Hoarding
Amendment
In March 2025, the chapter Self-Neglect and Hoarding was replaced by two new chapters ‘Self-Neglect’ and ‘Hoarding’
Hoarding involves the acquisition of items with an associated inability to discard things that have little or no value (in the opinions of others) to the point where it interferes with use of living space or activities of daily living. The types of items which are hoarded may include household items such as newspapers, books, letters, clothes, containers or household supplies. Some people also hoard animals or data. The Mind website provides further information on types of hoarding, see: Hoarding.
Hoarding should not be seen simply as a lifestyle choice or the way someone prefers to live. Even if the adult has the mental capacity and is declining support, professionals should still try to engage with the person and explore ways in which they can support.
Hoarding is recognised as a mental health issue called Hoarding Disorder. When hoarding becomes unmanageable, it can lead to the home becoming chaotic and make living areas hard to access. Everyday life can become more challenging for the person because normal use of space is prevented. For example, activities such as cooking, cleaning, moving through the house and sleeping become restricted because of the lack of space. It could also potentially put the adult and others at risk from fire. The adult may also be at a greater risk of Self-Neglect. See Self-Neglect.
Sometimes the adult is aware that there is an issue, however a strong attachment to their items and feelings of embarrassment or guilt may prevent them from removing them or accepting support. Hoarding can also lead to difficult relationships with family members, neighbours and the close community due to the impact it may have on them. This can include environmental issues such as vermin. See: Hoarding Disorder (NHS).
Multiple underlying factors can lead to Hoarding Disorder, such as:
| Environmental factors | Growing up where resources are limited, or growing up in a household where hoarding is normalised can be contributing factors in current hoarding behaviours. People who have experienced abuse or neglect as a child may develop hoarding behaviours to create comfort and stability. |
| Trauma and life changes | Hoarding can become a coping mechanism following trauma, loss, or following major life events often leading to feelings of anxiety and depression. There can be a temporary feeling of comfort and security whilst collecting and keeping items. |
| Other health conditions | Obsessive-compulsive disorder (OCD) is often linked to hoarding behaviours due to the repetitive collection of items which can reduce anxiety providing temporary relief at the time. In addition, the fear of losing items, or discarding items is considered obsessive in nature. Depression, dementia, substance addiction, brain injury, psychotic disorders (such as schizophrenia) or mobility problems could also be symptoms of why an adult may begin hoarding. |
It is essential to consider an adult’s decision-making ability in relation to their tendency to collect and hoard items. This will involve considering the adults understanding of the impact hoarding has on their lives, whether they can weigh up different options and are able to communicate their choices.
When a person’s hoarding poses a serious risk to their health and safety, intervention will be required. With the exception of statutory requirements, any intervention or action proposed must be with the customer’s consent. In extreme cases of hoarding behaviour, the very nature of the environment should lead professionals to question whether the customer has capacity to consent to the proposed action or intervention and trigger a capacity assessment. The Mental Capacity Act Code of Practice states that people may question a person’s capacity to make a specific decision if the person’s behaviour or circumstances cause doubt as to whether they have capacity to make a decision. Extreme hoarding behaviour could meet this criterion and if so, a mental capacity assessment should take place.
In particularly challenging and complex cases, it may be necessary for the local authority to refer to the Court of Protection. Any referral to the Court of Protection should be discussed with legal services and the relevant service manager.
If a court is required to review a case involving mental capacity and hoarding, they will consider an adult’s ability to manage their belongings as well as make informed choices about their living spaces. The aim of the court is to decide what is in the adult’s best interest to remain safe whilst also respecting their independence.
See: 39 Essex Chambers summary of case A Local Authority v X
Although hoarding is not a category of abuse Under section 42 of the Care Act 2014, hoarding can be an aspect of self-neglect. According to the Care Act statutory guidance, a decision on whether a response is required under safeguarding will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support. When deciding if intervention is required, a case-by-case approach needs to be taken to identify if there is a risk to the adult’s safety and welfare. During initial enquiries it is essential that agencies involved share information with the local authority to ensure a coordinated approach whilst considering the wishes and feelings of the adult. The duty applies regardless of mental capacity.
Some people living with a hoarding disorder can present themselves well to the outside world hiding their condition from others.
The following table contains actions which should be considered when supporting a person who hoards.
| Action | Considerations |
|---|---|
|
Multi-agency approach |
A multi-agency approach is crucial when working with individuals with a hoarding disorder, particularly housing providers.
Also consider what local community services are available in your area. |
|
Build a trusting relationship |
Be patient, it may take time. |
|
Involve family/carers |
Gather information from the people who know the adult best. |
|
Consider the role of carers |
If the adult has a carer, it is important to consider their ability to meet the needs of the adult and rule out any neglect or acts of omission. The carer may have unintentionally neglected the caring role because they are no longer able to cope. |
|
Assessment of needs |
The adult may be unable to care for themselves due to, for example a physical disability, therefore the most appropriate course of action may be a full assessment of needs and a care and support plan. |
|
Risk assessment |
This might cover: Mental capacity and consent. Use a multi-agency approach. Identify the environmental hazards and risks such as fire. Ensure the views and wishes of the adult are included. Consider the adult’s formal and informal support networks. Identify the impact of the risks on the adult’s physical health and overall wellbeing. Consider the impact that making changing in the adult’s home may also have on them. Consider the impact of any mental health and/or physical health needs the adult may have. Use tools such as the Clutter Image Rating (CIR) to help to assess the scale of the hoarding. See: Clutter Image Ratings. |
|
Consider the impact on others |
Discuss the adult’s relationships with neighbours and the wider community. Hoarding can result in unpleasant odour, pests, and/or fire hazards which can sometimes impact on neighbouring properties. |
The Environmental Health Service (EHS) has a range of powers to intervene where a property is in a condition that is prejudicial to health, or where the premise is materially affecting neighbouring premises.
In addition, where properties are verminous or pose a statutory nuisance, the EHS will take a leading role in case managing the necessary investigations and determining the most effective means of intervention. Where the adult is residing in conditions that pose a threat only to their own welfare the powers available to the EHS may have limited or no effect.
In cases involving persistent hoarding the powers may only temporarily address and/or contain the problem. It must therefore be recognised that utilising powers under public health legislation in isolation may not be the most effective use of resources.
Hoarding UK is a UK-based charity that supports people affected by hoarding behaviour. They offer a helpline, support groups, and one-to-one sessions. They also provide training for professionals, run awareness campaigns, and advocate for policy changes. Additionally, they produce educational resources and participate in research to better understand and address hoarding disorder. Their goal is to improve lives and reduce stigma around hoarding. See: Hoarding UK.
The National Network of Safeguarding Adults Boards (NNSAB) website provides lots of useful information about safeguarding, including sharing best practice. The following is a list of common themes from Safeguarding Adult Reviews of deaths due to hoarding:
- Lack of understanding of hoarding behaviours;
- Inadequate risk assessments;
- Failure to engage multi-agency working;
- Delayed intervention;
- Insufficient training for professionals;
- Inconsistent follow-up and monitoring;
- Limited availability of support services;
- Failure to address underlying mental health issues;
- Poor communication with the adult;
- Overlooking family dynamics.
For further information see: National Network for Chairs of Adult Safeguarding Boards.
Last Updated: March 13, 2025
v5
