Think Family – Hoarding Toolkit 2024 – 2026

• To ensure that agencies feel able to manage hoarding cases independently in the first instance and then have avenues to explore
• Provide a multi-agency pathway which will maximise the use of existing services and resources and which may reduce the need for enforcement action and includes a single point of referral.
• Ensure that when solutions are required, there is a process for planning and coordinating solutions tailored to meet the needs of the individual and utilising a person centred approach.
• Establish best practice and improve knowledge and support that relates to hoarding behaviour.

Hoarding is the excessive collection and retention of any material to the point that living space is sufficiently cluttered to preclude the activities they are designed for. Hoarding disorder is a persistent difficulty in discarding or parting with possessions because of a perceived need to save them. A person with a hoarding disorder experiences distress at the thought of getting rid of the items. Excessive accumulation of items, regardless of actual value, occurs.

Compulsive hoarding is often considered a form of Obsessive-Compulsive Disorder (OCD) because between 18 and 42 % of people with OCD experience some compulsion to hoard. However, compulsive hoarding can also affect people who don’t have OCD.

Hoarding is now considered a standalone mental health disorder and is included in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, many people are not diagnosed and hoarding can also be a symptom of other medical disorders.

Hoarding does not favour a particular gender, age, ethnicity, socio-economic status, educational, occupational history or tenure type. Anything can be hoarded in many different areas including the property, garden or communal areas. Items include, but are not limited to:

• Clothes
• Newspapers,
• Magazines or books
• Bills, receipts or letters
• Food and/or containers
• Collectables such as toys, DVDs or CDs
• Animals

There are typically three types of hoarding:

• Inanimate objects: This is the most common. This could consist of one type of object or a collection of a mixture of objects, such as old clothes, newspapers, food, containers or papers.
• Wet hoarding: including substances arising from bodily functions, this has ramifications for hazardous waste and blood borne viruses (BBV) and health and safety.
• Animal hoarding: This is on the increase and often accompanied with the inability to provide minimal standards of care. The hoarder is unable to recognise that the animals are at risk because they feel they are saving them. The homes of animal hoarders are often eventually destroyed by the accumulation of animal faeces and infestation by insects.

The following general characteristics of Hoarding are commonly reported:

Fear and anxiety: compulsive hoarding may have started as a learnt behaviour or following a significant event such as bereavement. The person who is hoarding believes buying or saving things will relieve the anxiety and fear they feel. The hoarding effectively becomes their comfort blanket. Any attempt to discard the hoarded items can induce feelings varying from mild anxiety to a full panic attack with sweats and palpitations.

Long term behaviour pattern: possibly developed over many years or decades of ‘buy and drop’. Collecting and saving with an inability to throw away items without experiencing fear and anxiety.

Excessive attachment to possessions: people who hoard may hold an inappropriate emotional attachment to items.

Indecisiveness: people who hoard may struggle with the decision to discard items that are no longer necessary, including rubbish.

Unrelenting standards: people who hoard will often find faults with others; requiring others to perform to excellence while struggling to organise themselves and complete daily living tasks.

Social Isolation: people who hoard will typically alienate family and friends and may be embarrassed to have visitors. They may refuse home visits from professionals, in favour of office based appointments.

Large number of pets: people who hoard may have a large number of animals that can be a source of complaints by neighbours. They may be a self-confessed ‘rescuer of strays’.

Mentally capacitous: people who hoard are typically able to make decisions that are not related to hoarding.

Extreme clutter: hoarding behaviour may be in a few or all rooms and prevent them from being used for their intended purpose.

Churning: hoarding behaviour can involve moving items from one part of the property to another, without ever discarding them.

Poor Personal Hygiene: a person who hoards may appear unkempt and dishevelled, due to lack of bathroom or washing facilities in their home. However, some people who hoard will use public facilities in order to maintain their personal hygiene and appearance.

Poor insight: a person who hoards will typically see nothing wrong with their behaviours and the impact it has on them and others.

The Mental Capacity Act (MCA) 2005 provides a statutory framework for people aged 16 and over who lack the capacity to make decisions by themselves. The Act has five statutory principles and these are legal requirements of the Act:

1. A person must be assumed to have capacity unless it is established that they lack capacity.
2. A person is not to be treated as unable to make a decision unless all practicable steps have been taken without success
3. A person is not to be treated as unable to make a decision merely because he/she makes an unwise decision.
4. An act done, or decision made, under this act for, or on behalf of, a person who lacks capacity must be done, or made in his or her best interests.
5. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.

