Latest news stories and opinions about the Dental, GP and Care Industries. For your ease of use, we have established categories under which you can source the relevant articles and news items.
Managing the risk of hoarding
I’ve written in the past about the issue of hoarding and the limited legal remedies that might be used to manage this sensitive but at the same potentially dangerous practice. A recent Coroner’s report from Liverpool has shown how dangerous this can be, and points to possible new legislation to manage this.
On a course teaching mental health and mental capacity legislation, I’ve used a video clip of the aftermath of a burnt out house in a wealthy neighbourhood in Vancouver to show the issues. You can view the clip at https://www.youtube.com/watch?v=mWGjxv-L8qI. This video is a news clip of the death of a man in the house, described as a hoarder house, where the house was so full of boxes that firefighters were unable to get into the property to remove the man’s body. They had to literally dismantle the house.
The idea of using the video clip as a learning experience is to generate discussion from the responses of people who are interviewed in the news items. First, the fire officer describes the extreme risks associated with hoarding, so extreme that firefighters could not get into the property through doors or windows. It’s not known whether the person would have survived if firefighters could gain quick access but the risks to firefighters meant the removal of the man’s body took days. Secondly, there are neighbours who say they foresaw something like this happening and something should have been done earlier. Lastly, in the clip a psychologist talks about the mental condition that is hoarding and how complex this can be. So the issues are
- Should authorities have more powers to prevent hoarding becoming dangerous?
- Does current mental health law offer solutions to manage situations like this?
- Is hoarding a mental disorder that can be treated?
So from learning the lessons of this tragedy in Vancouver, let’s move to a more recent tragedy in Liverpool in similar circumstances. In October last year, a couple in their seventies died in a house fire. The fire service could not get access into the house because it was so full of hoarded items they could not get in through doors and windows. Even their car in the drive was full of items that hampered the fire service’s efforts. After using search and rescue equipment to locate the couple, the fire service then excavated the contents from the roof downwards. As they did so they discovered the ceilings of the property were collapsing under the weight of boxes. The couple were found dead in their armchairs.
The cause of the fire was thought to be a small fan heater. The fire service report said they and environmental officers had visited the house a number of times before this to try and give home safety advice but they were refused access. They noted that there are no statutory powers for fire authorities to intervene to deal with hoarding in domestic properties. They made recommendations about a multi-agency protocol to deal with extreme hoarding. Following the inquest into the couple’s death, the Coroner for Liverpool and Wirral sent a report to the Home Secretary which asks for a review of legislation to give the service more powers. The Home Secretary is required to respond to this letter.
In terms of what powers are available now, a guide produced by the Chartered Institute of Environmental Health officers to deal with this issue lists a number of legal remedies, and possibly most powerfully the Environmental Protection Act 1990 which provides powers for local authorities to require the abatement of a range of problems including ‘any premises in such a state as to be prejudicial to health or a nuisance.’ The difficulty with this law and others is trying to enforce it. It may have been difficult to argue that the hazard in either of the case examples I’ve used was about disease or nuisance. The person with the problem may not comply with any legal notices and the legal stakes become higher. The courts may offer a ‘clean-up’ solution but if the person returns to the house the hoarding behaviour will resume.
Using the law
So can mental health law provide an answer? The Mental Health Act and the Mental Capacity Act might offer help where the person has a mental disorder which may be related to their hoarding behaviour. The Mental Health Act may allow the person to be admitted to hospital for assessment and treatment of their condition or to be received into Guardianship to live somewhere else. The Mental Capacity Act could be used where someone lacked the mental capacity to make a decision about their own living conditions and what was in their best interest. All of these solutions would involve removing the person from where they lived, even if temporarily. The underlining nature of dealing with the hoarding behaviour would still need to be addressed.
Origins of hoarding
So that leads us finally to this condition called hoarding. It is not specifically mentioned in a list of typical disorders in the Mental Health Act Code of Practice. The NHS website describes the condition on their website as having a number of origins. They have a useful article which you can read at: http://www.nhs.uk/Conditions/hoarding/Pages/Introduction.aspx
Hoarding may be a feature of a mental disorder such as Obsessive Compulsive Disorder, or it could be a symptom of suffering from depression. There may be other causes. The person may struggle to decide what items should be kept and which ones to discard. It may be part of a pattern of self-neglect. It may follow a pattern of lifelong behaviour, or the hoarding pattern of their parent. The consequences of hoarding may not be as catastrophic as the cases I’ve written about. However, there could be risks to health from keeping rotting food, or an excessive number of animals. There could be financial risks by allowing unopened letters and bills to pile up. In deciding whether hoarding is a problem we need to think about the risks associated with it. A useful question might be - is the impact on the person’s life (or potentially the people next door) of the hoarding behaviour so severe that the consequences of action, however distressing or disruptive, would outweigh the risks of no action?
*All information is correct at the time of publishing