The Public Health Challenge of Hoarding (50m Lecture)

Reports of problematic hoarding are increasing and are creating new challenges for Public Health Departments. Issues related to living conditions, accumulation of refuse, environmental and odour issues, possession of many animals, disruptive and harmful behaviours and self neglect demand an effective community response.

Many of the problematic hoarding situations are difficult to resolve, resolution rates are low and recurrence rates are high. Many cases involve isolated seniors and individuals with diminished capacity and other vulnerabilities that may hinder residents from understanding and accepting interventions and/or mitigation efforts.

Hoarding has serious personal, as well as public health implications. There is an increased risk of health and safety problems both for the individual who hoards and for those living with or near them. In addition, it has been reported that other community supports and services have refused or withdrawn services due to the potential risks or lack of ability to access these at risk homes (Steketee, Tolin & Kim, 2001) .

Although anyone can be affected by hoarding, people living in poverty are four times more likely to be compulsive hoarders (Tolin, 2010). Further, people who live in poverty typically live in high-density neighbourhoods, and the quality of the living environment can be significantly affected by hoarding behaviour.

There are extensive social and economic costs associated with compulsive hoarding. According to Tolin et al. (2008), compulsive hoarding is associated with higher economic costs for the individual, the community and to society than most other psychiatric disorders. These costs include lost work productivity, mental health services, non psychiatric medical costs and other community agency or organization involvement. Hoarding causes stress to both individuals and communities and can result in evictions, homelessness and threats to public safety.

Declining, not understanding or resisting service provided often results in additional practical and ethical problems for agencies, boards, commissions, corporations and divisions (ABCDs) in delivering services or discharging their mandates. Ultimately, the goal for problematic hoarding situations is to have timely response interventions through multi-agency approaches with supportive service delivery and long-term support, with reduced recurrence.