The principles of the presumption of capacity and respecting a person’s entitlement to make unwise decisions with capacity (principles 1 and 3 of the MCA) are the starting point for any capacity assessment. So in other words, we need to assume that someone who is hoarding has the capacity to make this decision unless we can find evidence to the contrary. It is up to us as practitioners to use all of our communication skills to determine whether someone is having genuine difficulty making particular decisions for particular reasons. So a presumption of capacity does not mean that we do nothing.

Capacity is decision and time specific, saying that someone lacks capacity is meaningless. We need to ask ourselves, “What is the specific decision that needs to be made at this point?” If we don’t define this question before we start undertaking the assessment, the exercise will be pointless and may lead us astray. So in other words, we may ask: “Do you understand that your hoarding has become dangerous and is now a real risk to your life?”

Prepare to assess capacity – A crucial step is to prepare for the assessment. We need to think about the best ways that we can put someone at ease, so that we can gain the information we need without distressing or isolating them further.

Take all practicable steps – What can we do which might mean an individual is able to make  the  decision  for  themselves?  Think  about  specific  types  of  communication  or

language, times of the day, etc., talk through the hoarding tool with the person and use the guidance questions in section 5 of this toolkit.

Applying the test – The MCA test for capacity has two aspects: the diagnostic element (is there an impairment of, or a disturbance in the functioning of, the mind or brain; what evidence is there of this?) and the functional element (is the person unable to make a decision because of the impairment?). Being unable to make a decision means being unable to understand, retain or “use or weigh” information relevant to the decision, or to communicate their decision.

The MCA Code of Practice states that one of the reasons why people may question a person’s capacity to make a specific decision is that “the person’s behaviour or circumstances cause doubt as to whether they have capacity to make a decision” (MCA Code of Practice, 4.35). Extreme hoarding behaviour may therefore in the specific circumstances of the case, prompt an assessment of capacity.

Guidance on assessing mental capacity in connection to hoarding

When assessing capacity, it is important to remember this is an assessment of whether the adult has capacity to access help for their hoarding – so, does the adult understand they have a problem with hoarding; is the adult able to weigh up the alternative options, e.g. being able to move around their accommodation unhindered, being able to sleep in their bed, take a bath, cook in their kitchen, sit down on a chair/sofa (this list is not exhaustive); can the adult retain the information given to them (e.g. if the accommodation is cleared, you would be able to move around your accommodation, etc) can the adult communicate their decision? It is essential that any capacity assessment is clearly documented on case records. Someone who has difficulty with their executive capacity may have difficulty carrying out specific tasks even when they appear to understand the need for them.

See section 4 regarding when a safeguarding assessment should be undertaken.

A household can start to resemble an obstacle course, full of trip hazards. It can become impossible to keep the place clean; infestations can follow. A tower of hoarded items can topple over and cause injury. The hoard can grow so large that it causes structural damage, increases fire risk, and, in the event of an emergency, responders might not be able to access parts of the residence. (Burki, 2018)

The most commonly hoarded items are old clothes, magazines, CDs/video tapes, letters, pens, old notes, bills, newspapers, receipts, cardboard boxes, pins, clothing rags, old medication, bodily products (hair, nails, faeces etc), used nappies, rotten food, animals (dead and alive), wool or fabric. (htt1) (www.hoardinguk.org/abouthoarding/)

Please refer to the clutter scale in section 5 to categorise the different scales of hoarding. This will enable professionals to have a shared language and introduce a standardised way of recognising hoarding.

Crash Cleans: one of the most popular responses to hoarding is to perform a “crash clean” – the clearing out all or most of the offending items. Crash cleans often feature repeatedly in the individual’s case notes or history. Whilst there may sometimes be a need for a crash clean to deal with environmental health or fire safety concerns it more often only serves the person or agency that is concerned or complaining about the hoarding rather than offering a long-term solution for the hoarding sufferer. Crash cleans are likely to significantly distress the hoarder and is a costly action to take. It does not address the cause of the hoarding behaviour and may exacerbate their symptoms. Without a longer-term solution such as hoarding specific cognitive-behaviour therapy (CBT) and/or other professional intervention the individual could well resume their hoarding activities.

Housing Providers and Environmental Health Departments: Housing providers (including the local authority and housing associations) and environmental health departments are often the first to receive complaints or concerns and will often face a clash of responsibilities between their tenants and seeking to ensure that an adult with care and support needs receives appropriate care and support. Without appropriate intervention and support by relevant agencies housing providers’ only other option will be to initiate proceedings in the county court for possession of the property, an access injunction or other action to assert their rights as landlords under housing or antisocial behaviour legislation. This could see an individual involved in legal proceedings when it may not be the most effective route for their personal progression through their manifesting condition.

