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Hoarding - CCI London and Area

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Hoarding
Dawn White MHS.,BScN.,RegN
Did You Know
Hoarding is not limited to social class, race, culture or education levelInterventions are normally costly, complex and time consumingWithout proper intervention, the hoarders environment will continue to evolve until the safety of the individual and the community might be put at risk
What is Hoarding?
Excessive accumulation and failure to discard proportionately (animals or things)Activities of daily living are impaired by spaces which cannot be used for intended purposesDistress or impairment in functioning to the person hoarding or others such as neighbours/family/fire department/landlord/condo corporations
Is Hoarding Cluttering?
NoIn cluttering the volume is lessClutterers are still able to discard things, albeit it may take effort on their partThe clutter does not debilitate their lives to the same degree as those who hoardCluttering MAY be a stage in developing hoarding
Prevalence
1-5% of General PopulationUSA based stats. No stats yet for CanadaIncreases as person agesOCD may be part of it, but is not evident in majority of those who hoardIn London, those who hoard could range from 3,500 to 17,500 people in the cityIf you had a complex of 64 units, with an average of 2 ppl per unit = 1-6 hoarders
Why Do People Hoard?
No conclusive answer yet but as of 2013 it will become an official psychiatric diagnosisIt legitimizes it as an illness and not simply slovenly or lazy behaviourNew brain imaging research (Tolin, 2012) has revealed that hoarders, when faced with being asked to pick and discard even junk mail feel intense discomfort and anxietyTheir brain does not activate the area that allows us to decide what is important and what is not so everything can feel important
Why do People Hoard? (cont)
Hoarders also took much longer to decide what to discard.Parts of the brain responsible for motivation and insight also under-performed, which might account for why hoarders are able to live with such extreme living conditions.They notice it, but feel no motivation to clean it up nor do they seem to recognize what a problem it is. This is also seen in people with autism.
Why Do People Hoard (cont)
Another part of their brain was over-stimulated; the part which causes attachment to personal objects and the ability to make decisions about their possessions that others would consider reasonableThis causes the anxiety, irritability, tearfulness, feelings of being overwhelmed, grief and sadness that is the hallmark of what someone who hoards experiences at the thought of throwing any of their possessions away
Why Do People Hoard
Genetics:May be a genetic link84% have a close family member with hoarding behaviour37% have a history of OCDNo conclusive proof, but it does seem to run in familiesLearned behaviour would also play a major role as well
Why is this an important subject?
For the person who hoards and their families: It can create impaired activities of daily living/unhealthy living conditions/unsafe living conditionsFor property managers, condo corporations/general public who live in close proximity: It can be a legal, public health and safety issue. Examples may be vermin, fire load, structural collapse and lack of ability for Emergency Responders to access the individualOften people who hoard will not voluntarily get help. It is often found by accident
Hoarding Types
Common hoardingSubcategories of generalist vs specialistDiogenes SyndromeAnimal hoarding
Common Hoarding
Anything can be hoardedGeneralists save everything. Very valuable items may be mixed in with garbageSpecialists save only specific items, ie dolls or tools.
Characteristics
Belief that emotional comfort comes from objectsObjects may be connected to important people in their lives; therefore the object BECOMES the personHaving these objects is almost like having the person still a presence in their livesThis is why it may be so hard to discard objects. It is as if they are discarding their loved one
Characteristics
Fear of losing something important “I might need that!”Feeling of loss of self or identityNeed for control of possessionsDue to distress of throwing away possessions; it is avoided at all costs
Characteristics and Beliefs
Just in case—I might need itItem must be saved because it could be useful in the future if not for the hoarder, then for someone elseSentimental saving– I can’t part with this..it means too much to meI love this—aesthetic saving; something about an object gives aesthetic pleasures and person cannot part with it
Diogenes Syndrome
Self neglectDomestic squalorHoardingFound in aproximately .5/1000 of the general populationIn London this would equal 175 casesGenerally affects seniors
DS
ElderlyLive aloneOften above average intelligenceReclusive, irritable, refuses helpIsolates self from society60% do not have a diagnosable mental illness (although now with hoarding dx, they will)Dementia onset may be a factorHigh risk and mortality (46%)
Animal Hoarding
Like other forms of hoarding; no one is sure why it developsFactors may range from genetic predisposition to attachment disordersResearch shows that animal hoarders may grow up in chaotic homes with inconsistent parenting where animals were the only source of consistent emotional contact (Arluke et al 2002, Patronek 2001)
Animal Hoarding
An individual acquiring more animals than they can care forInability to provide even minimal standards of nutrition, sanitation, shelter and veterinary care, with this denial often resulting in starvation, illness and deathDenial of the inability to provide this minimum care and the impact of that failure on the animals, the household and the human occupants of the dwelling
Animal Hoarding
Three types of animal hoarders:Overwhelmed CaregiverHoarder—more based in reality, become overwhelmed by the number of animals that they take inRescuer Hoarder—mission driven, they are actively and compulsively acquiring animalsExploiter Hoarder—feel no empathy towards animals or humans, acquire animals to serve their own needs
Animal Hoarding
71 incidents across USA and Canada were reviewed:83% involved woman ( 71% were widowed, divorced or single)53% of AH residences were home to other individuals including children(5%), elderly dependents and disabled people (21%)
Animal Hoarders
Often essential utilities and major appliances such shower, heaters, stoves, toilets and sinks were not functional93% Residential home interiors were usually unsanitary70% had a fire hazard16% of AH residences were condemned as unfit for human habitation25% of AH were placed under either permanent or temporary protective custody
What can be done?
