Last night, I watched a programme on Channel 4 ‘Obsessive Compulsive Hoarder’. I wasn’t planning particularly to sit down and watch it but I was too curious in the end. While this isn’t a review of the programme, I wanted to write about my experiences of people who become ‘hoarders’.
I was concerned the programme would evolve into some kind of ‘freak show’ to show the world, with little understanding, how ‘odd’ this phenomenon is. It was more sensitively treated than I expected with the reactions of the neighbours – from horror to help – presenting one of the more interesting aspects.
I’ve seen a fair bit of ‘hoarding’ through my work. I don’t work in a leafy Surrey ‘commuter-belt’ town. I work in an inner city location. Most of the people I work with are older and we come across, what we call ‘Diogenes Syndrome’ relatively frequently although at different levels.
The more extreme cases will be similar to the situation presented on the television with hoarding to the level that it is not possible to walk from one room to the other in the house or open the doors between the rooms. Sometimes, people will be collecting rubbish from the streets to bring it back to the house. Sometimes it will just be about accumulated papers and nothing being thrown out. Often it worries neighbours more than the individuals who have this pattern of behaviour. Indeed, mostly the referrals that we get for these types of situations will come from worried neighbours or housing officers.
There may be a spark that started the process, such as a bereavement and then it becomes so overwhelming that the person doesn’t know how to seek help or becomes embarrassed. It isn’t an overnight ‘issue’ and often it picked up by neighbours first, for obvious reasons.
Environmental Health will only have a role if there is an substantial impact to the community either through an infestation of vermin (rats particularly) that is affecting the local area or if there is structural damage to the building itself that may affect neighbouring properties.
So when does ‘collecting’ and ‘not throwing out’ become a mental disorder? In my opinion, there isn’t a necessary ‘progression’. We, in mental health services, need to think about the way we define lines between ‘wellness’ and ‘illness’ and there is never a particular line over which you pass. I am of the belief that we are all somewhere along the continuum but some activities that may be regarded as ‘compulsive’ by some are more acceptable by society than others.
A ‘compulsive’ stamp collector or train spotter rarely troubles ‘society’ but a similar type behaviour where the collection is newspapers and rubbish does. I’m not saying there isn’t a difference but sometimes it’s obvious through the referrals we see that the ‘difficulties’ are more about the neighbours than the individuals.
That isn’t to say that people shouldn’t have help when they need it but often state empowered ‘help’ isn’t as cosy as it was on the television with all the neighbours banding together to help Richard (the man featured) clear his home and property. State empowered help is more often about removing someone, possibly forcibly, from their property and belongings to ‘clear up’.
I don’t have answers to these dilemmas and without doubt the first thing we consider is about levels of risk but the problem with programmes like Obsessive Compulsive Hoarder is that the title of the programme seems to medicalise the difficulty Richard had.
What was clear from the programme and the situations I’ve seen is that medicating someone out of this behaviour is not possible and isn’t ethical.
One thing that I have found is that often people who live in situations where there is compulsive hoarding are isolated and lonely. There may be one or two people they know and trust but they are not usually a part of a local community and sometimes there can be an embarrassment and awareness of how things have escalated but a lack of willingness to ask for help due to embarrassment.
The way out is to build and establish relationships over time. All the things that are no longer measured by performance indicators. All the things that we no longer have the time to do for the most part. Relationships is something that social workers should be good at. It doesn’t need to always be about the ‘weight of the state’ behind us. Perhaps seeing a way through the statutory role, this is something the profession can build on in the future. Maybe, just maybe, ‘big society’ is the answer too but this isn’t the big society the government plans. This just people being people and caring about each other more.