Bradford Multi agency Hoarding Framework

Multi-Agency Hoarding Framework Guidance for Practitioners in the Bradford District

Department responsible: 

Document revised: January 2022

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1 Introduction

This document sets out a framework for collaborative multi-agency working within Bradford District using a ‘person centred solution’ based model. The protocol offers clear guidance to staff working with people who hoard.

This framework applies to all agencies and professionals within Bradford District area who are working with or supporting people who may hoard and those who have signed up to the Protocol.

There is an expectation that everyone in partnership with the protocol engages fully to achieve the best outcome for the individual, while meeting the requirements and duties of their agency or Board.

This framework is supported by the Bradford Safeguarding Adults Board.

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2 Aims of This Protocol

• Create a safer and healthier environment for the individual and others affected by the hoarding behaviour, e.g. family, neighbours.
• Develop a multi-agency pathway which will maximise the use of existing service’s and resources and which may reduce the need for compulsory solutions.
• Ensure that when solutions are required, there is a process for planning solutions tailored to meet the needs of the individual and utilising a person centred approach. Possible solutions could include clearance of the hoard, professional support and monitoring, property repairs and permanent or temporary re-housing.
• Develop creative ways of engaging individuals in the process.
• To establish best practice and improve knowledge of legislation that relates to hoarding behaviour through the Hoarding Panel.
• Ensure effective Partnership working and information sharing.

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3 Definition of Hoarding

A hoarding disorder is where someone acquires an excessive number of items and stores them in a chaotic manner, usually resulting in unmanageable amounts of clutter. The items can be of little or no monetary value.

Hoarding is considered a significant problem if:

• The amount of clutter interferes with everyday living – for example, the person is unable to use their kitchen or bathroom and cannot access rooms
• The clutter is causing significant distress or negatively affecting the quality of life of another person or their family – for example, family living with person or pest issues to neighbours.

Hoarding is now considered a standalone mental health disorder and is included in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) 2013.

Many people who hoard have strongly held beliefs related to acquiring and discarding things, such as: "I may need this someday" or "If I buy this, it will make me happy". Others may be struggling to cope with a stressful life event, such as the death of a loved one.

Attempts to discard things often bring up very strong emotions that can feel overwhelming, so the person hoarding often tends to put off or avoid making decisions about what can be thrown out.

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4 Signs of a hoarding disorder rather than a collector

Someone who has a hoarding disorder may typically:

• keep or collect items that may have little or no monetary value, such as junk mail and carrier bags, or items they intend to reuse or repair
• find it hard to categorise or organise items
• have difficulties making decisions
• struggle to manage everyday tasks, such as cooking, cleaning and paying bills
• become extremely attached to items, refusing to let anyone touch or borrow them
• have poor relationships with family or friends

Hoarding can start as early as the teenage years and gets more noticeable with age. For many, hoarding becomes more problematic in older age, but the problem is usually well established by this time. Some people with a hoarding disorder will hoard a range of items, while others may just hoard certain types of objects.

In many cases, the symptoms will be quite obvious, in terms of clutter, excessive items in the property or even spilling onto gardens or public areas, non-engagement, referrals from other agencies, for example environmental health, fire services and/or local authority housing management or housing associations.

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5 Why hoarding disorders are a problem

A hoarding disorder can be a problem for several reasons. It can take over the person's life, making it very difficult for them to get around their house. It can cause their work performance, personal hygiene and relationships to suffer.

The person hoarding is usually reluctant or unable to have visitors or even allow tradesmen in to carry out essential repairs, which can cause isolation and loneliness.

The clutter can pose a health risk to the person and anyone who lives in or visits their house. For example, it can:

• make cleaning very difficult, leading to unhygienic conditions and encouraging rodent or insect infestations
• be a fire risk and block exits in the event of a fire
• cause trips and falls
• fall over or collapse on people, if kept in large piles

The hoarding could also be a sign of an underlying condition, such as OCD, other types of anxiety, depression and dementia.

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6 Supporting someone with hoarding disorder

Refusal by hoarders to engage with professionals or other intervention poses a challenge to progress. Good professional practice would explore all remaining avenues for the individual to engage. This is because being met with a “shut door” is in the nature of the disorder or hoarding behaviour. It is worth remembering that non-engagement is not exclusive to those suffering from hoarding disorder. It should be treated within the same practical, professional and legal framework as someone who suffers from any other condition or disorder (for example, Alzheimer’s disease, schizophrenia etc).

