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WHAT TO DO WITH WHAT YOU SEE

Encountering Hoarding Disorder Matthew Kelleher

City of Gaithersburg Fire Marshal's Office

Elspeth Bell, Ph.D Bell Center for Anxiety and Depression

September 26, 2017

Workshop Objectives • Recognize the signs and criteria for hoarding situations • How hoarding differs from cluttering

• Assess the environment for signs of compulsive hoarding

• Identify potential interventions and methods for engaging individuals who hoard • Potential opportunities and limitations

WHY ARE YOU HERE?

Does Hoarding really have an impact? Does it matter?

CASE STUDIES:

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Case #1

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Case #2

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The crew backed out of the main entryway and reentered the home through the large bay window located on the ground level that led directly to the kitchen.

The main fire, which had originated in the toaster oven, was quickly extinguished. However, the fire had extended to the surrounding contents and continued to smolder.

Concerned with the continuing deep smolder within the large amount of contents and no practical way to remove everything in a timely fashion, an alternative method was used to address the problem…

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… High expansion foam was applied to penetrate into the deep-seated fire.

The owner moved into an apartment while the home was repaired and cleaned out. Today he is back in his residence. While it is not yet to the level of hoarding and accumulation as the day of the fire, he continues to “collect.”

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Case #3

When firefighters arrived they were told that someone was still in the house. They entered through the front door but encountered a huge pile of personal contents blocking their path. Fire was coming up the open stair from the basement. You can see the metal railing around the open stairway on the right. The stairs are covered with contents and debris.

One crew stayed at the entrance, using the hose to keep the fire in check at the open basement stair. A second hoseline was deployed to begin first floor extinguishment. At that point the original line was advanced down the stairs to the seat of the fire.

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Meanwhile, other firefighters were placing ladders up to the bedroom window. A rapid search found the victim in the bedroom just as flames were entering from the hall.

The woman was removed through the bedroom window and rushed to the hospital. She succumbed to her injuries a short time later.

This is the bedroom where the victim was found. Contents in the room were piled as high as the bed. You can see the window opening in the upper left corner.

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The Kitchen had contents piled up to the height of the counters. The opening you see is the back door.

The fire started in the basement furnace and was ruled accidental. Here you can see the hoseline lying on top of a large amount of accumulation. The stair is on the upper left

A closer look at the basement stairs shows just how hot it got with plenty of charring. The stairs are covered in debris.

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The First Responder’s Perspective •  Importance of being well aware of the risks associated

with homes where there is significant hoarding.

• How would you treat the situation if you knew what you were encountering?

• Hoarding was NOT the cause of any of these fires, but it was a HUGE contributing factor to the outcome.

Individual’s Right to Privacy

“The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated….”

- The Fourth Amendment to the United States Constitution

What is Hoarding Disorder?

•  Excessive Acquisition•  Failure to discard•  Clutter makes living spaces unusable•  Distress or impairment resulting from

behavior(Frost & Hartl, 1996)

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Elements of Acquisition

• Free samples •  Items discarded by others • Compulsive shopping (“Retail Therapy”) • On-line •  Infomercials • “Good Deals” • Hand-Me-Downs •  Items left behind by family • Gradual accumulation over years

Failing to Discard Items • Items appear useless to others • Identifying value

•  Instrumental • Sentimental •  Intrinsic

• This results in the growth of items and interferes with the functionality and use of living spaces.

Consequences of Hoarding

• Health Problems • Safety threats • Social isolation • Self-esteem problems •  Interpersonal difficulties • Legal conflict • Financial conflict

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Profile of a “Hoarder”

• More likely to live alone • Tend to be single

•  Low marriage rate, high divorce rate

• Average age for beginning to save ~ 13 • Average age for seeking treatment = 50 • Family history of hoarding is common • Difficulties in work and social activities • Strained family/friend relationships

