collector? clutterer? hoarder? · information sharing (cont.) in some cases, where an adult refuses...
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Collector? Clutterer? Hoarder?
Average saving Hoarding Collecting Cluttering
‘Lifestyle Choice?’
Hoarding Disorder-ICD 11
Hoarding disorder is characterised by accumulation of possessions due to excessive acquisition of or difficulty discarding possessions, regardless of their actual value.
Excessive acquisition is characterised by repetitive urges or behaviours related to amassing or buying items.
Difficulty discarding possessions is characterised by a
perceived need to save items and distress associated
with discarding them.
https://icd.who.int/dev11/f/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1991016628
Hoarding Disorder-ICD 11 (cont.)
Accumulation of possessions results in living
spaces becoming cluttered to the point that
their use or safety is compromised.
ICD:https://icd.who.int/dev11/f/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1991016628 Source: https://www.youtube.com/watch?v=OpXB3bi_thk
Hoarding Disorder (DSM-V) (cont.)
If all living areas are uncluttered it is only because of the interventions of third parties (e.g. family members, cleaners, authorities)
Source: Mataix-Cols, et. al. 2010 / http://sd.keepcalm-o-
matic.co.uk/i/please-keep-this-room-clean-tidy.png
Hoarding Disorder (DSM-V) (cont.)
The level of insight varies. Some may recognise and acknowledge that they have a problem; others may not see a problem.
Source: Mataix-Cols, et. al. 2010 /
http://static1.squarespace.com/static/55af53d9e4b0b824e76d2646/t/
568ff0b925981d5681b54093/1452273853167/newLevelOfInsight.png
?format=500w
Hoarding Disorder-ICD 11 (cont.)
The symptoms result in significant distress or
significant impairment in personal, family,
social, educational, occupational or other
important areas of functioning.
Source: Mataix-Cols, et. al. 2010 http://www.safetysign.com/images/catlog/product/large/F7878-
unsafe-area-do-not-enter.png
Hoarding Disorder-ICD 11 (cont.)
The hoarding symptoms are not due to another
medical condition (e.g. brain injury,
cerebrovascular disease, Prader-Willi
Syndrome, etc.)
Source: Mataix-Cols, et. al. 2010 /http://sweet.marketing/wp-content/uploads/2015/03/tick-
box.jpg
Problems within the problem
Many people with hoarding disorder also have associated problems such as indecisiveness, perfectionism, procrastination, disorganisation, and distractibility. These associated issues make the problem more complex.
Source: American Psychological Association /
http://www.olgadegtyareva.com/wp-content/uploads/2014/03/indecisiveness_eusci.jpg
Causes
Brain injuries have been found to cause secondary or acquired hoarding symptoms in some patients.
Source: American Psychological Association / http://previews.123rf.com/images/radiantskies/radiantskies1301/radiantskies130101810/17398262-
Abstract-word-cloud-for-Traumatic-brain-injury-with-related-tags-and-terms-Stock-Photo.jpg
Causes (cont.)
Associated with distinct abnormalities of brain function and neuropsychological performance, distinct from those seen in people with OCD or other disorders.
Significant linkage to compulsive hoarding on chromosome 14 in families with obsessive-compulsive disorder
Source: American Psychological Association / http://www.ncbi.nlm.nih.gov/pubmed/17329475
http://blog.naturaltherapyforall.com/uploads/small/1344332226.jpg /
http://images.alfresco.advanstar.com/alfresco_images/HealthCare/2012
/10/30/7a5a3779-e1e9-4ebd-a55c-3c16dacb4ea8//genetics_MIC030ML.jpg
Causes (cont.)
Comorbid with other psychological disorders, including depression, anxiety disorders, attention deficit/hyperactivity disorder, or alcohol misuse.
A stressful life event, such as the death of a loved one or trauma, can also trigger or worsen symptoms of hoarding.
Source: Mataix-Cols, et. al. 2010 /
https://libbyrosentreter.files.wordpress.com/2014/04/comorbidities.jpg /
https://drbarthwell.files.wordpress.com/2013/07/thoughts-trigger-feelings-black.gif
Person at the Centre
Behavioural
Practical
Psychological
Skills Deficits
Thinking distortions
It’s quite simple, really…
Excessive acquisition
Failure to discard
Hoarder
Declutter
Control acquisition
Spanners, spanners everywhere…
Declutter
Space cleared
Can’t access
Clutter grows
Clutter builds
Won’t clear
Declutter
Re-cluttered
Declutter
Legal actions
The deal changer
Hoarder
Behavioural
Risk
Relational
Psychological Hoarder
Behavioural
Risk
Relational
Psychological
Clutter Index Rating
With a show of hands how many people chose
which rating on the CIR?
