1. 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. 

2. The potential of objects – what do you see?

3. 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 – of  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

5. Multi Agency Duties
-Safeguarding Adults, Care Act 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 ,700 adults in Southwark: most not yet come to the attention of services

7. 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 “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.

9. 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

10. 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

12. 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

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