Blitz Cleans: one of the most popular responses to hoarding is to perform a “blitz clean” – the clearing out all or most of the offending items. Blitz cleans often feature repeatedly in the individual’s case notes or history. Whilst there may sometimes be a need for a blitz clean to deal with environmental health or fire safety concerns it more often only serves the person or agency that is concerned or complaining about the hoarding rather than offering a long-term solution for the hoarding sufferer. Blitz cleans are likely to significantly distress the hoarder and is a costly action to take. It does not address the cause of the hoarding behaviour and may exacerbate their symptoms. Without a longer-term solution such as hoarding specific CBT and/or other professional intervention the individual could well resume their hoarding activities.

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7 Mental Capacity

The Mental Capacity Act (MCA) 2005 provides a statutory framework for people who lack the capacity to make decisions by themselves. The Act has five statutory principles and these are legal requirements of the Act:

• A person must be assumed to have capacity unless it is established that they lack capacity.
• A person is not to be treated as unable to make a decision unless all practicable steps have been taken without success.
• A person is not to be treated as unable to make a decision merely because he/she makes an unwise decision.
• An act done, or decision made, under this act for, or on behalf of, a person who lacks capacity must be done, or made in his or her best interests.
• Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.

When a person’s hoarding behaviour poses a serious risk to their health and safety, professional intervention will be required. With the exception of statutory requirements, the intervention or action proposed must be with the individual’s consent. Article 8 of the European Convention on Human Rights (The right to respect for private and family life) - is engaged. Interference with a person’s life must be lawful, necessary and pursue a legitimate aim.

In extreme cases, taking statutory principle 3 (above) into account, the very nature of the environment may lead the professional to question whether the customer has capacity to consent to the proposed action or intervention and trigger a capacity assessment. All interventions must be undertaken in accordance with the 5 statutory principles and using the ‘two stage’ test of capacity (see MCA Code of Practice 4.11 – 4.25).

The MCA Code of Practice states that one of the reasons why people may question a person’s capacity to make a specific decision is that “the person’s behaviour or circumstances cause doubt as to whether they have capacity to make a decision” (MCA Code of Practice, 4.35). Extreme hoarding behaviour may therefore in the specific circumstances of the case, prompt an assessment of capacity.

Where it is identified that a mental capacity assessment needs to take place with an individual, it is possible that there may be some barriers to completing a capacity assessment with that person. For example, there may be reluctance on the part of the person to engage with the professional seeking to assess capacity or their circumstances might preclude them from participating in a capacity assessment.

Where there are barriers to an individual’s engagement then consideration needs to be given to alternative and creative means to reassure the person and to promote their engagement. It’s also important to think about whether their refusal to engage is due to the influence or actions of another person. Where this is suspected, then an alternative approach may be needed and it would be prudent to seek further advice.

If after having done all you can to support the person to take part in a capacity assessment the individual still refuses to engage you ultimately cannot force them to do this. At this stage further advice should be sought on the next steps to take where concerns persist.

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8 Information Sharing

Under the Data Protection Act 2018, we all have the responsibility to ensure that personal information is processed lawfully and fairly.

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9 Bradford District Hoarding Panel

This Protocol establishes the Bradford District Hoarding Panel as a forum for professionals and agencies dealing with hoarding cases within Bradford District to discuss and jointly find ways to resolve those cases.

The Panel’s role is to:

• review the circumstances of cases and the actions taken so far
• challenge and advise on the options available
• help the relevant organisations to coordinate and complete their actions
• remove barriers to cooperation
• signpost to agencies or organisations that could contribute

The Panel is available to all organisations and agencies within Bradford District that are signatories to this protocol.

The Panel will normally only accept cases for discussion in the following circumstances:

• Where the hoarding is graded at 5 or above on the hoarding clutter image rating scale (Appendix B) and:
• The presenting organisation has attempted to follow the guidance in this protocol has been unable to resolve the situation, or
• The presenting organisation has been unable to gain the cooperation of other organisations to take action, or
• The presenting organisation has good reason to believe that there is severe hoarding (5 or greater on the hoarding clutter scale) but has been unable to gain access to the property or engage with the person involved despite persistent attempts and needs the assistance of other agencies.

The Panel may recommend a course of action to progress a particular case or problem. It has no decision-making powers to direct organisations or Council departments to take or desist from a course action, but it acts as this protocol’s mechanism to manage and progress hoarding cases and maintain good practice standards. Organisations who wish to depart from recommendations of the Panel should be able to provide written reasons to the Panel and for their own records.

The Panel has no financial budget and is not able to provide or direct resources either from within the Council or from other organisations.

