Often what you find is that people are ‘under the radar’ says Ronan and have been hoarding for a long time. He explains 'you're getting people who have potentially hoarded for 20, 30 years, and that are more likely to become known to older people's services through their health failing.' You also realise that they 'people have been hoarding for decades and people that have been hiding, hiding is maybe the wrong word, but have been managing it themselves without any (help), or not managing it themselves… '
This, of course, relates to the fact that people who hoard don’t want other people to know about it due to the stigma and due to the shame they feel. That’s why they do awareness raising campaigns across the year in Fife through their Adult Protection Committee, and via local radio and their local newspaper, The Courier.
`'The point perhaps is that you can’t stop people hoarding, but you can better help them to manage and stay safe' says Ronan. So is this is about helping manage risk and reducing harm, rather than fixing people? It’s also a longer-term commitment:
'…we know that it can take up to a year to even get a bag of rubbish out of the house, just because of the length of time and the relationship-based practice really needed, to try and make an impact with somebody that's hoarded for a long period of time.'
Understanding the challenges moving forward…
The long term nature of it…
“The real challenge moving forward is about what services can help people that hoard because there is the long-term nature of it, the time that it takes to really make a positive intervention means that it takes a real commitment from all services to try and achieve that.”
Ronan is aware of the tensions this can create balancing different needs and agency requirements - 'for example, if you're in a four in a block and there's neighbours and there's issues with electrics…. Or there are environmental health concerns. (So) you're trying to balance the relationship, therapeutic aspect of it with the real safety aspects of hoarding at the same time.' 'We’re trying to get people on board with taking a longer-term approach, but sometimes that really isn't possible when you think about council homes or housing association homes where there's real safety aspects…' Ultimately, these are tensions to manage, rather than solve. 'There's no real right answer, is there?' says Ronan.
Early intervention and ASP?
In Fife they use the Clutter Rating Scale - 'so we would ask that if it's 7, 8 or 9 … to make a referral in terms of the clutter rating scale so we can essentially address those cases that are the most serious hoarding.' But what scope is there for earlier intervention?
In Fife they have an older people’s service and an adult service - with older people, classed as 65 years and above. 'It’s mostly older people service referrals that we get (for hoarding), and it's hoarding that's been in place for a long period of time… (and) not discovered until its long term.'
The implication is that people might be better identified and supported at an earlier age and not just through adult services given that hoarding behaviours can often start in adolescence. Earlier intervention can also be supported through more referrals from others who can spot it and know where to signpost, or from people referring themselves. But of course, until stigma and shame is tackled, people will remain hidden and will not ask for help themselves.
Key ingredients to positive impact from Fife
- Recognising that change is needed
- The involvement of different stakeholders - willing to engage and build from the ground up to engender a multi-disciplinary approach
- Creation of infrastructure - in shared guidance and shared spaces and showing commitment to making these spaces more permanent as long as they are needed
- Investment in training, and continuing to develop and share learning and expertise with other stakeholders; giving something back and cascading knowledge and expertise. Feeding people’s curiosity to learn and to achieve more!
- Capture of relevant data and making good use of it - to drive improvement and monitor progress and to make people who hoard more visible
- Continuing to raise awareness of problematic hoarding as part of an ongoing effort to increase knowledge and reduce stigma and increase access to support
- Support for innovation - and piloting and trialling new approaches to provide practical and sensitively delivered support to reduce risk
- Sharing risk with others to mitigate harm, manage risk more effectively and share the responsibility
- Continuing to challenge and identify opportunities for positive improvement - through first understanding the barriers in the system, ‘outing’ what remains hidden and showing leadership by putting these on the agenda and bringing people together.
- Keep going!
