Category: Obsessive Compulsive and Related Disorders
Hoarding is characterised by the presence of signiﬁcant clutter and extreme difficulty or unwillingness on the part of the individual to part with possessions, even those other people would discard easily. The prevalence of hoarding disorder has been estimated to be as high as 5.8% of the population. Hoarded homes pose a public safety threat, as the risk of fire hazards, pest infestations and noxious odours is heightened in both the home and neighbouring dwellings. Our research team has been conducting research into community-based interventions for problems associated with hoarding. We have worked especially closely with Vancouver's Hoarding Action Response Team (HART), which includes fire inspectors and mental health workers in a coordinated case management approach. The team priorities include ensuring safe living environments and preventing fires caused by excessive combustibles, as well as improving quality of life for residents of the home. This study describes the case management approach and presents basic outcome data.
Hoarding cases are referred to the team through a central phone number, then triaged based on immediate risk (e.g., presence of children or animals), and placed on a waiting list. Both a fire inspector and mental health nurse attend the initial inspection and make a judgement of the degree of risk in the home, including a safety assessment of the dwelling and the individual. They assess level of clutter using the Clutter Image Rating (CIR) scale. Across repeat inspections the team follows up on the client’s progress in satisfying fire codes and facilitate relevant mental and physical health referrals. Cases are closed once the home is no longer deemed a safety threat or if the client declines services.
Data are available on 68 cases inspected by the team between March 2015 and January 2017. Client age ranged from 36 to 95 years (M = 67.89, SD = 12.24, n = 60). Interventions lasted between 0 to 86 weeks (M = 27, SD= 24, n = 65.) The average initial CIR score was 6.35 (SD = 1.42, n = 68), and the average score at the last inspection was 4.56 (SD = 1.82, n = 60). This significant reduction was moderated by client age, F(1,52)= 12.51, p < . 01; older adults experienced more reduction in clutter volume. These preliminary results demonstrate the potential of community-based interventions. We conclude with practical recommendations for other communities interested in developing similar interventions.