Islington Hoarding ProtocolAppendix F
Islington Hoarding Protocol
Supporting individuals with hoarding disorder or who display hoarding related behaviours
JOINT WORKING PROTOCOL
Shadia Ousta Doerfel, Anthony Jonas,
November 2015
Table of Contents
1Summary32Contacts43Acknowledgements54Introduction65Purpose and Scope of the Protocol76Aims of the protocol87Core Values98What Is Hoarding Disorder?109The Islington Hoarding Panel1510Guidelines for handling hoarding cases2011Needs, mental health and mental capacity assessment2612Options under the law2713Care and clinical treatment2814Useful Contacts3115Glossary3316Acronyms34Appendix A.Clutter Image Rating Scale35Appendix B.Hoarding Assessment Tool38Appendix C.Needs, Mental Health and Mental Capacity Assessment45Appendix D.Options under the law48Appendix E.Alignment and Relationship between DSM-5 and ICD-1060Appendix F.Information Sharing Protocol61
SummaryHoarding disorder is the acquisition of, and inability to discard, items even though they appear (to others) to have no value. 2-5% of the population are thought to be either suffering from hoarding disorder or manifest hoarding behaviours.Hoarding disorder has been a recognised mental disorder in its own right since May 2013 in the USA and recognition is anticipated in the UK in 2017.The most commonly hoarded items are old clothes, magazines, CDs/video tapes, letters, pens, old notes, bills, newspapers, receipts, cardboard boxes, pins, clothing rags, old medication, bodily products (hair, nails, faeces etc), used nappies, rotten food, animals (dead and alive), wool or fabric.There is no one cause for hoarding, but research suggests that it is thought that its origins can begin in childhood but tend to most severely interfere with the individuals life in their mid-30s and then worsen as they get older.Refusal by hoarders to engage with professionals or other intervention poses a challenge to progress.Severe cases usually require the involvement of several agencies (including the fire service, mental health services, adult social care, housing providers and environmental health services).The Protocol establishes the Islington Hoarding Panel as a multi-agency forum for professionals and agencies dealing with hoarding cases within the borough to discuss and jointly find ways to resolve difficult cases.The Panel will normally only accept cases where the hoarding is severe and an agency has reached an impasse in its efforts to resolve the situation with the individual involved.The protocol recommends the use of a clutter image rating scale and a hoarding assessment tool to provide an initial assessment of a hoarding issue.A referral to the London Fire Brigade is essential in severe cases or where there are flammable, hazardous, electrical or other unusual risk items.The protocol gives information on how three key assessments (mental health assessment, mental capacity assessment and needs assessment) can be considered for the individual concerned.The protocol outlines options available under the law including the Mental Capacity Act 2005, the Mental Health Act 1983, the Environmental Protection Act 1996, the Court of Protection and Inherent Jurisdiction.
Contacts
Help with hoarding for yourself or someone else
Islington Councils Access and Advice Service
020 7527 2299
Minicom: 020 7527 6475
[email protected]
222 Upper Street, London, N1 1XR
Islington wants to support and advise anyone who is concerned or just wants some advice about hoarding. You can contact us even if:
You just want to speak with somebody about yourself or someone you may be worried about, or
You want to speak with someone about hoarding or
You want some help or support with your behaviour which appears hoarding-related, or
The Access and Advice Team will put you in touch with somebody who will listen and assist you.
For organisations and agencies wishing to make a referral to the Islington Hoarding Panel
[email protected]
It is essential that you read section 9 below for guidance before making a referral to the Hoarding Panel.
