This article showcases excerpts from a guide on Community Care Inform Adults about working with adults who hoard, written by safeguarding trainer Deborah Barnett. The full guide covers types of hoarding, assessment tools and supporting someone to change. Subscribers can read the guide on Inform Adults.
What is hoarding?
Hoarding can be described as the collecting of, and inability to discard large quantities of goods, objects or information. Hoarding may involve neglecting aspects of the home and/or self, resulting in poor sanitary conditions and social isolation which eventually impact on the person’s physical or emotional wellbeing.
Hoarding is characterised by:
- An intense emotional attachment to objects that are not regarded as having the same value or worth to others.
- The person feeling a sense of loss were they to dispose of the object.
- The person perhaps seeing other value in the object such as environmental recycling use, or intrinsic value, for example, seeing the object as a thing of abstract beauty such as pebbles, stones, driftwood or artwork.
Issues of capacity
Working with a person who hoards is likely to raise issues of whether the person lacks mental capacity to make particular decisions. This may particularly be the case when the person is reluctant or refusing to accept help for their hoarding, and practitioners may question whether the person has the capacity to refuse.
The first three principles of the Mental Capacity Act 2005, set out in section 1 of the act, support people’s right to make decisions where they have the capacity to do so:
- A person must be assumed to have capacity unless it is established that he lacks capacity.
- A person is not to be treated as unable to make a decision unless all practicable steps to help him have been taken without success.
- A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
The third principle is perhaps particularly relevant to working with a person who hoards.
Section 2(3) of the act also makes clear that a person’s lack of capacity cannot be established simply by “an aspect of his behaviour, which might lead others to make unjustified assumptions about his capacity”.
However, the Mental Capacity Act code of practice states that one of the reasons why people may question a person’s capacity to make a specific decision is “the person’s behaviour or circumstances cause doubt as to whether they have capacity to make a decision” (4.35, MCA code of practice, p52). Arguably, extreme hoarding behaviour meets this criterion and an assessment of capacity should take place.
Under section 2 of the MCA, a person lacks capacity to make a decision if they are unable to make the decision at the material time because of an impairment or disturbance in the functioning of the mind or brain. As set out above, this is likely to apply to a person who hoards because it is often a symptom of a mental health condition or can be seen as a disorder in its own right.
Under section 3, a person is unable to make a decision if they are unable to:
- Understand the information relevant to the decision.
- Retain that information.
- Use or weigh that information as part of the process of making the decision.
- Communicate their decision, whether by talking, using sign language or other means.
Any capacity assessment carried out in relation to hoarding must be time specific, and relate to a specific intervention or action. This may include decisions about where a person should live, their tenancy agreement, care provision, healthcare or more generally accepting support for their hoarding.