

While the bath was still full of items, Jacob had access to his sink, and he had new toiletries laid out. My colleague and I were, and still are, immensely proud of what Jacob was able to achieve and overcome. Four weeks on and I completed my final visit with Jacob, and he was keeping on top of his home along with the support of his care coordinator. His mother and sister came to visit and broke down in tears with what they saw and were so grateful that we had been able to help Jacob.