We’ll have a brief discussion about why looking
at:
Subjective nature of assessment
oPersonal standards
oPersonal beliefs about cleanliness
Contextualise risk assessment
People who hoard make adjustments in regard to
choosing to live with the clutter:
No heating
Electrical items
Controlled water
Adaptive lifestyle choices
You may judge these, but do they work to reduce
risk?
Fire Brigade
25% of people who died in fires were people living in a hoard
Level 5 and above and/or hazardous materials
Duty to report?
Safety of person as well as professionals
Check your own processes and procedures
Legal
Legal requirement to report risk to self and others.
Mental Health Act 1983 (2007) and/or Mental Capacity Act 2005 relevant?
ASBO’s 2014 (New legislation)?
Care Act 2014 (New legislation)
Eviction
Step-Up
Information Sharing
Practitioners must always seek the consent of the adult at the heart of the concern before taking action or sharing information.
However there may be circumstances when consent cannot be obtained because the adult lacks the capacity to give it but the best interests of the individual or others at risk of harm demand action. (MCA)
Information Sharing (cont.)
In some cases, where an adult refuses consent, information can still lawfully be shared if it is in the public interest to do so. This may include protecting someone from serious harm or preventing crime and disorder. The key factors in deciding whether or not to share confidential information are:
• Necessity – sharing is likely to make an effective contribution to preventing the risk, and;
• Proportionality – the public interest in sharing outweighs the interest in maintaining confidentiality.
Mental Capacity Act (2005)
Capacity is assumed to be in place unless:
Diagnosed mental impairment and;
Issue specific and;
Comprehend information and;
Retain information and;
Make a choice and;
Communicate the decision
Mental Capacity Act (2005)
Section 4: Best Interests
If a person has been assessed as lacking capacity regarding their then a MDT determined best interests decision can be taken on their behalf. Depending on the situation, an application may be required to be made to the Court of Protection.
Tenancy Agreements Hygiene
You must keep your home clean and free
from rubbish and get rid of your rubbish properly if we ask you to.
You must not hoard items in your home if that may be a fire or health risk or prevent access to your property.
If you do not keep to conditions a and b above, we will charge you for any work we do to put the situation right, such as removing rubbish.
You must take reasonable action to control any vermin or pests that enter your home. If you have rats, mice, cockroaches or other vermin or pests in your home, you must report this to us.
Source: http://www.hackneyhomes.org.uk/Your_tenancy_conditions.pdf
Anti-social Behaviour, Crime and Policing Act 2014
Injunction – a way of prohibiting a certain activity or requiring some positive activity from the offender where they have caused nuisance or annoyance within a household context or harassment, alarm or distress elsewhere.
Criminal Behaviour Order – offender convicted or received conditional discharge, caused or likely to cause harassment, alarm or distress to people outside their household and making the order will help prevent them doing it again.
Dispersal Powers – allows police constables to direct people to leave a public place and not return for a specified time.
http://asbhelp.co.uk/what-the-law-says/
Anti-social Behaviour, Crime and Policing Act 2014 (cont.)
Community Protection Notices and Orders – designed to deal with particular, ongoing instances of environmental anti-social behaviour and can be used against individuals or organisations.
Public Spaces Protection Order- dealing with a particular nuisance or problem in a particular public area and the order applies to everyone.
Closure of Premises – prohibits access to premises because use of said premises has resulted in anti-social behaviour.
http://www.newlawjournal.co.uk/nlj/content/mind-gap-2
https://goo.gl/images/psxPmY
Anti-social Behaviour, Crime and Policing Act 2014 (cont.)
Definition of homelessness/ threatened homelessness
Section 175 of the 1996 Act defines that a person is threatened with homelessness if it is likely that they will become homeless within 28 days.
The Homelessness Reduction Act 2017 extends the number of days from 28 to 56. In addition, people who have received a valid notice under section 21 of the Housing Act 1988 and the expiry date is within 56 days, will be treated as being threatened with homelessness.
Homelessness Reduction Act (2017)
Currently, section 179 of the 1996 Act places a general duty on English LAs to ensure that advice and information about homelessness, and preventing homelessness, is available free of charge to everyone in their district.
