Team approach is best to address hoarding

Hoarding — the accumulation of large quantities of clutter, much of which has little or no value — is a mental health disorder that is best addressed with cognitive therapy, according to Jesse Edsell-Vetter, a case management specialist for the Metropolitan Boston Housing Partnership and an expert on the issue.

“You can’t just pay attention to the clutter,” Edsell-Vetter told the April 1 meeting of the Local Officials Human Services Council in Framingham, which focused on hoarding intervention approaches and case studies.

Local officials and human service workers need to understand the complexity of hoarding and take action in a multi-disciplinary manner involving people from different departments, he said. If not addressed, hoarding can become life-threatening.

Edsell-Vetter suggested using HOMES, a multi-disciplinary hoarding risk assessment tool that is used in 13 states and three countries.

The initial assessment, in which an inspector is usually present, is vital in any hoarding intervention, he said. The relationship between the client, inspector and human service worker will be the bedrock of the process.

Getting to know the client by asking questions about their lives, not their clutter, will be more effective in identifying the underlying problem, he said. Once trust is established, the client will be more likely to open up.

He said there are certain things to look for and questions to ask, which he says will help determine the next step to take. Fire, health and trip hazards should all be identified and noted. The location of the clutter is also worth noting, as sometimes it can help give insight about why the person is hoarding.

An incident report should be as detailed as possible. Areas that need to be brought into compliance, as well as what needs to be done to meet the standards, need to be clearly noted.

Edsell-Vetter recommended using language that the resident and service providers can easily understand. State codes for example, should be clearly cited. Using tiers to describe the extremity of the violations can also be useful.

“If you don’t do a good assessment,” he said, “things go wrong.”

There are several ways that hoarders accumulate their clutter. Compulsively saving things that have sentimental value is one way clutter can pile up. Other ways include compulsive buying, compulsively acquiring free things like giveaways and advertising handouts, and stealing.

There are many misconceptions that hoarders are lazy and don’t care about their surroundings, Edsell-Vetter said, but 69 percent of hoarders suffer from major depression. Some also suffer from anxiety disorders and social phobia.

Cognitive therapy, and not prescription pills, is the most successful method of treating hoarding, he said. Cognitive therapy can be used to address the underlying issues that contribute to hoarding behavior.

There are two different types of interventions, voluntary and involuntary. Most interventions are involuntary.

Intervention roles, Edsell-Vetter said, need to be very clear. There are two primary roles: supporting and enforcement. The enforcement role’s primary responsibility is to explain to the client what is causing the health or fire violations, and what could lead to violations. The support role involves helping the client identify resources for assistance.

“It’s important to be clear what role you should take,” Edsell-Vetter said.

A taskforce made up from different departments will help ease the burden of responsibility and can help with networking for resources and funding. (He suggested looking for hoarding intervention funding by reaching out to local businesses and nonprofits.)

Departments that should be involved in hoarding include housing, protective services, public health and safety/first responders, mental health, and medical and legal professionals, he said. Informal partnerships with cleanup providers and self-help groups can also be useful.

The task force team should have a clear mission and constant communication, according to Edsell-Vetter.

The city of Marlborough informally started a hoarding task team made up of various people across departments that meet on a monthly basis. Deputy Fire Chief Ronald Ayotte said the team’s first objective is to keep staff safe.

Edsell-Vetter recommended having one person be the point person of the group. Creating a list that includes everyone’s address, phone number and email address helps with communication among team members.

Post-compliance monitoring is critical when working with a client, Edsell-Vetter stressed. Short visits are quick and easy and will help the client understand that it’s an ongoing process.

“There is no 1-800 number for hoarding,” Edsell-Vetter said, “We have to build it now, ourselves.”