The messy world of hoarding

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A new study shows that hoarders resist help and groups trying to help them declutter find it difficult even to gain entry to their homes.

One cramped flat was filled with teetering piles of newspapers soaked in cat urine. Another reeked of rotten eggs and mould, with cockroaches multiplying underneath the clutter that the flat owner was still hoping to sell.

The occupants of both flats resisted help and weeks turned into months before their hoarding problems were resolved.

These issues are typical of the challenges faced by social service organisations and welfare groups as they try to tackle the problem of hoarding in Singapore, a new qualitative study led by researchers from the Institute of Mental Health (IMH) has found.

Often pressured to find quick-fix solutions, these groups are hampered by resistance from the people they are trying to help and find it difficult even to gain entry to their homes to begin the decluttering process, the study said.

It was put together following interviews with 18 members of Singapore's hoarding task force, which was set up in 2014 and involves several government agencies, including the Housing Board, Singapore Civil Defence Force (SCDF) and various ministries.

The paper was published in the Singapore Medical Journal in January, with its authors noting that the findings echoed those from similar studies done in the United States. Common themes included resource constraints and enforcement issues, although the pressure to deliver a quick fix seemed uniquely Singaporean.

"This may be in part due to the lower tolerance for unhygienic clutter of people in the neighbourhood of individuals with hoarding behaviour," the authors said.

 

WHEN CLUTTER CROSSES THE LINE

Hoarding was recognised as a standalone medical condition distinct from obsessive-compulsive disorder by the World Health Organisation only in 2018.

But around the world, studies far predate this classification. Some researchers have suggested a possible genetic cause, while others note that hoarding behaviour could be linked to loss or trauma.

In Singapore, a 2010 IMH study found that one in 50 people will display hoarding behaviour at some point in their lives.

Unlike mere clutter - which can be the result of a person being unable to clean his home due to mental or physical impairments - those who hoard often have a strong reluctance to part with accumulated items even if they are not useful, said Dr Kelvin Ng, a consultant at IMH.

They may even experience emotional distress, such as anxiety attacks, when asked to discard them, he added.

For some people, hoarding behaviour may be due to underlying mental health problems such as severe depression, schizophrenia or obsessive-compulsive disorder, Dr Ng said. When the illness is treated, hoarding behaviour may improve as well.

But not every case of hoarding behaviour is caused by an underlying illness, he said. Instead, they have typically experienced losses or stress in the past, leaving them with an emotional void which they may try to fill with physical items.

The Sunday Times spoke to five organisations that help those who hoard, including non-profit and volunteer groups. All attested to the difficulty of getting people to give up what they see as treasured items.

Ms Faith Png, a senior social worker at one of Montfort Care's Goodlife! centres, recounted the case of an elderly man who accumulated objects in his flat for more than 20 years. "I don't think he realises he has a hoarding issue," she said. "Even after a year of working with him, he doesn't feel that he's hoarding. They're all his things - they all have purpose."

Ms Sandy Goh, regional head of Touch Senior Activity Centre, said some people refuse to part with things they believe will be needed one day, or objects that hold sentimental value and are linked to the owners' sense of identity and security.

Her organisation took six months to convince an elderly couple, whose house was packed with second-hand items they hoped to sell, to get rid of the clutter. Their flat was cleared within two days but after some years, it was full again.

It is often hard to help such people understand why hoarding is a problem, Ms Goh said. "Many do not think it is an issue, even when their pile of trash reaches the ceiling or if their home is infested with bedbugs."

Ms Fion Phua, founder of informal volunteer network Keeping Hope Alive which pays regular visits to low-income households, said that simply broaching the topic can be a challenge.

"They don't want to open the door. They don't want to see you and they don't want to let you see them. They don't want to communicate at all," she said.

Last month, a 48-year-old woman died after her three-room flat in Ang Mo Kio caught fire. The SCDF said firefighters' movements were "severely impeded as they had to carefully manoeuvre over heaps of items".

When contacted, Ang Mo Kio Town Council said it had not received any complaints about the unit before the fire. But the area's MP, Mr Gan Thiam Poh, added that in his experience, these issues can prove tricky to resolve.

He recounted one incident involving a woman whose belongings had spilled out of her house, into the corridor and onto the staircase landings directly above and below her floor. The woman had suffered a blow after her business failed, and the situation took months to resolve.

"Sometimes people threaten to commit suicide, so you have to be very careful especially if the person is already very emotional," Mr Gan said. "You want to take care of that particular person's safety, without compromising public safety."

 

ROAD TO RECOVERY

When it comes to helping people declutter, building trust is the first and most critical step, with months often elapsing before a person is ready to take the plunge.

Social workers often show "before and after" pictures to motivate homeowners, and highlight the dangers of clutter and inconvenience to other people, Ms Goh said.

The flats are then formally assessed, with volunteer groups meeting homeowners to discuss the logistics, as well as what items should be disposed of.

During the actual cleaning process, homeowners can usually see everything that is going on in the house, said Ms Sim Chunhui, who is overall-in-charge of Project HomeWorks under Habitat for Humanity Singapore.

Her team of volunteers takes on cases referred to them by other organisations, providing the manpower needed to clean homes.

"It goes at a reasonable pace, not crazy fast such that the changes happen overnight," Ms Sim said. "It can go very fast, but doing so can traumatise the homeowner emotionally."

Sessions are usually kept short, from three to four hours, she said. "Emotions can run quite high and not just on the homeowner's part. Even staff and volunteers can get very stressed with the surroundings when the air is bad, you are in a mask and you can hardly breathe."

In many cases, the Housing Board is also called in to help with fumigation or repair works, while town council staff clear clutter along corridors.

Ms Goh stressed the importance of managing expectations on all sides, adding that volunteers are always reminded to respect the homeowners' wishes and get their consent before discarding items.

"It is their home. Sometimes, it could be a situation where the home is only half-decluttered and that is good enough."

Ms Phua said those who hoard often "have their pride and reasons". "We must understand their reasons and do according to their wishes."

Although hoarding often causes friction between the hoarders and their relatives or neighbours, the experts said there are various ways to help.

Care, patience and understanding are the key to helping family members with hoarding disorders, said Dr Chew Yat Peng, a principal counsellor at voluntary welfare organisation O'Joy Care Services.

Although family members may try to drive home the dire consequences of hoarding - such as the risk of fires - this approach may not get the desired results, she said. "You need to find out what motivates them, what are some of the goals and values they have in life and help them fulfil them."

Montfort Care's Ms Png said those in need of help often lead lonely lives and have a need for connection with others. "If the relatives haven't really sat down and connected with the person, maybe it's time to do that," she said.

She and her team try their best. But Ms Png added: "You can't really replace a family member with a social worker."

Meanwhile, neighbours and members of the public can try to have more empathy and understanding, said Ms Janhavi Vaingankar, who is deputy director of IMH's Research Division and lead researcher of the study. For instance, getting neighbours involved in the mitigation process, where possible, can help improve tolerance and understanding on both sides, she said. It also eases pressure on service providers, allowing them a longer lead time to build trust.

Neighbours can serve as the first line of help for people with hoarding problems, alerting social service providers to issues, Ms Goh said, adding: "We cannot do this alone."

 

Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.

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