Under the 2017 Act, LAs would be required to provide or secure the provision of free services to give people in their area information and advice on:
• preventing homelessness
• securing accommodation if
homeless
• the rights of people who are
homeless or threatened with
homelessness, and
• any help that is available for people who
are homeless or likely to become
homeless as well as how to access that
help
LAs would be required to ensure services are designed to meet the needs of particular groups that are at increased risk of becoming homeless
Homelessness Prevention Act (cont.)
Particular groups including (but not limited to);
• care leavers
• People leaving prison
• people who have left the regular armed forces
• victims of domestic abuse
• people leaving hospital
• people suffering from a mental illness or impairment.
Homelessness Reduction Act (cont.)
Duty to assess all eligible applicants’ cases and agree a plan
The prevention duty : In cases of threatened homelessness
The relief duty: In cases where the applicant is homeless
Failure to co-operate by an applicant for assistance
Public authority duty to refer
Homelessness Reduction Act (cont.)
Care Act (2014)
The eligibility decision-making process for adults with
care and support needs involves the consideration of
the following three criteria:
Source: http://www.scie.org.uk/care-act-2014
Care Act (2014) (cont.) Two ways in which outcomes are discussed within the Care Act and guidance:
Desired: Outcomes a person wishes to achieve in order to lead their day-to-day life in a way that maintains or improves their wellbeing. These are the outcomes that the assessment should focus on.
Eligibility: Outcomes set out the minimum eligibility criteria (next slide) local authorities must meet in order to comply. These are the outcomes that the eligibility determination should be based on.
Source: http://www.scie.org.uk/care-act-2014
Care Act (2014)-Eligibility Outcomes for adults with care and support needs
Managing and maintaining nutrition
Maintaining personal hygiene
Managing toilet needs
Being appropriately clothed
Being able to make use of the adult’s home safely
Maintaining a habitable home environment
Developing/maintaining family/other personal relationships
Accessing/engaging in work, training, education or volunteering
Making use of necessary facilities or services in the local community
Carrying out any caring responsibilities the adult has for a child.
Source: http://www.scie.org.uk/care-act-2014
Care Act (2014)-Wellbeing
Source: http://www.scie.org.uk/care-act-2014
Dignity
Free from abuse
Mental Health
Emotional
Economic
Family Life
Personal Life
Suitable Housing
Care Act 2014-Safeguarding
The Care Act statutory guidance 2014 has formally recognised self-neglect as a category of abuse and neglect, meaning that people who self-neglect can now be supported by safeguarding adults approaches, as well as receiving more general support from practitioners.
The term ‘self-neglect’ refers to an unwillingness or inability to care for oneself and/or one’s environment. It encompasses a wide range of behaviours, including hoarding, living in squalor, and neglecting self-care and hygiene.
https://www.ripfa.org.uk/blog/entry/how-can-we-support-people-who-self-neglect
Care Act 2014-Advocacy
Requires local authorities to involve people in assessments, care and support planning, and reviews.
Introduces a new requirement to arrange independent advocacy for people:
Who have substantial difficulty in being involved/ engaged in these processes and;
Where there is no one available to help facilitate this involvement and engagement.
http://www.londoncouncils.gov.uk/London%20Councils/AdvocacyandtheCareActInformationAdvice.ppt
What do we need to do?
When rapport is lost, the skill is to focus on building rapport (by listening, by reflecting and body language) not ploughing on with the agenda.
Facilitator’s ‘response ability’ e.g. cannot change others, but can change your behaviour to get a different response.
Fuller and Taylor 2005
Rapport
Difficulty organising/decision making
B
R
E
A
K
It
D
O
W
N
Time
Task
Process
Inability to discard
Create hierarchy:
What is important
to the person?
Highest risk
priority?
LEAST IMPORTANT
LESS IMPORTANT
MOST IMPORTANT
LESS IMPORTANT
MOST IMPORTANT
Singh
15 Plus!
Wait
• 15 minutes before acquiring
Do
• 15 minutes a day
Remove
• 15 items per session (doesn’t matter how large or small)
Active change-Can/May/Won’t
Three piles:
Goes out immediately
Removed completely
CAN GO
Moves to agreed space
Used, or discarded
later
MIGHT GO
Stays
Put away appropriately
or used
WON’T GO
Singh
If it’s got to go!
Removal
Support in Identifying
Time for labelling
Oversight on the day
Specific
Measurable
Attainable
Relevant
Time-Bound
Remember SMART goals!
