The Northern Ireland Frontline Network is facilitated by Homeless Connect to support frontline staff working with people experiencing homelessness across the voluntary, statutory and public sectors. In response to a growing call to learn more about this less understood topic, the network recently held a workshop focused on the issue of responding to hoarding.

Homeless Connect’s Lived Experience Co-ordinator, Nikki McConville, writes about what she learned from the experience...

I attended a Hoarding Workshop on the 14^{th of} March at NICVA. It was facilitated by Jack Moore from ‘Respect my Stuff’. Jack has over 15 years’ experience of training staff on mental health and hoarding related issues and how to address them. The session provided me and those who attended with a range of insights. It was informative and direct with practical advice and instruction on how to deal with the issues surrounding hoarding.

Most people will have an awareness of hoarding with little understanding of the complex issues that may lie behind this behaviour. There is a distinct lack of information and support available for those on the front line who work with individuals who hoard. 

What is hoarding?

As Jack informed us, a hoarding disorder is where someone acquires an excessive number of items and stores them in a chaotic manner. The items can be of little or no monetary value and usually result in unmanageable amounts of clutter.

It is often the case that front-line staff of mental health and housing services are expected to address these issues and resolve them. However, for understandable reasons many housing support workers will not have encountered these issues before and may not have adequate tools and resources to know how to support the household concerned. The issues surrounding hoarding cannot simply be addressed and rectified via a clear out and deep clean of the property.  Unless the underlying issues are identified and a support plan put in place, the behaviour will continue.

Hoarding is a mental illness in its own right

In May 2013, hoarding disorder was officially recognised in the DSM-V (the fifth edition of the Diagnostic and Statistical Manual of Mental Health). Hoarding was recognised by the World Health Organisation in 2018.

Unfortunately, this condition has become increasingly common in Northern Ireland and can impact on households living in a wide range of tenures. For social housing providers, it can pose particular challenges.

Reasonable adjustments must be made to facilitate this condition. If the issue of hoarding has been brought to the attention of a social landlord in Northern Ireland, there are procedures that must be followed in line with organisational policies. These will be bespoke for each organisation.

If a tenant breaks or does not meet the terms set out in their tenancy agreement, eviction may be sought. Before an eviction is sought the landlord must attempt to communicate with and provide information and support to the tenant. Legal action and eviction should always be a last resort. However, there can be a very real risk of a household falling into homelessness with all of the consequences this can have as a result of hoarding behaviours. Regrettably, the level of support required is not currently available and front-line workers are often responsible for managing hoarding.

There are many complex issues surrounding hoarding and these cannot be identified or resolved through brief interactions with a support worker over a short period of time.  

These issues will impede on an individual’s health, functioning relationships and lifestyle. The ability to perform basic tasks to simply live and function may be hindered due to hoarding items. For example, a person may be unable to prepare or cook meals if they have no access to cooking facilities or worktops as the kitchen is full.

Feelings of shame, frustration and embarrassment may isolate people struggling with hoarding from friends and family. Even simply thinking about clearing out or decluttering can cause deep emotional stress. Once they have parted with their possessions people who hoard may experience feelings of anxiety, sadness and guilt. It is important to understand that hoarding disorders do range from mild to extreme. Each person’s case will be unique and part of the challenge for housing officers is found in providing person-centred bespoke support to each person impacted. However, crucially, there are ways to support people who are impacted by these disorders.

Treatment options

There are treatments available including Cognitive Behavioural Therapy (CBT) for individuals with a hoarding disorder. Simplified, CBT propagates the theory that all behaviours start with a thought. Thoughts become feelings and feelings lead to behaviour.  If you can prevent the thought from becoming a feeling, then you can prevent the associated behaviours.

But what can we do to assist a person with a hoarding disorder?

It is of course for qualified professionals to provide CBT to people impacted by hoarding disorders. So what can staff in the housing and homelessness sector do to be supportive of those who are impacted?

1. First and foremost, staff can be compassionate. Holding a non-judgemental position coupled with unconditional positive regard for the individual you are working with can make a real and tangible difference. Staff who take time to know the person and rate their level of insight regarding their own behaviour will have a better chance of addressing the behaviours involved.
2. Staff can build a relationship rooted in trust and transparency. They can use motivational language and positively prompt people impacted to encourage reducing the number of items in their home. Managing expectations around the level of support which can realistically be provided is vital.
3. Identifying key partners involved in safeguarding can be beneficial. People impacted by hoarding may need support from a range of different agencies depending on the severity of the condition. These can include landlords, health services, social services, environmental health and housing to name a few. When services are flexible and forward looking in working together, the outcome can change dramatically for the better for everyone.
4. Finally, to reiterate - when in doubt, be compassionate. It is the most powerful, underrated virtue and it never fails to bring people together.

Find out More

This is only a short summary of what I learnt from the workshop with Jack. I would thoroughly recommend him as a trainer for any organisation looking to provide staff with an insight in to how to respond to hoarding.

If you or your colleagues are interested in attending a training session on understanding hoarding, but cost is a barrier, we may be able to help you. The Frontline Network’s Training Fund can provide up to £500 for an individual or up to £1,500 for a group training session to support frontline homelessness workers. See here for further details and to apply.

Other upcoming FREE training workshops with the Northern Ireland Frontline Network

• Trauma Informed Care Training Workshop 17^th May, 9.30am-1pm online
• Mental Health First Aid- 2 day accredited training workshop on 3^rd and 4^th June. FREE in person in Belfast.
• If you would like to find out about upcoming training and network events the Northern Ireland Frontline Network is providing to frontline staff working with people experiencing homelessness in Northern Ireland, you can register to their regular e-news here.