Social work 3.2 Hoarding
Mental health - Laurie Lutonski, works at ypsi township
Washtenaw has one of the most resources in michigan
Social workers should be connected to the local government so that you can get resources for patients.
Laurie worked at CMH(community mental health)
Hoarding disorders, DSM(Diagnostic and statistical manual) 5, billing code book for psych disorders, behavioral stuff
Help people develop new ways of dealing with things and behavioral things
It has to be up to the person to change
Manage your expectations, its up to what the client wants
First reference of hoarding was in Dante's inferno in 14th century
First psychological reference was in 20th century
DSM III 1980 linked it to OCD
Then in 2014 DSM V came out and recognized it
Media coverage in 40s with the Collyer brothers
The brothers were discovered dead, they had to cut a hole through roof and dig down to find them because they couldn't find them due to all the stuff
Edith Bouvier Beale and daughter 1970s
Hoarder
Washtenaw county hoarding task force
A collaborative effort of both public and private agencies throughout washtenaw county
They raise public awareness, reduce community impact, provide early intervention, and develop best practices
Hoarding is on a spectrum
Starts at clutter and then eventually gets to hoarding
Can be started by depressive episodes, or other things that cause cause you to have clutter
Difference between clutter or hoarding
Excessive clutter items can be discarded and items are accumulated without much thought. The volumes of items does not interfere with the person's ability to use their home for its intended function
Hoarding disorder is collecting a large number of unneeded items, regarding all items as equal valuable, activities of daily living unable to be performed because areas blocked by items, and thoughts of discarding items causes great distress
Key characteristics
Difficulty discarding items, acquiding excess items(¾ hoarding engage in excess shopping, 50% collect free things), organizational problems
There is some evidence of genetic links
No evidence showing prior deprivation in life has significant impact in the development of or causation
Insight
Lack of awareness of severity of hoarding problem is common and a treatment challenge (clutter blindness)
Most persons seek treatment after being pressured by loved ones or landlords, city officials, etc
Often believe they can discard, but their approach is so time consuming it can never happen
See item acquisition retention as pleasurable and helpful
Multifaceted
Information processing
Emotional attachment
Mistaken beliefs about possessions
Behavioral avoidance
Underlying beliefs
Underlying hoarding disorder is a set of beliefs about the nature and meaning of possessions. Each of these beliefs is related to an overestimation of catastrophe or loss
Perfectionism- perfection is not only possible, but also expected
Responsibility - feel more responsible to meet future needs, “just in case”. A second type of responsibility is for the proper care and use of possessions; guilt and waste. Ownership carries with it a responsibility to use a possession properly
Need contro- less willing to share or to have others touch or use their possessions
Emotional comfort- without my possessions i will be vulnerable
Prevalence
Hoarding disorder is found in the elderly and lower Socioeconomic groups
Hoarding behaviors are considered more prevalent than previously expected
Some estimated show serious hoarding behavior to occur in 1 out of 50 people, others may be as high as 1 out of 20
Men more often found to exhibit hoarding behaviors more than women
Women who display hoarding behaviors more likely to seek treatment
Hoarding behavior is found to run in families
Excessive storage as a problem
Fire hazard, problem for others
Stressors
Legal issues, eviction, divorce, etc
Harm reduction model(HRM)
Recognizes that abstinence is not always possible
Minimize adverse social, health, and economic consequences
Motivation positive change through small steps
Five levels of hoarding, focuses on
Structure
Household functions
Pets and rodents
Sanitation and cleanliness
Level 1
Minor clutter
Doorways and stairs are accessible,
Like a busy week
Level 2
One exit is blocked
Major appliances don't work
Some pet odor
Clutter may inhibit use of a room
Limited evidence of housekeeping
Level 3
Visual clutter
Indoor items stored outdoors
Minor structural damage
Excessive pets
Small amounts of hazardous waste
Bathroom unusable
Narrow hallway
Level 4
Structural damage
Mild or mildew
Hazardous electoral wiring
Excessive pets with poor care
Bedroom unusable
Rotting food
No clean dishes or utensils
Level 5
Significant structural damage
Electrical, sewage and or water disruption
Fire hazard
Infestation
Huma defecation
Rotting food
What does not work with hoarding disorders
Quick clean outs not effective
Throwing things away in secret or lying to hoarder
Forced discarding often increases distrust of others and increases attachment
May cause increased collecting a fear of losing items increase
Tips for addressing hoarding disorder
Divide living space into small targeted areas
set multiple short term inspection of targeted areas
Be specific about your expectations for each area
Leave written instructions when possible
Follow through with inspection
Work with the person while encouraging them to keep working
Help the person maintain focus on the task at hand
Only handle it once rule, make decision in less than 5 minutes
Limit choices when making decision
Use objective standards, like how big pathways need to be
Be careful not to judge