The Panel members are named representatives from the Council and other organisations. The following services will normally be represented at all Panel meetings:

• Adult Social Care
• Mental Health Service
• Registered Social Landlord (if applicable)
• West Yorkshire Fire and Rescue Service
• Housing Standards Team
• West Yorkshire Police

The following services are expected to attend when requested by the Panel coordinator:

• Children’s Services
• Health services
• RSPCA (where animals are, may be or have been involved)
• Any other relevant or involved service, individual or organisation

The Panel will nominate a case lead for each case it considers. The case lead will normally be the representative of the organisation that requested the Panel hearing unless it is more effective or appropriate to nominate another agreed case lead.

The case lead will take responsibility for putting the recommendations of the Panel into effect and ensuring the cooperation of the other services. The case lead may refer the case back to the Panel for further discussion if the circumstances of the case have substantially changed, an impasse has been reached or they have been unable to secure the cooperation of other services. The case lead will update the panel on all completed actions at the following meeting.

The Panel will meet every six weeks or less often depending on its case load or any intervening urgent matters requiring an earlier meeting.

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10 Referrals to the Hoarding Panel

Organisations should email requests for discussion by the Hoarding Panel to the Housing Standards Team using the following email address: CHPEnquiries@bradford.gov.uk. 

Requests must be accompanied by:

• a completed Hoarding Assessment tool (see Appendix B);
• Photographs of the property/clutter where available;
• Supporting evidence including referral to West Yorkshire Fire Service, consideration of vulnerability, contacts with next of kin, involvement of other support services, safeguarding, tenancy conditions enforcement, antisocial behaviour enforcement, clearing and cleaning work undertaken;
• any other relevant information held by the organisation;

Contact details for all other organisations and individuals who are or have been involved in the case.

All information must be sent electronically and securely in accordance with this Protocol’s information sharing agreement.

Referral to the Hoarding Panel does not mean that immediate procedures to minimise risks to individuals are delayed – referrals to the West Yorkshire Fire and Rescue service must be made in cases where hoarding is rated at 5 or above on the Clutter Rating Image Scale (Appendix A) or where it is under 5 but there are flammable, hazardous, electrical or other unusual risk items.

Where you are concerned about the potential safety of or risk posed by hoarding related behaviours to a child, you must make a referral to Children’s Social Services in case child protection measures need to be implemented. You should notify Children’s Services whether or not you have also made a referral to the Hoarding Panel. You should also notify the Hoarding Panel if you have made a referral to Children’s
Services as it may well be that the Panel will want a representative from Children’s Services to attend any relevant meeting.

Where there is evidence of self-neglect and hoarding related behaviours a referral must be made via the self-neglect protocols in case self-neglect measures need to be implemented. Organisations should also notify the Hoarding Panel if self-neglect measures have been taken. Bradford safeguarding Adults social care may request a representative from the Hoarding Panel to attend any relevant meeting.

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11 Assessing a hoarding case

Firstly establish whether the person does appear to be displaying hoarding related behaviours or suffering from hoarding disorder and that they are not just exercising their right to collect items or express different lifestyles and habits. Some things to look for:

• Are rooms in their property (bathroom, toilet, bedroom and kitchen) not used or unusable for the purposes to which they have been designed, because of an excess of clutter?
• Can appliances and furniture (cooker, fridge, settee, chairs etc.) be used?
• Are they unable to freely open their front or back door?
• Are all plug sockets and pipes hidden from view or trapped in by possessions?
• Are rooms packed with items to such an extent that it could pose a fire, health or safety hazard?
• Is their mobility around the property or otherwise limited by the amount of items?
• Do the items pose any environmental or other health and safety related obstacle/issue?

Assess the level of the hoarding by using the CIRS (clutter image rating scale) for each room. See Appendix A.

If the hoarding is graded at 5 or above on the hoarding clutter image rating scale then complete the hoarding assessment tool. See Appendix B.

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12 Resident is vulnerable

Take advice from Social Services or other agencies as appropriate. In cases where the tenant is elderly or vulnerable in some way, Social Services or some other agency needs to be involved in trying to remedy the initial problem and, if possible, prevent its reoccurrence.

Particular note needs to be made if there are or appear to be children involved in the property, with the hoarding related behaviours and where the potential hoarding poses or may pose a risk to a child – in such cases, immediately refer to Children’s Social Care. It is more likely that any protection or assistance provided or considered for the child will be performed under the Children Act 1989 and relevant Child Protection Measures / Guidance.