If there is disrepair in the property, officers from Dudley Council can inspect the property and ensure that the landlord carries out all repairs. This may be difficult; however, if the tenant has filled the property with possessions and the landlord cannot gain proper access to do the work. For more information about disrepair contact 0300 555 2345.

Mental Health Services: those who display hoarding behaviours or who suffer from hoarding disorder are more likely to be supported by Mental Health Services if hoarding disorder is a recognised severe and enduring mental illness. This service will often be the key liaison and conduit between the social services and clinicians involved with the individual concerned.

Working with a clinical psychologist: Talking to a clinical psychologist can be really helpful in working out ways to deal with hoarding difficulties. They are trained in a range of therapy approaches including cognitive-behaviour therapy (CBT). There is some research showing that CBT can be helpful for hoarding difficulties. CBT is a collaborative non-judgemental therapy that pays attention to negative automatic thoughts (NATs), and behaviours that are driving the problem. Taking part in this kind of therapy is hard work and will involve doing work between sessions, as well as trying out new ways of doing things. Not only are clinical psychologists trained in CBT but they can also provide information and support in dealing with other agencies, such as your landlord or social worker.

The first port of call for getting this kind of help would be through the person’s GP, who will be able to give advice about accessing NHS services.

Firstly establish whether the person does appear to be displaying hoarding related behaviours or suffering from hoarding disorder and that they are not just exercising their right to collect items or express different lifestyles and habits. Some things to look for:

• Are rooms in their property (bathroom, toilet, bedroom, kitchen) not used or unusable for the purposes to which they have been designed, because of an excess of clutter?
• Can appliances and furniture (cooker, fridge, settee, chairs etc.) be used?
• Are they unable to freely open their front or back door?
• Are all plug sockets and pipes hidden from view or trapped in by possessions?
• Are rooms packed with items to such an extent that it could pose a fire, health or safety hazard?
• Is their mobility around the property or otherwise limited by the amount of items?
• Do the items pose any environmental or other health and safety related obstacle/issue?
• Is there evidence of a pest infestation or are there accumulations of waste food?

Consider whether the problem can be resolved purely by taking steps to ensure that the resident complies with their conditions of tenancy or lease or whether the resident needs some assistance to try to deal with the hoarding behaviours in issue (for example because they are elderly or appear to be vulnerable.)

It may be possible to obtain an injunction to remedy and prevent further incidents of hoarding but in the most extreme cases, where all other ways of resolving the problem have failed it may be necessary to commence possession proceedings.

Possession proceedings are unlikely to be helpful where a person does display hoarding related behaviours because:

• there are likely to be mental capacity issues which may impact their ability to understand or participate in proceedings, or
• the individual may be breaching their tenancy because of a potential mental illness rather than for cooperation reasons.

The result would be counter-productive as it may lead to just “moving the problem around” as opposed to resolving the issue. Relying on strict contractual or tenancy rights should only be considered once this protocol has been exhausted and there are no capacity issues relating to the individual.

It is possible, if complaints have been received from neighbouring properties that the hoarding-related behaviours could be classed as antisocial behaviour, in which case proceedings can be brought against an individual in this manner. A thorough assessment as to whether the individual manifesting the hoarding-related behaviour is vulnerable should be made before any action is considered. Persons demonstrating hoarder related behaviours or who suffer from hoarding disorder are likely to consider that their behaviour is not problematic or irrational, so it may be counter-productive to argue the case with them on the basis of what is normal, rational or acceptable. However, it may be possible to lead the person to understand that their hoarding is having a detrimental effect on others. Informal action should be taken first, usually a letter confirming the steps that need to be taken. This may be followed by formal action if necessary. However, this must be done with the involvement of any support officer such as a social worker or personal assistant.

A local authority has a duty to conduct a Needs Assessment where it appears that they may have needs for care and support. The duty is likely to be triggered in such circumstances and social services would need to be notified so they can commence a Needs Assessment under the Care Act 2014.

(This section needs to be read in conjunction with paragraph Crash Cleans above)

In cases where the resident is not an adult with care and support needs and the only reason for mass accumulation of items is because the resident concerned has not made proper arrangements to dispose of large amounts of material or an accumulation of bulky items, you should aim to come to an agreement with the resident concerned to dispose of the items and prevent a repeat of the activity

Consider staggered time frames for clearance; i.e. over a period of 6 or 12 months, agreeing a small area to be cleared each month and re-visiting to ensure compliance.

In all cases you should carry out a health and safety risk assessment of the property and consider employing specialist contractors where appropriate.