Acknowledgements
Thanks and appreciation to the following who participated in discussions and / or contributed to this protocol:
Carole Crawford
Business and Office Cleaning services Ltd
Claire Dawson
Islington Learning Disabilities Partners
David Mataix-Cols
Consultant Clinical Psychologist
David Olusesan
One Housing Group
Dimitrios Paschos
Consultant psychiatrist
Donna Clarke
Hyde Housing Association
Ellis Turner
Islington Council Environmental Health
Emily Giles
Hyde Housing Association
Emma Burnham
Partners
Finlay Campbell
SHP
George Howard
Islington CCG
Jackie Creighton
Islington Council Housing Operations
Jamie Hickling
St Mungos Broadway
Jason Houston
Family Mosaic
Jennie Rooney
Barnsbury Housing Association
Jennifer Mackley
Islington Learning Disabilities Partners
Jennifer Speller
NHS England
Jim Beale
Islington Council Access Service
Jo Holloway
Islington Council Adult Social Care
Laurie Kenny
London Fire Brigade Islington
Lynne Johnston
Business and office cleaning services Ltd
Megan Karnes
Hoarding UK
Natalie Arthur
Islington Council Strategy and Commissioning
Nicola Carruthers-Dennis
Islington Council Home Ownership Unit
Patrice Lawrence
Islington Carers Hub
Paul Byer
Islington Council Housing Needs and Strategy
Sunita Parbhakar
Islington and Shoreditch Housing Association
Talibah Asafo-Ohene
Islington Council Housing Operations
Theresa Renwick
Camden and Islington Mental Health Trust
Theri Thompson
Islington Council Adult Social Care
Introduction2-5% of the population are thought to be either suffering from hoarding disorder or manifest hoarding behaviours. Dealing with them effectively and providing appropriate care and support to this significant section of the population by addressing the cause rather than the effects of hoarding, will have wide ranging effects for sufferers and professionals alike. Hoarding disorder has begun to be recognised as a mental disorder in its own right meaning that the potential options available for treatment have been significantly extended.Avenues to the Court of Protection have been opened up as hoarding disorder may now be considered an impairment in or disturbance of the functioning of the mind of brain for the purpose of the Mental Capacity Act 2005, as amended. So too can it be a condition for which the Mental Health Act 1983 may apply (as amended) as it also fits the definition of mental disorder within this Act. Housing providers often face the problem of dealing with hoarding in isolation. Other agencies such as the fire brigade and environmental health can become involved but a lack of coordination between the different organisations can mean that actions are much less effective than they could be. Housing providers do not need to deal with this issue in isolation, core services like adult social care, mental health and health services should be involved, particularly as hoarding is a safeguarding matter.Quite often, the potential sufferer themselves will not self-refer; most referrals have been noted to come from concerned families, neighbours, housing services or associations, fire services and/or the police.
Purpose and Scope of the ProtocolThis protocol is for all professionals and agencies working within the borough of Islington including those in the health, mental health, housing, social care, fire, police and environmental health services. It is intended to assist them to plan, coordinate, assess, diagnose and treat adults who display symptoms of hoarding disorder or hoarding-related behaviours. Together with its partners, Islington Council has commissioned a strategy to place hoarding high on its Health and Well-Being Agenda and Joint Strategic Needs Assessment. There is a commitment to enable practitioners across the board to adopt a multi-agency approach to hoarding so that cases can progress towards an effective outcome. This Protocol is not intended to be considered or act as a replacement for any of the statutory procedures relating to the functions of the Safeguarding Adults Board where a safeguarding alert is triggered in accordance with Sections 42 to 47 and Section 68 of the Care Act 2014 and Chapter 14 of the Care and Support Statutory Guidance. It is also not intended to displace any duties or responsibilities towards children who may be found in or potentially suffering from or involved with hoarding disorder or the effects of hoarding-related behaviours which may be more appropriately progressed under the Children Act 1989 and other relevant legislation. The Hoarding Panel is intended to act under the auspices of the Islington Safeguarding Adults Partnership Board, as a multi-agency forum within which hoarding cases or issues may be progressed.
Aims of the protocolThis protocol aims to:
Fulfil the local authority's collective responsibility towards all adults in the community who may or do suffer from this condition or display hoarding behaviours;
Generate awareness of how to respond to hoarding;
Support individuals and their advocates
Provide a support network for agencies dealing with hoarding cases and enable sharing of best practice;
Provide guidance on how to deal with