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13 Consent

Be mindful of the need for obtaining the individual’s consent where appropriate. Exceptions to this are when in the public interest where other people are affected or circumstances where a local authority or agency exercises their statutory duties or powers. In some cases members of the resident’s family or friends may also be able to provide help or support – often family members or concerned third parties will approach services for assistance to work with an individual. If individuals lack capacity to make decisions please refer to Section 6 – Mental capacity.

Any capacity assessment carried out in relation to hoarding behaviour must be time and decision specific, and relate to a specific intervention or action. If the person is assessed as not having capacity to make decisions in relation to their self-neglect, then any decisions should be made following the best interests process, which includes taking into account the person’s views and taking the least restrictive action. Due to the complexity of such cases, there must be a Best Interests Meeting and appropriately recorded in formal minutes. Additionally, consideration should be given as to whether an Independent Mental Capacity Advocate (IMCA) should be instructed.

In particularly challenging and complex cases, it may be necessary to seek legal advice in order to refer to the Court of Protection (CoP) to make the best interests decision.

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14 Information gathering

At the beginning of the process, gather as much information as possible. Remember confidentiality when speaking to neighbours / friends / family. Individuals should not disclose any unnecessary information or information about the lifestyle of the hoarder.

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15 Tenancy conditions

Consider whether the problem can be resolved purely by taking steps to ensure that the resident complies with their conditions of tenancy or lease or whether the resident needs some assistance to try to deal with the hoarding behaviours in issue (for example because they are elderly or appear to be vulnerable.)

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16 Arranging for the removal of hoarded material

In cases where the resident is not vulnerable and the only reason for mass accumulation of items is because the resident concerned has not made proper arrangements to dispose of large amounts of material or an accumulation of bulky items, you should aim to come to an agreement with the resident concerned to dispose of the items and prevent a repeat of the activity.

Consider staggered time frames for clearance; i.e. over a period of 6 or 12 months, agreeing a small area to be cleared each month and re-visiting to ensure compliance.

In all cases you should carry out a health and safety risk assessment of the property and consider employing specialist contractors where appropriate.

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17 Referring to the Hoarding Panel

In cases where the hoarding is severe (5 or above on the clutter scale, see Appendix A), and the individual will not come to an agreement to deal with the hoarding and all reasonable measures have failed then consider a referral to the Hoarding Panel.

The hoarding panel will agree a strategy to try to address the hoarding problem and to give advice to the referrer to reduce the reoccurrence of the problem.

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18 Safeguarding Children

Safeguarding Children refers to protecting children from maltreatment, preventing the impairment of their health or development and ensuring that they are growing up in circumstances consistent with the provision of safe and effective care. Growing up in a hoarding property can put a child at risk by affecting their development and, in some cases, leading to the neglect of a child, which is a safeguarding issue.

The needs of the child at risk must come first and any actions we take must reflect this. Where children live in the property, a Safeguarding Children alert should always be raised on 01274 435600.

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19 Safeguarding Adults – When to raise a safeguarding concern

Safeguarding Adults means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent, and stop, both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action.

This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances.

The revised Statutory Guidance (March 2016) contains additional advice concerning when self-neglect which includes hoarding should be reported as a safeguarding concern and dealt with as a section 42 enquiry – suggesting that it:

“May not prompt a section 42 enquiry. An assessment should be made on a case by case basis. 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.”

An "adult at risk" may also be living with the hoarder in the property. There may be a safeguarding concern about that adult if they are at risk of harm due to the living circumstances. If in doubt, discuss the issue your manager or contact the local authority to get advice or raise a Safeguarding Concern.

This framework accepts the guidance as supplied by the Joint Multi-Agency Safeguarding Adults Policy and Procedures for raising a concern and referring in order to safeguard an ‘Adult at Risk’.

Please refer to I want an assessment page to make a referral or for further guidance;

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20 The Care Act 2014

The Care Act, 2014 provides a coherent approach to adult social care in England. Local authorities (and their partners in health, housing, welfare and employment services) must now take steps to prevent, reduce or delay the need for care and support for all local people.

The Care Act encompasses hoarding under self-neglect. Supporting people who self-neglect does not always fall under safeguarding and section 42. It is also part of promoting well-being individuals wellbeing under section 1 of the Act.

However, where an adult at risk has been identified as having been subject to serious self-neglect which could result in significant harm and where there is evidence of self-neglect and hoarding related behaviours a referral should be made via the Bradford Access service in case self-neglect measures need to be implemented.

Organisations should also notify the Hoarding Panel if a referral about self-neglect has been submitted. There may be a request for a representative from the Hoarding Panel to attend any relevant meeting.

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Appendices

View the Bradford Multi agency Hoarding Framework appendices