(This section is also to be read in conjunction with Crash Cleans above)

It may be appropriate for a ‘special cleanse’ of the property to be arranged. Again, consider a staggered cleanse if possible. A “one-off” cleanse or the removal of a couple of bulky items will not offer a solution to the potential or actual hoarding problem, either because of the nature of the hoarding related behaviours, the need for a more general clean-up of the property or the continued vulnerability of the resident concerned. In these cases it will be necessary to seek assistance from other sources.

You may encounter situations where, in addition to the hoarding, there are infestation problems such as rats, mice, cockroaches, ants, bed bugs, beetles, or wasps. The council’s pest control service provides a chargeable service to all council residents (regardless of tenure). The service is heavily subsidised and there is a reduced rate for those on benefits or receiving pension. However in hoarding cases, to ensure that infestations are dealt with promptly and that preventative action is taken immediately to prevent further infestation, the charge to individual residents may be initially covered by the council This is more likely to be where the enforcement team have needed to serve a notice on the occupier for an infestation. The money can then be re-claimed at a later date. This is of particular importance where the infestation has or is likely to spread to neighbouring properties.

Where the individual dwelling infestation is of fleas, this problem is deemed to be the responsibility of the occupier. If the council’s pest control service undertakes the works the normal practice would be to recover the cost direct from the occupier. However, the service can use its discretion about whether to recharge the resident concerned in cases of hardship or vulnerability. It may also be advisable to carry out treatment to prevent other people from being infested. For more information contact 0300 555 2345

Hoarding increases the risk of a fire occurring and makes it more difficult for people living within the property to evacuate safely. Fire can spread to neighbouring properties if the level of hoarding is severe or if flammable items such as gas containers are being stored. It can also pose a high risk to fire fighters when attending the scene.

West Midlands Fire Service provide a free service called a Safe & Well visit which is a person centred home visit to identify the person’s risks and vulnerabilities to fire. The personnel carrying out the visit will be operational fire fighters. They will provide support and guidance, the aim of which is to reduce the risk and vulnerability. This may include recommendations for resources, adaptations and equipment, for example, fire retardant bedding for an individual who smokes in bed.

Cases of hoarding with a number of complexities would be escalated to a Complex Needs Officer (CNO), a fire service member of staff specially trained to deal with complex cases such as hoarders.

Their priorities are:

• Carry out a detailed assessment as a priority
• Make the person/s as safe as possible
• Fit required safety equipment as soon as practicable
• Refer to another organisation where appropriate
• Work with agencies to help resolve issues

To make a referral please contact the Home Safety Centre on 0800 389 5525 or homesafety.centre@wmfs.net or visit  www.wmfs.net

Where children live in the property, and the hygiene conditions within the home present a serious and immediate environmental/health risk to children or the physical accommodation places the child in danger, a referral to the Children’s Front Door must be submitted using the Request for Help and Support Form via the DMBC website. You can also call direct on 0300 555 0050.

[13:12] Lisa Burn (Commissioning and Support)

The Graded Care Profile 2 (GCP2) and Graded Care Profile 2 Antenatal* (GCP2a) tools should be used to evidence concerns around quality of care delivered to and home environment of an individual child and in unborn babies.  It should be used where neglect is suspected or known and is a tool that can inform your overall assessment(e.g. Child & Family Assessment, Early Help Assessment or any specialist Health Assessment). In order to use the GCP2 tool you must complete the GCP2 Training – for more information please visit the Learning Zone

*training will be available 2024 onwards

Adult Social Care offer a range of prevention and re-enablement services to support people to live independently. They can also arrange an assessment of someone’s care and support needs. For further information please contact via 0300 555 0055 or by emailing: accessteam.dachs@dudley.gov.uk

The Care Act 2014 introduced three new indicators of abuse and neglect to Adult Safeguarding, the most relevant to this framework is self-neglect. This covers a wide range of behaviours around personal health, hygiene, and environment and can include hoarding where there is evidence of such neglect. In practice, when an adult with care and support needs is at risk of neglect from their hoarding or is at risk from a household member who hoards, then a safeguarding enquiry should be considered. Consent from the adult should be gained wherever this is possible and where the adult has mental capacity to understand the referral being made. To report a safeguarding concern visit the Adults Portal

Where an individual who has hoarding behaviour is unwell or injured medical attention should be called by the staff member at the scene. This may be by contacting the individuals GP surgery or in an emergency an Ambulance should be called. If the person declines essential medical services, medical practitioners will make the assessment under the Mental Capacity Act to make a decision on how to proceed.

