About hoarding and squalor

In recent years, severe domestic Squalor and compulsive Hoarding (also known as Challenging Domestic Environments) has received national and international attention. There has been a growing understanding of the complexities involved in each case and the difficulties presented when aiming to achieve successful, sustainable outcomes. 

There are many different and complex reasons why people display these behaviours. As a support person the most crucial way of supporting a person is to demonstrate patience, a non-judgmental attitude and be open to learning more about the behaviours. 

Definitions of Hoarding and Squalor

Hoarding and Squalor are complex issues that can present in a number of different forms. To be able to properly tackle these issues a clear understanding of these different presentations and the possible reasons behind them is essential.

Hoarding

Hoarding and Cluttering involves excessive collection of items (which appear to have little or no value) and a failure to remove or discard them. This often means that the environment in which they are being kept becomes so cluttered that it can no longer be used for the purpose for which it was designed. This will consequently impair the basic living activities (such as cooking, cleaning, sleeping, showering and moving) of the occupant. (Catholic Community Services NSW/ACT Squalor and Hoarding Toolkit)

Squalor / Severe Domestic Squalor

‘Squalor / Severe Domestic Squalor refers to households that are extremely cluttered, in a filthy condition, and where the accumulation of items such as personal possessions, rubbish, excrement and decomposing food creates an environment that jeopardises the health and wellbeing of the occupant(s). Furthermore, ‘normal’ household activities such as cooking bathing and sleeping are impeded or not possible. In extreme cases, severe domestic Squalor may also have an impact on neighbours because the property may be a fire hazard, emit a foul odour and harbour vermin.’ (Government of South Australia, SA Health, 2013, p.8).

Animal Hoarding

Animal hoarding is more than just having a large number of animals, although numbers do need to be taken into account. The published definition of an animal hoarder [Patronek 1999] is someone who:

    • Accumulates a large number of animals, and
    • Fails to provide minimal standards of nutrition, sanitation, and veterinary care, and
    • Fails to act on the deteriorating condition of the animals (including disease, starvation and death) or the environment (severe overcrowding and extremely unsanitary conditions), and
    • Fails to act on the negative effect of the collection on their own health and well-being and that of other household members. (International OCD Foundation: www.ocfoundation.org/hoarding/types.aspx) 

Self-Neglect

Self-Neglect involves behaviours in which an individual does not (either intentionally or non-intentionally) appropriately address their basic personal needs. Issues of personal hygiene, appropriate clothing, feeding, bathing and medical needs often go unattended leading to an exacerbation of medical issues as well as social exclusion and isolation. It is important to note that self-neglect has serious implications for both the individual and the community. (Catholic Community Services NSW/ACT;www.catholiccommunityservices.com.au; Squalor and Hoarding Toolkit)

Neglected Home Environments

Domiciliary Care also recognises that there are some homes which are not squalid or have evidence of hoarding, but are physically and structurally unmaintained and neglected. This may present some safety risks to both the client and service providers. It is important to know that this may not be associated with the other definitions. (Domiciliary Care: Challenging Domestic Environments Definitions)

How do Compulsive Hoarding behaviours develop?

According to the Government of South Australia’s ‘A Foot in the Door guidelines’ Compulsive Hoarding behaviours develop through complex cognitive processes and avoidance behaviours that drive the development of Compulsive Hoarding. These complex cognitive processes include but are not limited to compulsive acquisition, incapacity to discard items and poor organisational skills.

Cleanliness varies between homes and between individuals and can be presumed to be influenced by multiple factors, including upbringing, peer and family expectations, living arrangements, social and financial circumstances, cultural background and surroundings.

Although the various processes mentioned above may occur simultaneously it is important to understand that severe domestic Squalor can occur when individuals display only one of these processes. Service providers addressing compulsive Hoarding issues and severe domestic Squalor should aim to understand these processes. Attempts to solve cases of severe domestic Squalor where compulsive Hoarding behaviours exist prove futile when the underlying patterns of behaviour are ignored.

