Making space: Tackling hoarding with tech and compassion

If you want to tackle hoarding, it’s crucial to understand what the contributory factors are and how to respond in a supportive and constructive way. Alma Sheren investigates the novel and collaborative ways in which housing providers and others are doing just that.

Almost a decade ago, The Chartered Institute of Environmental Health published a paper that sought to offer advice to environmental health officers and local authorities dealing with hoarding. There was an emphasis on identifying common causality, along with engaging with tenants to address mental, as well as physical, health concerns. 

The research found the condition presented most frequently with a variety of psychiatric disorders, was more common with older residents and those with issues of self-neglect, had a strong connection to OCD (obsessive compulsive disorder), and often followed a life trauma.  

More recent research published by Hoarding UK suggests many hoarding issues – which affects up to 3.5 million people in the UK – begin in adolescence, before becoming a significant problem in people’s thirties. The average hoarder doesn’t seek support for their disorder till around the age of 50. 

Clinical and statutory interventions, however, have traditionally been strongly resisted by hoarders, with success rates low and recurrence rates high, even with multi-agency approaches involving long-term support. But inaction can lead to a deterioration of tenant’s physical and mental health and can become costly for local authorities to deal with. It can also become a nuisance to surrounding residents, result in damage of the property, and, most seriously, can result in preventable deaths. 

Hoarding UK’s founder and chair, Megan Karnes, points out that, despite being nearly double the statistical average of other recognised mental health conditions, there remains little support for the disorder. 

“The Care Act 2014 requires that services implement a prevention model of engagement,” she explains. “However, we are largely working in a reactive, expensive, ineffective and non-person-centred way.” 

Identifying, addressing, and preventing the root causes early on through a variety of combined – and in some cases, innovative – methods, however, offers the potential for more successful and fruitful long-term outcomes. 

A problem shared 

The London Fire Brigade (LFB) often sees first-hand the devastating consequences of hoarding, where fatalities have occurred due to inaccessible properties and faster spread of fire due to its contents. This not only dangerous to the person with hoarding behaviour, but also surrounding tenants and the firefighters themselves. 

The brigade holds a monthly ‘hoarding panel’, which brings together senior firefighters, mental health workers, social landlords, and housing and environmental health council officers. The group keeps a database of hoarders in the local community and discusses with the panel interventions for individual cases. 

Making visits to offer smoke alarms and flame-retardant bedding, referrals to a specialist support programme, and in some cases, forcible cleaning or eviction by landlords are just some of the options discussed. LFB's community engagement team also work closely with Hoarding UK and have a representation from Hoarding UK on their community forum, which helps them better understand the needs of people with hoarding behaviour. 

Hoarding Disorders UK

As many as 3.5 million people are affected by hoarding in the UK

“If a fire breaks out, a property with a large amount of possessions will make it harder for someone to escape safely, and it can make it more challenging for our firefighters tackling the fire,” says deputy assistant commissioner in fire safety Pam Oparaocha. 

“Fires tend to take hold more quickly, and injury is more likely. This is why we take a person-centred approach to hoarding, and we work with local communities to catch hoarding tendencies early.” 

Pam and her team try to identify this behaviour by working with partners such as local authorities, through home fire-safety visits, when attending incidents. They also operate through referrals, of which the LFB received more than 1,600 in 2022.

The team works with social care teams, too, to identify people with hoarding tendencies and get them the care and help they need; they encourage people to reach out for help by completing their Home Fire Safety Checker.

“The brigade can offer a wide range of support for those with hoarding tendencies, including providing specific safety advice for them and, where appropriate, the people that care for them,” Pam explains. 

“We will work to ensure that there is adequate smoke and fire detection in the property, referring people to partner agencies, visiting properties regularly, and putting plans in place to help reduce the behaviour.”

London Fire Brigade attend a flat fire in Lewisham caused by a portable heater being placed too close to stored items (Cr: LFB)

Keeping a record of a hoarder’s current and ongoing situation allows the fire brigade to gain a comprehensive understanding of what they might be faced with in the event of a fire and to better mitigate risks. It also allows the local authority to assess the ongoing condition of a person’s mental and physical health which, in theory, should give the tenant better access to the right kind of support. 

