I expect many of us working across a range of social care services have come across a service user who lives in total squalor, often amassing piles of rubbish and seemingly unable to throw anything away. It can be absolutely baffling trying to understand the reasons behind such extreme behaviour, and it can also make us feel like failures in our jobs when even our most assertive attempts to try to help them clear their home up a bit are flatly refused. Hoarding can present huge risks to the service user themselves, their family, neighbours and even the wider community around them. Fires, floods, electric shocks, vermin, structural damage as well as the more hidden issues around quality of life are all potential problems; in other words a lot of work for a social care worker!

Despite these difficulties I can bet that very few of us have ever had any formal training around hoarding. In the USA there are specific programs based on cognitive behavioural techniques that are showing some success, but what about us? Fear not! It may be that our existing skills put us in a good position to work effectively with hoarders, at any rate, this is one of the findings from my recent dissertation as part of my Masters in Social Work at Goldsmiths College.

* A long term approach is essential. Progress comes slowly, and must be at the client’s pace.

* Good rapport and trust with the client are essential if any progress is to be made. With whom the relationship is made is immaterial, and this role can fruitfully be carried out by community support teams given that they are committed and skilled enough to work sensitively.

* Blitz cleans or other cleaning interventions that occur without the clients’ good will are likely to fail. They should be seen as a short term solution if they are to be used at all.

* Where family members are involved with hoarders they often represent the only social contact outside of professionals. It may be of benefit to consider collaborative work with families in order to foster a therapeutic relationship and improve living conditions.

* Workers must be aware of the power inherent in their role and check that their own desire for cleanliness does not dominate.

* Workers must expect difficult feelings of frustration and powerlessness. This appears to be the norm with this client group.

* Consider the use of talking therapies where available, but be prepared for resistance!

All the people I interviewed talked at length about the frustration they felt, and the difficulties in effecting any meaningful or lasting change. It certainly made me look back with less remorse at my own chaotic attempts to work with hoarders and understand that my experience was not unusual. As we know, success must be measured in modest amounts in social care, and hoarding is no exception. According to my study, hoarders responded best when they could really trust a worker, and it was these longer term, practical relationships that seemed to prompt improvements in living conditions. Where our own roles do not allow for this kind of intensive support, we can aim to find more appropriate help elsewhere. I found that workers often negotiated a delicate balance between respecting the lifestyle choice of the service user and making them aware of the realities of eviction, Environmental Health departments and even the police. It is these skills of creating rapport, respecting choice and offering support to deal with life’s difficulties that make social work and social care values an important tool in working effectively with hoarders.

Alison Barr