Under the General Data Protection Regulations 2017 (GDPR), we all have the responsibility to ensure that personal information is processed lawfully and fairly. All individuals have a right to view any information held about them. Practitioners should consider this when they are recording information about that person. However, the data protection act should not be a barrier to sharing information. Information should be shared with agencies where there is a significant risk to the individual, neighbours or workers visiting the property.

Hoarding Insight characteristics

Use this guide as a baseline to describe the person’s attitude towards their hoarding. Provide additional information in your referrals and reports to enable a tailored approach that is relevant to the individual.

Good or fair insight:

The person recognises that hoarding-related beliefs and behaviours (relating to difficulty discarding items, clutter or excessive acquisition) are problematic. The person recognises these behaviours in themselves.

Poor insight:

The person is mostly convinced that hoarding-related beliefs and behaviours (relating to difficulty discarding items, clutter or excessive acquisition) are not problematic despite evidence to the contrary. The person might recognise a storage problem but has little self-recognition or acceptance of their own hoarding behaviour. 

Absent (delusional) insight:

The person is convinced that hoarding-related beliefs and behaviours (relating to difficulty discarding items, clutter or excessive acquisition) are not problematic despite evidence to the contrary. The person is completely excepting of their living environment despite it being hoarded and possibly a risk to health.

Detached with assigned blame:

The person has been away from their property for an extended period. The person has formed a detachment from the hoarded property and is now convinced a 3rd party is to blame for the condition of the property. For example a burglary has taken place, squatters or other household members

Listed below are examples of questions to ask where you are concerned about someone’s safety in their own home, where you suspect a risk of self- neglect and hoarding.

The information gained from these questions will inform the referral process and provide the information needed to alert other agencies. Most individuals with a hoarding problem will be embarrassed about their surroundings so adapt the question to suit the individual

• How do you get in and out of your property, do you feel safe living here?
• Have you ever had an accident, slipped, tripped up or fallen? How did it happen?
• How have you made your home safer to prevent this (above) from happening again?
• How do move safely around your home ( where the floor is uneven or covered, or there are exposed wires, damp, rot, or other hazards)
• Has a fire ever started by accident?
• How do you get hot water, lighting, heating in here? Do these services work properly? Have they ever been tested?
• Do you ever use candles or an open flame to heat and light here or cook with camping gas?
• How do you manage to keep yourself warm? Especially in winter?
• When did you last go out in your garden? Do you feel safe to go out there?
• Are you worried about other people getting into your garden to try and break-in?
• Has this ever happened?
• Are you worried about mice, rats or foxes, or other pests? Do you leave food out for them?
• Have you ever seen mice or rats in your home? Have they eaten any of your food? Or got upstairs and be nesting anywhere?
• Can you prepare food, cook and wash up in your kitchen?
• Do you use your fridge? Can I have look in it? How do you keep things cold in the hot weather?
• How do you keep yourself clean? Can I see your bathroom? Are you able to use your bathroom and use the toilet ok? Have a wash, bath? Shower?
• Can you show me where you and your children (if relevant) sleep and let me see your upstairs rooms? Are the stairs safe to walk up? (if there are any)
• What do you do with your dirty washing?
• Where do you sleep? Are you able to change your bed linen regularly? When did you last change them?
• How do you keep yourself warm at night? Have you got extra coverings to put on your bed if you are cold?
• Are there any broken windows in your home? Any repairs that need to be done?
• Because of the number of possessions you have, do you find it difficult to use some of your rooms? If so which ones?
• Do you struggle with discarding things or to what extent do you have difficulty discarding (or recycling, selling, giving away) ordinary things that other people would get rid of?

West Midlands Fire Service – 0800 389 5525

Adult Social Care Enquiry – 0300 555 0055

Children and Families Service, contact: Tel 0300 555 0050

Dudley Welfare Rights 0300 555 0055, or via the DMBC website

Private sector housing – 0300 555 2345

Environmental Health – 0300 555 2345

Dudley MBC Housing Team 0300 555 2345

• Help for Hoarders – A comprehensive hoarding website, with a good page of resources with counsellors and groups specialising in hoarding
• Children of Hoarders – Offering support and advice to the families of those that hoard
• Compulsive Hoarders – A website dedicated to raising awareness and understanding of hoarding
• Hoarding UK offer phone, email and advocacy support free of charge
• OCD UK supports those with OCD who hoard
• Hoarding Disorders UK – advice for people affected by hoarding behaviours, chronic disorganisation and extreme clutter
• National Housing Federation – good examples of best practice when working with hoarders from a housing perspective
• RSPCA 0300 1234 999 https://www.rspca.org.uk/utilities/contactus/reportcruelty