IN Brisbane, 45,000 households are in a state of squalor – no better than pigsties – yet this is not because their occupants are lazy or slothful, rather they suffer from hoarding disorder.
Hoarders collect and save so many possessions – often junk – which can be piled from floor to ceiling and can render entire rooms unusable.
In extreme cases the whole house can be overrun.
Sometimes keeping large numbers of pets, often in squalid conditions exacerbates the problem.
“Overall in Queensland we don’t have data on hoarding, but we know in Brisbane it affects 45,000 properties,” Melissa Horton, community service manager of the Floresco Centre, Aftercare, one of the few agencies, including Centacare, which is dedicated to the problem, said.
“The impact of hoarding is not only on the people themselves, but their families, carers, neighbourhoods and communities.”
Only in recent years has hoarding been classified as a psychological disorder.
It is almost five times as frequent as schizophrenia and twice as common as Obsessive Compulsive Disorder, and it affects between two and five per cent of the population.
There is no national strategy to address the problem although it is estimated to affect 600,000 people nationwide.
The health and welfare cost is about $1.8 billion.
“It is such a secretive act, often behind closed doors,” Catholic Community Services NSW/ACT manager of hoarding and squalor Mercy Splitt said.
“You can lead a relatively normal 9-5 work life and then you’ve got the home life.
“We can find a home packed floor to ceiling, or a family living in a tent in the backyard unable to enter their home, or living under an umbrella on the veranda.
“We need to work on re-ordering, to find out what is the cause.”
University of New South Wales psychologist Jessica Grisham said the deep desire to hoard can be triggered by loss, poverty, psychiatric illnesses and physical disorders.
She said hoarders were typically emotionally attached to their possessions and often experienced intense anxiety and distress when they were asked to discard them.
Ms Grisham said it appeared some HD suffers cannot throw things away for sentimental reasons including feeling like their possessions were part of them or that they had human-like qualities.
Other hoarders were concerned about waste and about losing and opportunity.
“Throwing these things away can lead to a grief-like process for some clients,” Ms Grisham said.
“They may believe that saving possessions and keeping them in sight will serve as a reminder of past events or a memory cue for future obligations.
“I have seen in one home a woman who lost her husband, but kept a huge collection of bowling trophies.
“People will also retain clothing of loved ones, craft items, scrapbooks, sometimes a huge mausoleum of objects.
“Others refuse to discard their possessions because they think the items will be useful at some future time – that is, ‘I might need this one day’.”
In Brisbane the issue of hoarding and squalor was not well recognised until just a few years ago.
Brisbane City Council was often involved in neighbourhood disputes and forced clean-ups – which proved expensive.
Now the issue is considered a priority.
City agencies are mobilised and working together under the auspices of the Brisbane Hoarding and Squalor Working group.
Ms Horton joined Aftercare earlier this year after working with Centacare’s specialist “fee for service” cleaning service.
She has just set up a working group in Ipswich.
“Often the issue is hidden for a long period of time,” she said.
“Some people have hoarded for 20 to 30 years without family or friends being aware.
“We help them to de-clutter and remove rubbish gradually over a long period of time while trying to connect them with their GP or psychological help.”
Ms Horton suggested for anyone coming across a family member or friend who was a hoarder, conducting a massive clean-out was not the best option.
“A forced clean-up can be detrimental. It can be traumatic for the person because the items have such a special significance to the person,” she said.
“The best thing to do is support them in a gradual process.
“It is not like supporting a person with a drug addition. A drug addict can reach a milestone in six weeks.
“But with hoarding it is complex and long term. It could take 18 months or two years.”
Ms Horton recommends a systematic approach to assist hoarders to de-clutter their homes and treat the disorder.
“Good psychological support on-the-ground should accompany any extensive cleaning,” she said.
Therapy includes targeting the excessive emotional attachment to the items, and rigid beliefs about possessions and saving.
“Hoarders can be taught step-by-step how to re-order their lives and slowly avoid cluttering again,” Ms Horton said.
Ms Splitt uses a similar, gradual approach to help hoarders.
“A forced clean-up can be devastating. The issue is – hoarding didn’t happen overnight. It can be years and years of a behaviour, ” she said.
“We need to work on re-ordering, to find out what is the cause. Was there a specific life event that caused it?
“It could be loss of a loved one, removal of a child and then the person couldn’t cope.
“The hoarder might be saying ‘these items protect me and keep me safe’.
“Others will say I feel broken, worthless, and so they surround themselves with broken, worthless objects.”
Ms Grisham said a complicating factor in treatment was that many hoarders did not recognise they had a problem and resisted efforts to help.
“They can express fear that they will be forced to discard their highly-treasured items. Others are ashamed of the state of their home,” she said.
Ms Grisham said hoarding disorder was not the same as collecting.
“Collectors demonstrate pride in their collection, organising and displaying it,” she said.
Hoarders, on the other hand tended to acquire a variety of items that others did not find valuable.
“They are often embarrassed by their possessions, avoid inviting people into their home, and maintain their items in a disorganised manner,” Ms Grisham said.
She said hoarding could occur as a result of other conditions, such as a traumatic brain injury or dementia.
Mary’s story: A real life case study on Brisbane’s southside
MARY lives in a house in the Brisbane southern suburbs. She lives alone and has lived in the same house for more than 20 years.
From the outside the garden looks overgrown and unkempt and there are lots of pots, tubs and containers in the front yard.
There are also unusual household items stacked up and it looks like someone is either storing the items or getting ready to move or something.
They are not organised and appear a little like rubbish to most people.
The house is visibly in a state of disrepair, there is not a lot of paint left on the outside, and doors and windows are not in good condition.
You can’t see inside the property as the windows are all covered with drawn curtains or household items.
Mary knows her neighbours, but doesn’t really get along with them as they have lodged many complaints to council.
Mary receives support visits from community organisations.
They help her address her hoarding and assist her to de-clutter and remove rubbish.
It took Mary about six months to develop enough trust to receive help and it causes her a lot of distress sometimes, but slowly she is starting to make progress in the yard.
Mary is overwhelmed with her mental health issues.
The hoarding is part of her complexity and really the only visible sign to the community as to how unwell she actually is.
What Mary needs is an awareness and understanding of her needs and a consistent treatment model.
She can regain the use of her everyday living areas, but this is normally gradual and can take years.
A respectful and dignified recovery plan is the best and most successful method for addressing the hoarding disorder and differs greatly to other mental health treatment plans.
By Mark Bowling