Safety is the most important goal. If the fire load looks extreme; contact the Fire Department. In London, Inspector James HindPublic Health Unit for health risks to building, ie bedbugs/verminLondon City Hall has a bylaw that limits animals to a total of twoLondon is in the process of forming a community coalition to address hoarding. City Hall, Fire Department, Health Unit and community agencies such as CMHA and specialized cleaning services
Practical Tips for Condo Corp
May need to use all legal means to ensure that unit is cleaned up. Ie court/bylaws/declarationsIf Property Managers are part of engaging clean up crews; be sure to hire ONLY bonded crewsIf the person does not receive help and the risk was sufficient that a ‘clean sweep’ was done; be prepared for the situation to occur againThe safety of the neighbouring units may be at risk, so inaction is not an option if the situation appears severe
Practical Tips for Condo Corp
Remember the person may be challenging to work with and may want to resist every intervention, but safety of others is paramountIf the person ASKS for help, suggest they call service agencies such as the London branch of the Canadian Mental Health Association at 519.434.9191, or they could speak to the Fire Department if they are worried about the excess materials in their home (not likely, but possible)
10 Most Common Things Hoarded
Paper especially newspaperThe things used in everyday life which don’t get put awayExcessive recycling materials which don’t get recycledClothingPlastic bagsSentimental thingsMechanical things, car parts, tools, nuts etcWool, fabric, craft suppliesFurnitureAnimals (Birchall Consulting)
5 Red Flags that Hoarding Might Becoming a Problem
How many areas of your home can’t be used for their intended purpose, without shifting things around?How easy is it to find things when you want them?How difficult is it to walk through each of the rooms of your home because of clutter?To what extent are furniture tops cluttered?When you see things you want, do you feel compelled to have them? (Birchall Consulting)
Hoarding Quiz
Rating Scale: 0=not at all 2=mild 4=mod 6=severe 8=extremeBecause of the number of possessions you have, how difficult is it to use the rooms in your Home?How upsetting is it for you to have your home in its current condition?How upsetting/concerning is it for others to have the home in its current condition?
0=not at all 2=mild 4=mod 6=severe 8=extreme
4. Have other people/agencies tried to intervene (offer to help you tidy up) because of the clutter?How difficult/distressing is it for you to get rid of things?How often have you spent money you don’t really have because you saw something and “just had to have it”
Scoring
If you answered above 2 to questions 1, 4 or 5; Assess your situation by asking for feedback from someone you trust who knows you and ask for help accordinglyIf you answered 2 keep an eye on your situation, these situations are red flagsIf you answered 4 or higher to questions 2,3 or 6 ask for feedback from a trusted friend who knows you and search yourself for the reasons and your ability to tackle the problems yourself (Birchall Consulting)
Websites
www.hoarding.caBirchall ConsultingYouTube: look up Dr. Randy Frosthttp://healthland.time.com/2012/08/07/inside-the-hoarders-brain-a-unique-problem-with-decision-making/This is the imaging studyhttp://vitals.nbcnews.com/_news/2012/12/08/15757938-not-crazy-cat-ladies-hoarding-gets-new-diagnosis?liteThis discusses the new DSM categoryhttp://www.london.ca/d.aspx?s=/Fire_Dept/Fire_Safety_Tips/Hoarding.htmLondon Fire Dept
www.hoarding.caBirchall ConsultingYouTube: look up Dr. Randy Frosthttp://healthland.time.com/2012/08/07/inside-the-hoarders-brain-a-unique-problem-with-decision-making/This is the imaging studyhttp://vitals.nbcnews.com/_news/2012/12/08/15757938-not-crazy-cat-ladies-hoarding-gets-new-diagnosis?liteThis discusses the new DSM categoryhttp://www.london.ca/d.aspx?s=/Fire_Dept/Fire_Safety_Tips/Hoarding.htmLondon Fire Dept

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Hoarding - CCI London and Area