By Jenna Fisher
Posted Jan 12, 2017 at 2:00 PMUpdated Jan 12, 2017 at 2:49 PM
Hoarding disorder in Brookline is a present, delicate issue, say experts.
The recent incident in Brookline where a woman was found to be living with the body of a deceased woman for more than a year while her house fell into disrepair highlights that Brookline is not immune to the challenges of hoarding disorder, and that there are often deeper mental health issues that need to be addressed.
“A lot of times people think people with hoarding disorder can just be talked or snapped out of it – that they’re dirty or lazy people. [But] it’s a mental health problem. The idea of that you could just yell at or talk someone out of it is a common misperception,” said Jordana Muroff, an associate professor of Clinical Practice at Boston University School of Social Work who works on the issue.
The most common coexisting disorder is depression, with about 50 percent or so exhibiting it. Generalized anxiety disorder shows up in about 25 percent of cases, social anxiety 24 percent, and inattention issues such as ADHD around 28 percent as well.
Understanding this better helps social services address the issue, she said.
And hoarding – a specific diagnosis – is more common than people realize.
Each year Brookline officials get reports of a handful of cases. and have to intervene, said Maloney who added the number of instances that rises to the level of having to shutter a home for a while is more rare, once or twice a year.
But it’s not an easy task for officials or the families involved, he said.
Stats on hoarding
The state doesn’t track instances of hoarding, according to Tom Lyons of the Department of Health for the state. But a growing body of research has been showing that as many as 5 percent of the population deals with it (think: around 15 million people). To give that some context, experts estimate that there are only 5.4 million people in the US with some form of dementia.
In 2006, a Massachusetts man named Jesse Edsell-Vetter along with Gail Steketee of Boston University a leading expert on the disorder, among others began pushing for way to intervene when it came to hoarders that went beyond cleaning up a house and took time to personally address individual issues behind the mess. The results have been positive, say experts and stats.
The issue was legitimized as a diagnosis by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in 2013.
What’s next in Brookline
The Public Health Department is working with the town to revise the housing code to help implement a standard matrix when it comes to identifying cases of hoarding.
“This is an evolving science to us,” Pat Maloney of the Brookline Health Department.
Clinicians in some cases use a sheet that shows pictures identifying – on a scale of 1 to 9 – clutter as a way to help inspectors, emergency response and others share information on a situation.
Jordana Muroff of Boston University and several students developed a free app based on this tool so that providers could use it in the field.
“I want that to be the standard so that when an inspector, police or fire can say –with some training – oh this was a 6 or 9 and then you know what you’re walking into,” said Maloney.
“The Brookline Hoarding Task Force defines hoarding as the collection of materials to the point where an individual’s quality of life and the functions of one’s living space is diminished. Detectable signs of hoarding include blocked egresses, nonfunctioning toilets, and fire hazards due to an abundance of material. Other signs include infestations, collected spoiled food and squalor,” according to the website.
“Hoarding conditions may present a nuisance or safety hazard to the surrounding community due to potential fire hazards, odor or pest issues. Some individuals present extreme cleanliness and organization in addition to their hoarding behavior. Hoarding is not exclusive to the elderly population; it is observed in a full range of age groups, education levels and mental health states.”
Instances of hoarding in Brookline in the past have included animal hoarding and clothing hoarding.
“What would be ideal of course is that some of these cases would be identified earlier,” said Jordana Muroff of Boston University, adding sometimes people recognize there’s an issue, but don’t address it until it gets catastrophic.
That’s where the task force work can come in. If you suspect you or someone you know may show signs of hoarding check in with the Task Force.
Hoarding Task Force*
The Task Force is a collaboration between the the Brookline Health Department, the Brookline Community Mental Health Center, and the Brookline Council on Aging. The goal of the Hoarding Task Force is to develop and implement best practices for assisting Brookline residents who struggle with compulsive hoarding, according to the website.
-By Jenna Fisher email@example.com@JennaFisherTAB
“I have to say since I’ve been doing it over 30 years these are the cases that really test you as a public health person because there are so many levels of issues there. They’re tough to deal with,” said Maloney. “They’re very challenging. You have multiple potential issues involved, some are mental health related, some are substance abuse related some are elder related where they’re not able to care for their environment. So … when it comes to our attention usually something in their system has broken down that has allowed it to get to such a severe level.”
Emergency responders usually alert the Health Department to potential hoarding situations.
It could be that someone falls and needs an EMT, and when they get into the property they encounter conditions of hoarding.
Fire department members aren’t trained specifically on how to identify cases, said Acting Deputy Fire Chief of Fire Prevention Dan Carroll. But they tend to know it when they see it, and to have compassion on those who are dealing with it, he said and refer it to the health department.
But it doesn’t make their jobs any easier.
“It can be very dangerous for the guys if there’s a fire. If you get piles of newspapers or something like that stacked high it could easily fall on a guy,” he said.
Houses that exibit hoarding can be more susceptible to fires as well – when clutter reaches the point where an individual has to run extension cords because they can’t reach outlets and stuff piles on those it can heat up and combust.
Maloney’s department will then visit homes and assess the situation to determine if the clutter rises to the level of a public health safety issue – items in the home taking up so much space that there is hardly room to enter or access the kitchen or bathrooms.
Sometimes they have to deem the unit unfit for human occupancy until they get it back into a livable condition, which can take anywhere from a week to a year, he said.
But a house cleanup only addresses the immanent problem of public safety he said. And leading experts agree.
“It doesn’t address the underlying problem,” said Muroff.
Enter the Hoarding Task Force
Muroff said that it’s critical that when these cases are identified that they’re linked to social and mental health services, special coalitions and task forces, which have been successful in taking a team approach to individuals dealing with hoarding than the old approach of mass clean up and send the person back home.
Brookline was one of the first municipalities to develop such a task force, according to Maloney and Ruthann Dobek of the Council on Aging.
It gathers social workers, mental health professionals from Brookline Community Mental Health Center, emergency services, the Council on Aging and the Health Department in one place to meet and talk about how to handle specific cases as well as how to help the community understand their resources at hand, said Dobek.
“We put an online toolbox together in 2009 through some funding from the Community Foundation,” said Maloney. He said the town’s informal hoarding task force committee was struggling and wanted to help families with a set of best practices.
It even attracted the attention of the makers of the reality TV show, “Hoarders,” which debuted that year, he said. But the town has turned down requests to work with the show, saying it sensationalized a serious issue.
The Brookline Community Center for Mental Health did not respond to request for comment.
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