This blog is focused on results from a recent research report on supports for individuals with hoarding disorder in Peel Region titled, Hoarding in the Region of Peel: A Collaborative Response to a Complex Issue. The research was funded by the Ontario Trillium Foundation and commissioned by the Coalition on Hoarding in Peel (CHIP). Hub Solutions, a social enterprise of the Canadian Observatory on Homelessness, worked with CHIP to conduct the research.
Hoarding Disorder Background
Hoarding disorder is recognized as a distinct mental health diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). It is commonly defined as feeling compelled to collect and save items, and a persistent difficulty to discard items (Kress et al, 2016; Dozier & Ayers, 2017). It is estimated that two to six percent of the population may have hoarding disorder (American Psychiatric Association, 2017). One study focused on supported housing residents found that 18 percent exhibited hoarding behaviours (Greig, Tolin, & Tsia, 2020).
Individuals with hoarding disorder may be at risk of homelessness. For example, private market landlords and non-profit housing providers may evict tenants due to the condition of the housing unit [e.g., hoarding can pose a fire hazard, increase the risk of injury in the unit, and result in unsanitary environments (Frost et al., 2000)]. Therefore, within the housing and homelessness sector, it is important to have community-based supports to assist individuals with hoarding disorder.
Coalition on Hoarding in Peel (CHIP)
CHIP was formed by several front-line service organizations that worked with individuals with hoarding disorder in Peel Region. CHIP supports community members who experience social and health issues related to hoarding disorder by advocating for wrap-around services and a coordinated approach to service delivery. CHIP works to improve coordination between service providers, educate the public and professionals, and advocate for relevant policy changes.
Hoarding in the Region of Peel: A Collaborative Response to a Complex Issue
The purpose of the research was to examine how service provision for individuals with hoarding disorder could be enhanced and to suggest key steps CHIP could take to ensure that community members are well supported. The project incorporated a number of different sources of evidence: 1) A literature review; 2) A policy review; 3) Interviews with individuals with lived experience of collecting behaviours and key stakeholders in Peel Region; and 4) An environmental scan examining how other Regions developed community level responses.
Key Findings
Below we present the key findings from the report.
Best practices for service provision include strengths-based, client-centered approaches. Best practices when supporting individuals with collecting behaviours were identified as taking a strength-based approach, working at a pace that is comfortable for the individual with collecting behaviours, and developing a strong relationship with individuals with collecting behaviours built on mutual respect.
Building trusting, non-judgmental relationships is key when addressing collecting behaviours in the community. Developing trust between individuals with collecting behaviours and service providers, including Fire Services Officers, Bylaw Officers, Paramedics, and Polices Officers, is essential.
A breadth of services is required to support individuals with hoarding disorder, including those for family members and other natural supports. Individuals with collecting behaviours appreciated the support they were provided by Hoarding Specialists in Peel Region. They found these supports to be convenient and easily accessible. Having access to mental health services, Hoarding Specialists, and peer support groups were understood to be particularly important. Providing peer support groups for family members and other supports were also identified as important services that should be made available in Peel Region.
Efforts should be made to enhance knowledge on collecting behaviours and hoarding disorder in Peel Region among policy makers, frontline workers, first responders, and the public. Public education is one way CHIP can support community members in Peel Region. Enhanced knowledge in four main areas were recommended: (1) Educating frontline workers and first responders on hoarding disorder and collecting behaviours; (2) Educating frontline workers, first responders and policy makers about hoarding services to facilitate a coordinated response; (3) Educating the general public on hoarding disorder and collecting behaviours to reduce stigma; and (4) Educating the general public about hoarding resources and services available to them and their family. Through education, stigma related to collecting behaviours will be addressed, awareness of service offerings will increase, policies will be adapted, and the skills and knowledge of service providers will be improved.
Coordination of services is needed in Peel Region. A key theme uncovered was the need to improve coordination of services within the Region. Methods to help achieve this goal were: advertising available resources, training service provider across the Region via workshops, and creating a protocol of how and when each service provider can provide support, and who they can refer clients to. Moreover, having service providers informed on how to assess, prioritize, support, and refer community members will help to create effective coordination of services in the Region.
CHIP can play an important role in addressing collecting behaviours in Peel Region through facilitating the coordination of services across sectors and increasing awareness of hoarding disorder/collecting behaviours among the public, emergency service providers, and policymakers. A coordinated approach to hoarding, led by CHIP, can yield several benefits as it addresses the limited resources available when there is a division of labor across different groups. Coordination can also lead to a cross-pollination of information and ideas, and consequently a deeper understanding of an individual’s collecting behaviours when multiple perspectives are involved. Expanding coalition membership, sharing knowledge, developing care paths, and creating methods of measuring the success of coalition efforts will all be important to providing improved coordination of services in Peel Region.
To access the report, please click here.
To access a webinar focused on the report, please click here.
To learn more about CHIP, please contact Madelaine Crevier: madelaine.crevier@brampton.ca
To learn more about Hub Solutions, please contact Allyson Marsolais: amarsolais@edu.yorku.ca
References
American Psychiatric Association. (2017). What is hoarding disorder? Retrieved from: https://www.psychiatry.org/patients-families/hoarding-disorder/what-is-hoarding-disorder
Dozier, M. E., & Ayers, C. R. (2017). The etiology of hoarding disorder: A review. Psychopathology, 50(5), 291-296. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/28810245/
Frost RO, Steketee G, Williams L (2000) Hoarding: A community health problem. Health and Social Care in the Community. 8:229–234. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2524.2000.00245.x
Greig, A., Tolin, D., & Tsai, J. (2020). Prevalence of hoarding behavior among formerly homeless persons living in supported housing. Journal of Nervous & Mental Disease, 208(10), 822-827. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/33002938/
Kress, V.E., Stargell, N.A., Zoldan, C.A., & Paylo, M.J. (2016). Hoarding disorder: Diagnosis, assessment, and treatment. Journal of Counseling and Development, 94(1): 83-91. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1002/jcad.12064