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Cluttered Minds
by Belinda Lyons
The San Francisco Task Force on Compulsive Hoarding and Cluttering is a joint initiative of the Department of Aging and Adult Services and the Mental Health Association of San Francisco. The task force launched in the summer of 2007, convening representatives from major city departments, nonprofit housing and service providers, and others to strategize on how to facilitate needed collaboration among service systems to implement multidisciplinary strategies to reduce the negative impacts of compulsive hoarding in San Francisco. “Compulsive hoarding can take a huge toll on people who hoard, their families and friends, as well as their landlords and neighbors and many public and private health and safety departments and agencies,” said Tom Ammiano, California State Assembly member and Hoarding Task Force member.
Through its 19-month collaboration with private and public community agencies, as well as individuals suffering from hoarding behaviors, eight recommendations were created to address the high human and financial costs of compulsive hoarding behaviors.
Compulsive hoarding and cluttering is a serious and treatable behavior that is often related to several mental illnesses, including obsessive-compulsive disorder and major depression. Hoarding behaviors have significant negative effects on people who struggle with them, their loved ones and the community, including tenants and landlords. Compulsive hoarding and cluttering is characterized by the acquisition and retention of overwhelming quantities of objects that do not—to an outsider—seem useful or necessary, and that cause the individual significant distress or impairment.
An estimated 12,000 to 25,000 San Franciscans struggle with compulsive hoarding and cluttering. Hoarding behaviors create isolation, safety hazards, risk of eviction and homelessness, and conflicts with family members, neighbors and landlords. Research conducted by the task force found that above and beyond the negative personal suffering caused by compulsive hoarding, these behaviors are costing the City of San Francisco approximately $6 million annually.
The task force’s recommendations were developed in response to the results of extensive research into how compulsive hoarding is affecting San Francisco. The task force examined the current research and work of other task forces across the country and undertook locally specific research: focus groups consisting of people with hoarding behaviors; surveys of people with hoarding behaviors; key stakeholder interviews with police, first responders, housing providers, mental health providers, policymakers and social service agencies; an environmental scan eliciting information from a wide array of service providers; and, lastly, a landlord survey of SFAA members about their experiences with hoarding tenants. The economic analysis and survey research was conducted by Wendy Max, co-director of the Institute for Health & Aging and adjunct professor of Medical Economics at the University of California, San Francisco.
The task force found that people with hoarding and cluttering behaviors use a variety of services, including healthcare services, behavioral health services, social services and legal services. Impacted agencies and organizations include the Department of Aging & Adult Services, the Environmental Health Section, the Department of Public Health, the Housing Authority, the San Francisco Fire Department, the San Francisco Police Department, Animal Control, legal aid, health clinics, behavioral health centers and senior service agencies. Individuals who compulsively hoard also interact with private agencies, such as cleaning services, professional organizers, landlords, and medical and behavioral health programs. Use of these services results in the significant costs noted above.
It was found that hoarding behaviors create some serious safety concerns, such as fire risk, risk of falls to occupants and pest problems. The fire department may become involved if a fire hazard is identified or a fire occurs. Police involvement may result from complaints filed by neighbors, family members and others. If eviction proceedings occur, the property owner and the tenant might both incur legal costs. In the case of older individuals with hoarding behaviors, legal costs may also be incurred if the individual’s capacity to make decisions and/or ability to live independently is questioned and guardianship is sought.
The landlord survey, conducted in partnership with SFAA, surveyed 80 landlords on how compulsive hoarding impacts them, and noted specific challenges including pest infestations, the need for heavy cleaning, the need to involve animal control, injuries and fires. Costs mentioned by landlords surveyed included pest infestations ($50-$1,499), animal control costs ($200-$1,499), foregone rent ($1,000-$3,999), eviction-related costs ($2,000-$74,999), and heavy cleaning ($75-$3,999). A small number of catastrophic events (evictions costing $50,000-$74,999 and a fire-related cost exceeding $500,000) were also reported.
Organizations providing services to people with compulsive hoarding behaviors noted additional staff time, costs and challenges in finding staff to work with clients with hoarding behaviors. One tenant attorney commented that he could resolve 20 nonhoarding eviction cases in the amount of time it took to resolve one hoarding case. Twenty-nine percent of agencies surveyed reported higher costs to serve individuals with compulsive hoarding behaviors, ranging from $50 to $20,000 per client
Eight Recommendations
These findings reinforced the idea that collaboration is needed to adequately address the human and financial impacts of compulsive hoarding and cluttering behaviors in our communities. To improve local response to compulsive hoarding, the Task Force recommends that the appropriate entities undertake the following activities:
- Develop an assessment team/crisis team to respond to referrals about hoarding cases and coordinate appropriate next steps to facilitate meaningful, long-term improvement for individuals.
- Increase access to treatment for hoarding, including in the person’s home. Treatment can include therapists, organizers, coaches and peers, using a team that aligns with identified best practices and local experience.
- Expand support groups available locally, including peer support groups, groups for family members and training for peer support facilitators. Build on the successes of support groups by offering groups for people at different stages of dealing with their hoarding behaviors, ranging from early awareness and those just starting out to those with substantial experience working on behavior changes.
- Create a services roadmap for people with hoarding behaviors and their families, service providers and landlords so that people know what agencies to contact in different situations and have a way to identify and seek assistance. Establish a single point of entry into the system of supports and resources that uses a single form for referrals, follows the services roadmap and engages the assessment team.
- Develop evaluation guidelines for landlords that coordinate with fire department and health regulations.
- Provide long-term case management services as an extension of initial assessment and treatment.
- Offer training for therapists, 2-1-1/3-1-1 staff, landlords, agency staff and families; recruit and train trainers; provide cross-training for identification, screening and assessment across agencies.
- Ensure overarching coordination and evaluation of recommended priorities (hoarding and cluttering “czar”); track implementation of priorities and evaluate success.
The San Francisco Task Force on Compulsive Hoarding has broken new ground in its efforts to assess and respond to compulsive hoarding. The proposed recommendations are designed to address this multifaceted problem and will result in greater coordination, new resources and a clearer sense of how to navigate available services. Task Force members will be working with policy makers and other constituents in the months ahead to advocate for the implementation of these recommendations.
The opinions expressed in this article are those of the author, and do not necessarily reflect the viewpoint of the SFAA or the SF Apartment Magazine. Belinda Lyons is the executive director of the Mental Health Association of San Francisco. The Task Force Report can be downloaded from the MHA-SF website at www.mha-sf.org. Training materials and other resources on compulsive hoarding are also available on the MHA-SF website. For more information, contact the Mental Health Association at 415-421-2926 x. 304. Copyright © 2009 by Black Point Press. All rights reserved.