Hoarding: a multi-agency approach to working with Southwark's vulnerable residents                               Emily Brunton, Team Manager CAST, ASC        Roberston Egueye, RSM,Housing         Caroline Harrison, Psychotherapist, CADAT, SLAM        Acknowledgements:        Dr Victoria Bream, Neil Chisholm, Laurna Huggins. 

The potential of objects – what do you see?

What is hoarding? Separate disorder in ICD-11 / DSM V. No longer seen as part of OCD - though co-morbidity Affects 1.5 – 5% of general population – between 4710 – 15700 of 314000 people in Southwark Excessive acquisition, difficulties discarding, clutter Risk: Fire   Stress on family and strain on children reporting less happy childhoods not being able to have friends. High levels of hostility to/ rejection of hoarding relative. Tolin et al., (2008) Infestation / unhygienic / physical ill health Being crushed beneath the hoard Damage to property / neighbouring premises

Multi Agency Duties -Safeguarding Adults, Care Act 2014. Hoarding=self neglect=safeguarding adult duties apply to all agencies Housing: duty of care under housing legislation. To ensure safety of property and required checks completed Adult social care: large number of adults who hoard eligible under Care act 2014 Health: hoarding disorder now a specific and diagnosed mental disorder(DSM V 2013).Ongoing development of effective ways of treating this disorder. Hoarding disorder is likely to affect between 4710-15,700 adults in Southwark: most not yet come to the attention of services

What is an evidence based intervention for hoarding? Multi agency approach: housing, social care, mental health Psychological interventions: CBT, Harm reduction, motivational interviewing (Tolin et al: 2015). CADAT research into improving outcomes Pilot of Metropolitan Boston Housing Project from 2011 -2014 “Rethinking Hoarding Intervention – MBPH’s analysis of the Hoarding Intervention and Tenancy Preservation Project” (Edsell-Vetter: 2015) had impressive results and is currently being replicated.

Current provision in Southwark Health: CBT for hoarding disorder, at IAPT, IPTT, CADAT. Short term and outpatient. Some hoarders find it difficult to engage due to symptoms of HD. Adult social care: only specialist agency for hoarding is Clouds End.  £50 an hour. No psychological intervention. Generic home care /outreach providers: do not have specialist skills required: little impact on the hoard and /or relationship quickly ruptures. Housing: Blitz cleans: expensive, traumatic for client and client re-hoards. Legal action: not financially viable and traumatic Temporary accommodation & storage: very expensive and only moving the problem

Current Spending in Southwark MH Adult Social Care: (Dec16 – Jan19) Blitz cleans, care provision, Clouds End, storage, temporary accommodation £176,067 Housing: (Dec16 –Dec18) Legal, repairs, Temporary accommodation £76,203 Health: Delayed discharges: average £626 per night Total cost to council (conservative estimate) £252,270

Southwark Innovations Southwark hoarding Panel Dockhead Fire station group Application for SLAM charity grant to skill up champions and support workers in the CAST team Development of a multi-agency hoarding strategy proposal

Exercise What would an effective multi agency strategy for hoarding look like ?