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‘Floor to ceiling porn’: how new psychiatric definitions impact staff and patients

Picture credit: annrkiszt (Flickr)

Picture credit: annrkiszt (Flickr)

Blair McPherson looks at how the inclusion of ‘hoarding behaviour’ as a mental illness in a new psychiatric manual could impact social work practice.

In his hospital bed he looked like a frail old man. The fall had shaken his confidence. He had lain there all night on the floor until the meals on wheels people found him. He wanted to go home.

The doctor wanted him discharged and out of the bed. But there was a problem. The home visit with the Occupational Therapist and the social worker had revealed a life time’s collection of pornography.

It was not the content of the magazines – the OT and social worker considered themselves unshockable – it was the sheer volume. Floor to ceiling porn.

The hallway had magazines two deep and six foot high either side leaving a narrow passage way from front door to kitchen. The front room had magazines staked high on the table and all the chairs.

It was the same upstairs, only the bathroom and kitchen were free of his reading material. There was a real danger that one of these towers of porn would collapse on to you to say nothing of the fire hazard that this ware house of adult literature presented.

The man wanted to go home. The hospital wanted him to go home. The social worker wanted him to go home but he would need more than just meals on wheels. He needed a home help. The home help supervisor visited and said no way can I let my “girls” visit this house.

The problem was not the pornography or providing support to a “sad dirty old man” but a health and safety issue. The house was too cluttered to be a safe work environment. The magazines would have to go.

The social worker explained the situation to the ward staff but emphasised that neither she nor the home help could throw out anything belonging to the patient against his wishes. He didn’t see why he should have to throw away any of his collection.

There was a brief discussion as to whether this behaviour constituted some sort of mental health problem but no one seriously thought it did. Someone needed to take the decision to clear the clutter.

There was a real risk of a prolonged stay in hospital followed by a transfer to an old people’s home – something he didn’t want and didn’t need. In the end, in the absence of any relatives, the social services manager responsible for the care budget made a financial decision. A clean up team was sent in.

Yet the response may be different in the future because the latest edition of a psychiatric manual published on behalf of the American Psychiatric Association has included this type of hoarding behaviour as a mental illness.

The Diagnostic Statistical Manual of Mental Disorders is a globally recognised publication and has considerable influence on the treatment and diagnoses of people with mental health conditions.

I am neither a psychiatrist or a behavioural psychologist but have worked alongside these professionals.

In my experience the psychologists would say they may be able to help and the psychiatrist would say ‘well it may be a mental health problem’ but this type of low level mental health problem would not be a priority for the community mental health team, a response GP’s would recognise.

So the risk is that no one will accept a referral from a GP either because it is a mental health condition and therefore the responsibility of the community mental health team, or because it’s a condition the psychiatric service is not funded to deal with. In the current financial climate it must target resources at those in greatest risk.

Blair McPherson is an author and commentator on health and social care 

About Andy McNicoll

Andy is community editor at Community Care, with a focus on reporting on mental health. He has previously worked for titles focusing on the NHS and substance misuse sectors. You can contact him at andy.mcnicoll@rbi.co.uk

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