SCA Exam Tips: Hoarding Case

Hoarding Disorder Overview

Hoarding is a recognised mental health disorder characterised by excessive acquisition and an inability to discard items. It differs from collecting because the accumulated items are disorganised and often of little or no monetary value.
Hoarding becomes a clinical concern when the clutter interferes with the person’s normal functioning. Those with a hoarding disorder often exhibit emotional distress when discarding items. Many individuals with hoarding disorder have limited insight into the severity of their illness.

Aetiology:

What causes hoarding is not fully known, but there are risk factors and associations

1. Mental Health: Psychosis/Depression/Anxiety/OCD
2. Living alone
3. Stressful life events like losing a partner
4. Deprivation during childhood or a cluttered environment in childhood

Why you should worry about your patient with hoarding

1. Fire hazard: cluttered environment risk of fire increased
2. Health & Safety: Falls, Infestation
3. Social Isolation: May start to lose connection with friends and family that can’t cope
4. Safeguarding concern

Data Gathering in a Hoarding Case : Consider asking the following

• How long have you had this pattern of collecting?
• Do you remember when it started?
• Can you think of anything that may have triggered this?
• Do you live alone? How long for? Show empathy if expressing the loss of a loved one
• What sort of things do you collect, and where do you keep them? Helps ascertain the risk of falls/fire
• What does your house look like now that you have this collection?
• Has it blocked or made it more challenging to get about your house?
• Have you had any falls as a consequence?
• How would you get help if you fell?
• Have you struggled with getting out of the house?
• Do you have food? Who does your food shopping? Level of independence/carer needed or not
• Has anyone else expressed any concerns about your collecting habit?
• How is the hygiene in the house, Mrs Johnson? Has it made it difficult to clean?
• Have you noticed any pests or insects?
• Do you feel you have a problem with hoarding? Helps assess insight
• How is your mood, Mrs Johnson? Do you feel low?
• Sometimes, when people feel low, they can have thoughts of self-harming or even darker thoughts of wanting to end things. Have you experienced anything like that?

Management in Hoarding Case

Acknowledge the problem:

• I understand this is a complex issue to discuss, and I want to reassure you that we’re here to support you.
• It’s essential to recognise that hoarding can be distressing and affect your mental and physical health.

Psychological support:

• I understand you feel very strongly about not having things removed, Mrs Johnson
• Why don’t we get you access to some CBT–talking therapy to help you gain a better understanding and begin the process of helping you be safe at home

Home Visit:

Mrs. Johnson, I would also like to arrange a home visit to assess you in your home environment. This will allow me to decide which services to refer you to.
Medication:
• if needs be, in the future, we will consider antidepressants if your low mood or anxiety becomes an issue
• I also noticed you are on some blood pressure medication; when I visit you, we can check your blood pressure to see if we need to stop or reduce the dose to reduce your risk of falls; what do you think, Mrs Johnson?

Safety: Do you have access to a mobile phone or a way of contacting the emergency service if you have an accident at home, Mrs Johnson?

Family support: Can we involve anyone in the family or friends to support you through this process?

Safeguarding referral if:

• The person’s care needs are being neglected due to hoarding.
• They are unable to protect themselves from harm due to their behaviour.

Gradual decluttering plan:

• I don’t want you to panic. No one is going to remove everything from your house suddenly
• This will be a long process which will involve you actively taking part in a decluttering plan with the help of a therapist

 

Memory Aid: Safely CLEAR IT

Identify and address safeguarding concerns & refer if needed

Cognitive Behavioural Therapy (CBT) +/- medication
Living Environment: Home visit to assess if needed
Empathy and non-judgmental conversation about the hoarding issue
Assess and readiness to make changes.
Risk Management: assess for falls/fire/pest/social isolation

Involve Family or Support Network: to assist the decluttering process.
Tailor a Gradual Decluttering Plan: a slow, structured approach + therapy.

 

Reference: NHS. (n.d.) Hoarding disorder. Available at: https://www.nhs.uk/mental-health/conditions/hoarding-disorder/ (Accessed: 14 September 2024)

 

Dr Sakaria Farah
PassCME Tutor