Co-Morbid Diagnoses

• Major Depression (57%) • Social Phobia (29%) • Generalized Anxiety Disorder (28%) • Obsessive Compulsive Disorder (17%) • Specific Phobia (12%) • Post-Traumatic Stress Disorder (6%) • Dysthymia (4%) • Panic (2%) • No Other Diagnosis (8%)

Frost, Steketee, Tolin, & Brown, 2006

Signs of Hoarding

•  Blocked access or exit to any door or window due to clutter

•  Clutter that impedes or prevents movement in and around residence;

•  Clutter that prevents any part of the inside or outside of a dwelling to be used for its intended purpose

•  Trash and garbage inside or outside residence

•  Signs of infestation or health concerns for resident or neighbors

•  Visible damage stairs, ceilings, floors or walls

•  Kitchen and bathroom appliances are not usable

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Signs of Hoarding (cont.)

•  A large number of animals that are not being cared for and cause a health risk for the occupants, neighbors, and/or general public

•  Combustible materials stored too close to a source that could ignite it or potentially ignite it, i.e. stove, over heater vents, portable electric heaters, furnace, gas cans, fireplaces

•  Look for existence of working smoke detectors

•  Gas cans or other noxious materials, stored in a residence, of which the fumes become a potential health hazard

•  Look for evidence for running water, heat and electricity

Evaluation Process: Risk to Individual or Others

•  Local ordinances and codesw  Fire and Safety

w  Housing Code (utilities, water and sewer)

w  Animal

•  Risk to health and well-being (individual and others)

•  Level of urgency

•  Unsafe or unsanitary conditions resulting from clutterw  Structural integrity of the property

w  Fire code violations

w  Water/sewer functioning

•  Community standards

•  Individual’s ability to consent to interventions

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Resources and Services•  Therapists - Cognitive Behavioral Therapy•  Pharmacotherapy•  Professional Organizers•  Coaches & Clutter Buddies•  Case Management•  Hoarding Task Forces

w  Adult Protective Services

w  Law Enforcement

w  Animal Control

w  Fire and Rescue

w  Health Department

w  Housing

w  Mental Health

When Intervening…

•  There is no easy answer!•  Remember that decluttering…

w  Takes time and is slow-going

•  Clarify the expectationsw  For identified hoarderw  For community

•  Determine boundariesw  What you can and can’t givew  Learning when to say “no”

•  It’s okay to feel frustrated, irritated, or angry•  It’s never too late to start changing patterns!

Challenges To Clean-Up Efforts

•  Thought Processesw  Perfectionismw  All-or-Nothingw  Missed opportunities

•  Information Processingw  Categorizingw  Churningw  Determining importancew  Assumptions about items w  Distraction from

decluttering

•  Emotional Attachmentw  Comforted by possessionsw  Exaggerated lossw  Attach greater sentiment

•  Difficulty making decisions

•  Avoiding decisions and discarding

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Dangerous Approaches • Quick cleanouts

•  “Interventions”

• Unrealistic time frames

• Having others do the work

•  “Ambushing” the individual •  Inspections

•  Cleanout efforts

Effective Communication • Clear and Consistent

•  Between meetings •  Among involved parties

• Document Communications •  Share these documentations with the individual

• Confirm that the individual understands •  Ask for the individual to verbalize the details of communication •  Record the agreement and consent

In Conclusion…

•  Identify the context in which the hoarding behaviors are occurringw  Mental healthw  Medical issues

•  There is more to the individual than the physical clutter•  Hoarding screening

w  Individualw  Physical space

•  Interventionsw  Pharmacotherapyw  Professional Organizersw  Collaborative Therapy for Clutter Managementw  Coaches & Clutter Buddiesw  Case Managementw  Hoarding Task Forcew  Cognitive Behavioral Therapy

•  An effective treatment intervention begins with a thorough assessment of the individual, looking beyond the clutter

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THANK YOU! Matthew Kelleher City of Gaithersburg Fire Marshal's Office 240-805-1033 Matt.Kelleher@gaithersburgmd.gov Elspeth Bell, Ph.D Bell Center for Anxiety and Depression 410-480-8052 ebell@bellcad.net