Takeaways from a hoarding intervention strategy

Hoarding poses increased fire safety risks as hoarded items often include combustibles — such as reading materials or clothing — piled on or near heating sources. Hoarded materials may also impede escape in the event of fire and can impair first responder entry, navigation and exit.

Hoarding is identified by the American Psychiatric Association as a mental disorder characterized by the accumulation of clutter to the point where it interferes with the functional use of the home. Between two and six percent of the general population is estimated to suffer from the hoarding disorder.

Hoarding intervention challenges

An effective intervention into a hoarding situation by fire departments and community agencies can be difficult. Residents may:

• Be embarrassed about their behavior.
• Lack the organizational skills to make necessary changes.
• Be overly attached to belongings.
• Lack insight into dangers posed by hoarding.
• Revert to the same behavior if moved to a new location.
• Reject the authority of enforcement officials.

The City of Vancouver’s intervention approach

In May 2012, the City of Vancouver (Canada) formed a multi-agency Hoarding Action Response Team (HART) comprised of fire and property inspection departments, along with mental health workers from the city’s health department. Their purpose was to build a coordinated intervention whenever hoarding cases were identified.

Vancouver Fire Rescue Service Protocol

Upon referral, a fire inspector and health official will:

• Make an initial visit to see if the case is serious enough to warrant an intervention.
• Assess home safety and the physical and mental health of the resident.
• Work to develop a good relationship with the resident to get voluntary entry for the fire inspection.
• Determine if a situation involves imminent danger. Such a situation triggers immediate action by the HART. This might include steps such as installing smoke alarms, disconnecting the stove if open flames are near combustible items, and in extreme cases, barring anyone from living in the home until the fire danger is resolved.
• Communicate the health and safety concerns to the resident(s) following inspection. The HART will then develop an intervention strategy that often involves repeated visits to the home to ensure progress is made toward compliance with safety issues.

The team will also make referrals for social, health and mental health resources. Health workers may assist by:

• Advocacy with landlords.
• Engaging social services.
• Helping the resident set manageable weekly goals.
• Educating family members and the resident about hoarding.

Key takeaways from the HART intervention approach

1. Hoarding cases can be particularly challenging if there are many fire code violations or if the hoarder is a homeowner. Homeowners have strong property rights and can delay inspections and withhold cooperation.
2. Hoarding cases require patience. For this study, cases took an average of 4 ½ months to resolve. Ninety-four percent of the cases were successfully resolved by using an informal, relationship-oriented strategy.
3. Build goodwill and form a supportive relationship first. Offer community services, such as free smoke alarm installation, to gain voluntary admittance for the initial inspection. Raise the possibility of legal sanctions, such as fines and eviction, only if necessary.
4. Invest resources into hoarding intervention. You must ensure inspectors are trained to recognize when egress problems or excessive combustibles pose an imminent danger or when a slower approach is acceptable. Train staff to understand hoarding as a mental illness and how to effectively collaborate with other community agencies.
5. Communication is key. All team members must be consistent in their communications with hoarding residents, so good case notes are essential. Hoarders often may not fully recognize the severity of their problem and their motivation to make changes can fluctuate. For the best success, give clear, specific and manageable goals to hoarding residents.