Self-neglect and hoarding

"Cases of self-neglect are complex and pose ethical dilemmas between promoting individual autonomy and fulfilling a duty of care……..” The University of Sussex, 2014 

Responding to self-neglect can be one of the most complex areas of practice for today’s professionals, partly because self-neglect and hoarding often present within the context of personal choice. This creates a tension between a fundamental aim of safeguarding, that of reducing risk and implementing Making Safeguarding Personal (MSP). Individuals experiencing self-neglect can often put themselves and others at risk through their actions e.g. by creating a fire hazard. 

Self-neglect can be a difficult issue for friends, family, professionals and volunteers to address.  There is a need to find the right balance between respecting a person’s autonomy, their rights and choices with a duty to protect health and wellbeing. 

In some circumstances, where there is a serious risk to the health and wellbeing of an individual, it may be appropriate to raise self-neglect as a safeguarding concern. 

It is important to determine whether the person has capacity to make decisions about their own wellbeing, and whether or not they are able or willing to care for themselves. An adult who is able to make choices may make decisions that others think of as self-neglect. 

If the person does not want any safeguarding action to be taken, it may be reasonable not to intervene further, as long as: 

• no-one else is at risk
• their ‘vital interests’ are not compromised – that is, there is no immediate risk of death or major harm
• all decisions are fully explained and recorded
• other agencies have been informed and involved as necessary. 

Hoarding is the excessive collection and storing of items, often in a chaotic manner, to the point where their living space is not able to be used for its intended purpose.

Many people who hoard don’t see it as a problem, or have little awareness of how it’s impacting their life or the lives of others. Others realise they have a problem, but are reluctant to seek help because they feel extremely ashamed, humiliated or guilty about it.

Hoarding is considered a significant problem if: 

• the amount of clutter interferes with everyday living – for example, the person is unable to use the spaces designed for living in such as kitchens living rooms bathrooms because they have become “store rooms”. 

• the clutter is causing significant distress or negatively affecting the person’s quality of life or their family’s 

A person with a hoarding disorder may have significant difficulty in discarding or parting with possessions. They may experience distress at the thought of getting rid of items or simply be unable, either physically or through other health-related factors, to get rid of things despite acknowledging that changes need to be made. 

Hoarding is considered a standalone mental health disorder, however, it can also be a symptom of other medical disorders. Hoarding could also be a sign of an underlying condition, such as OCD, other types of anxiety, depression and dementia. It is not a lifestyle choice and hoarding must always be treated as a sign of vulnerability. 

Types of hoarding: 

• Compulsive hoarding – one type of object or collection of a mixture of objects, such as old clothes, newspapers, food, containers, human waste or papers. 

• Bibliomania – books and written information, such as newspapers, magazines and articles, as well as DVDs and videos. It can also include ‘data hoarding’, which is the excessive storage and reluctance to delete electronic material which is no longer of use – such as computers, electronic storage devices, copies of emails, and other information in an electronic format.

• Animal hoarding – this is often accompanied with the inability to provide minimal standards of care. The person may be unable to recognise that the animals are at risk. The homes of animal hoarders are often eventually destroyed by the accumulation of animal faeces and infestation by pests. 

If you suspect someone has a hoarding disorder, try to persuade them to see a GP.

Reassure them that nobody is going to go into their home and throw everything out. You’re just going to have a chat with the doctor about their hoarding to see what can be done and what support is available to empower them to begin the process of decluttering.

Clutter Image Ratings are available to download here. These can then be used to assess the condition of a hoarded home and the hoarder’s level of insight. 

Self Neglect and Hoarding Toolkit

Appendix 1 - Hoarding and Clutter Rating Scale

Appendix 2 - Self Neglect and Hoarding Risk Assessment &Defensible Decision Making Tool

Appendix 3 - Actions following determination of Risk

Appendix 4 - Myths and Truths

Further information and resources 

Working with People who Self Neglect– Research in Practice (RIP) includes practice tips, a case study, detailed assessment and legal resources 

NHS Choices – Overview of Hoarding Disorder - Includes distinction between hoarding & collecting, indicators and potential treatments. 

A Psychological Perspective on Hoarding – British Psychological Society PDF that provides guidance to those working with individuals that hoard. 

Hoarding and how to approach it – guidance for Environmental Health Officers and others

– This is a professional practice note that provides an overview of the issue, the statutory powers to address it, and case studies to highlight possible responses.