Characteristics and Behaviours of Hoarding and/or Squalor

Hoarding and Squalor is a complex set of conditions and may be identifiable by some or all of the following behaviours and conditions:

  • Home environments and living conditions are filthy, unsanitary and could be classified by some as uninhabitable
  • Large volumes of items are hoarded which impairs the functionality of the home and living areas. Residents of the home are therefore unable to undertake everyday living tasks such as bathing, cooking, sleeping and cleaning
  • Neglecting of household maintenance both internal and external (including lack of functioning utilities)
  • Utilities are not functioning
  • Failure to attend to indoor and outdoor maintenance
  • Unconventional behaviours and lifestyles
  • Poor personal hygiene and insufficient nutrition due to a lack of self-care
  • Significantly poor personal appearance. For example an individual may appear to have not changed their clothes or bathed for substantial periods of time including weeks, months and even years
  • Social marginalisation and isolation, unwillingness to socialise with others
  • Missing medication doses, not attending medical appointments
  • Inability to sustain secure housing

The behaviours associated with Hoarding and Squalor may stem from one or more of the following factors/ experiences:

  • Traumas stemming from; violence, childhood abuse, war, physical and emotional abuse, neglect and more
  • Previous and current substance abuse for example alcohol, illicit drugs and prescriptions medication
  • Mental Health disorders can cause damage to the frontal lobe of the brain impairing concentration, problem solving, socialisation and impaired risk taking and rule obeying functionality. Some of these disorders include Schizophrenia, Depression, Personality Disorders, Autism, Obsessive Compulsive Disorder (OCD) and Attention Deficit Hyperactivity Disorder (ADHD)
  • Dementia and other age related issues
  • Poverty
  • Physical health disorders

Reference: Catholic Community services, 2013, Squalor and Hoarding Toolkit, NSW, accessed http://SqualorandHoarding.catholiccommunityservices.com.au/getting-started/features-and-characteristics

Risks and consequences connected to Hoarding and Squalor

There are multiple and complex risks and consequences associated with Hoarding and Squalor. The level to which Hoarding and Squalor impact both individuals and communities varies from case to case. The following section gives a brief overview of such risks and consequences.

Risks to Individuals

  • Social isolation and marginalisation – as a result of Hoarding and Squalor individuals may become quite introverted and withdrawn, and often will not have anyone coming to their homes and will not socialise with anyone at all. It is important to understand that Hoarding and Squalor is a form of crisis and although it is not an immediate form of crisis it is chronic and continues over time to intensify.
  • Unstable and poor relationships - often Hoarding and Squalor contributes to the breakdown of relationships and families. It is not uncommon when compulsive hoarders are given ultimatums to choose between people and objects they choose the objects. This could be a result of personifying objects and their values. Some compulsive hoarders may have experienced a sense that people have always let them down and caused them pain in contrast to their objects which have not let them down. Therefore they form attachments to objects rather than people.
  • Anxiety and fear of eviction - the unacceptable state of home and risks to the community such as fire and other health hazards
  • Increased risk of health problems due to: - Falls - Loss of medication - Lack of medical attention
  • Negative Financial impacts - due to the costs involved in fees (lost bills and occurrence of late payment of bills), the cost of storage, heavy cleaning and removal service costs, risks to employment as a result of disorganisation within the home and the chaos attributed to Hoarding and Squalor

 Risks to the Community

  • Safety risks from fires
  • Health risks as a result of squalid environments
  • Neighbours may face consequences such as damages to common property, vermin infestation etc
  • Poor relationships with neighbours and other community members; stress caused by the difficult nature of these relationships
  • Large financial costs for repairs of damage and clean-ups
  • Costs for health care and community well-being involved with people living in Squalor (healthcare is often more expensive as there are a larger number of presenting problems due to long periods of time without medical attention)
  • Unsightly homes contributing to the value and status of a community
  • Minimisation of community pride 

Reference: Catholic Community services, 2013, Squalor and Hoarding Toolkit, NSW, accessed http://SqualorandHoarding.catholiccommunityservices.com.au/getting-started/features-and-characteristics . 

Treatment options

Treatment can help people with Hoarding Disorder (HD) to decrease their saving, acquisition, and clutter, and live safer, more enjoyable lives. There are two main types of treatment that help people with Hoarding Disorder:

  1. Cognitive-Behavioural Therapy (CBT) 
  2. Medication

During CBT, individuals gradually learn to discard unnecessary possessions with less distress, diminishing their exaggerated perceived need or desire to save for these possessions. They also learn to improve skills such as organization, decision-making, and relaxation. For many people, certain anti-depressant medications may be helpful and may produce more rapid improvement.

(http://www.psychiatry.org/hoarding-disorder )