However, with limited resources, this can be a challenge. What’s more, these kinds of interventions often feel invasive to individuals, many of whom already have underlying anxiety, driving them to keep themselves further under the radar. 

With public scrutiny of housing providers currently at an all-time high, it can be controversial to take statutory actions against tenants who are clearly in need of support, especially in light of reduced funding for mental health services and pressures such as the cost of living crisis impacting everyday life. 

And with growing pressures on landlords to produce better outcomes for service users with tighter resources, less staff and higher costs, is it time we took a less invasive, more modern approach to hoarding?

Getting meta 

One group of researchers at Stanford University in the US has been looking at the use of technology, mixed with therapy, to help hoarders become more empowered to declutter their own homes in a non-invasive way – with some encouraging results. 

One of the main reasons hoarders resist discarding objects was the anxiety of ‘letting go,’ which for those with acute hoarding issues can be an extremely debilitating fear. 

The pilot study, undertaken by Stanford, used a combination of virtual reality (VR) ‘rehearsing’ of discarding objects, along with targeted therapy. The aim was to help tenants with hoarding disorder to practice relinquishing their possessions safely inside a simulation of their own home. 

The simulations, alongside cognitive behavioural therapy, assisted tenants to practice organisational and decision-making skills, which then helped them to desensitise to the distress they would usually feel in real life when attempting to declutter. 

Nine participants took part in the experiment, all of whom were all over the age of 55 and had been diagnosed with hoarding disorder. Each was asked to take photos and videos of the most cluttered room in their home, along with 30 possessions, which were then transformed into custom 3D virtual environments. The participants then navigated around their rooms and manoeuvred their possessions using VR headsets and handheld controllers.

National Housing Federation

Total cost of maintaining a hoarder in social housing over the course of their tenancy is c.£45,000

Alongside the VR sessions, the participants took part in a 16-week online group therapy, which, combined with cognitive behavioural skills development, were designed to empower participants to address their hoarding behaviours and triggers. 

Through these sessions, participants learned to gain a better understanding of their attachment to the objects and then practiced placing them in recycling, donation or rubbish bins, which were taken away by a virtual recycling truck. Once comfortable, they were tasked with discarding the real item at home. 

Seven of the nine participants reported an improvement in their hoarding symptoms, with an average decrease of 25 per cent. Eight of nine participants also had less clutter in their homes based on visual assessment by clinicians, with an average decrease of 15 per cent. 

Whilst not too dissimilar to the results of therapy alone, the study shows these kinds of less invasive intercessions could help those harder to reach tenants who fear the stigma and scrutiny of more forceful interventions to become more empowered to overcome their challenges. This has the potential to not only save lives but build better relations between tenants and landlords.

A computer screen showing a live feed of a participant's VR session (Cr: Stanford University)

Room for hope? 

In the UK, the estimated cost of maintaining a hoarder in social housing over the course of their tenancy is around £45,000. Investing in early intervention through initiatives such as meaningful tenant engagement, whilst offering less invasive options through a combination of gamification and targeted mental health support, could help to reach more people with hoarding disorder whilst saving housing providers time and resources and managing future risk more effectively. 

In December, we uncovered some of the housing teams who are seeing some excellent results in terms of tenant engagement, efficiency, savings and outcomes through their innovative use of technology for repairs and maintenance. These initiatives allowed tenants to take more control over their services, yielded better outcomes, whilst providing valuable data for future improvements. 

With 2024 being a pivotal year for the housing sector in terms of time, costs and resources – and of course, the tenant experience – it could be argued that there is no better time to invest in technology driven solutions for some of the most challenging tenant issues. 

However, while the future of this space looks promising, Hoarding UK’s Megan Karnes offers some words of caution to those looking for quick wins. 

“Looking at technology may be a useful part of implementing solutions,” she says, “but...seeking easy fixes has never been effective in providing support to people who hoard and those who are engaging to help them.”

Indeed, there are no easy fixes. But through collaboration and innovation, hoarding could become that little bit easier to tackle.

Main image: Shutterstock AI