Housing people with a hoarding disorder - what should a best practice approach look like?

Every so often reports about people with a hoarding condition appear in the media, often managing to both sensationalise the story and trivialise the condition - presenting the condition and its consequences as simply a case of 'wilful obstruction'  and/or a hidden 'horror' story. This does not help to challenge the stigma attached to the condition, or to change people's understanding of the problem. Shifting people's perception is important because the problem of ‘hoarding’ is much wider than the fascination with one or two well publicised cases. In Australia it is estimated more than 600,000 people - around 2.6% of the population - may suffer from hoarding disorder.

Academic clinical psychologist Professor Jessica Grisham of UNSW Science is an expert on the mental health condition. She has recently initiated a broader conversation towards better understanding of the issue, explaining: 'It’s a myth that people who hoard are just lazy or messy – hoarding disorder is a treatable mental health condition and we need to make the public aware of that and remove the stigma – people with hoarding problems are much less likely to seek treatment if they feel ashamed.'

What is 'hoarding'?

Hoarding disorder is a psychiatric condition to describe excessive collecting and extreme inability to discard worthless objects. In some cases, situations of hoarding can lead to living in squalor, where there can be serious health, safety and quality of life risks for sufferers, family and/or other people who live with them, neighbours and communities.

A much simpler definition comes from Professor Adrian Franklin of ‘Collectors’ fame, a popular program on ABC TV a decade ago. He distinguishes ‘hoarders’ and ‘collectors’. He says: ‘You’re a hoarder if light can’t get into your house.’

There is now significant literature around hoarding, a much better understanding of its prevalence and recognition that it is a mental health condition. Since 2013 the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (often referred to in shorthand as DSM-5 and considered perhaps the most important document for the diagnosis and the classification of mental disorders) has recognised hoarding as a mental health disorder. The DSM-5 estimates between 2% to 6% of people in the United States and Europe are affected by hoarding disorder, with more men affected than women, and much higher prevalence among older adults (55 to 94 years). People over 55 years are almost three times more likely to be impacted than younger adults.¹

When someone has a hoarding condition it has a huge impact for them. Their family and friends are often impacted, as is the broader community. Apart from the possible consequence of squalor (unclean, unsafe living conditions) and significant fire and general health risks related to this, a person with a hoarding condition may withdraw or see relationships with family and friends break down, they may face significant financial repercussions, and - if they are a renter - they may face eviction from their rented home.

‘Hoarding’ as a disorder does not discriminate on the basis of housing tenure or class: it affects rich and poor; those who own their own homes or with a mortgage, those who are renting their homes. However, it's consequences can be particularly hard for tenants who face the real possibility of homelessness if evicted.  Hoarders in the private rental market in particular are vulnerable, except where owners and real estate agents do irregular property inspections.

What can be done to help renters who have a hoarding condition? Best practice is to go to the root of the matter and encourage the tenant to seek ongoing support through tenancy and living skills programs which address their problem. A recent article from the United Kingdom provides an example of what this can look like, with Julia Newcombe outlining the changed approach of social landlord Raven Housing Trust to a 'person-centric approach' to tackle hoarding, recognising 'hoarding is an emotional issue, not just a fire risk'.

Supporting renters to address hoarding and cluttering behaviour

In terms of self awareness of a problem in terms of difficulty in discarding items, clutter or excessive acquisition, people with a hoarding disorder may have: 

• good or fair insight, where they recognise hoarding-related beliefs and behaviours are problematic;
• poor insight, where they are mostly convinced that it is not problematic, despite evidence to the contrary; or,
• absent insight, where they are completely convinced that it is not problematic, despite evidence to the contrary.

Even for those with awareness (good or fair insight), but especially for those with poor or absent insight, addressing the problems that arise as a result of a hoarding disorder, including issues regarding squalor, is very challenging.

Hoarders in social housing – both public and community housing – have benefited in recent years from a more enlightened understanding by their providers of the psychology and dynamics that underlie hoarding. Over the last decade the Tenants’ Union of NSW has organised workshops to raise awareness and understanding of the issues facing people with a hoarding disorder (and how best to address the squalor that can result). The training aims to provide practical guidance on how to support renters with a hoarding disorder, and best practice responses from social housing providers. We've had keen engagement in the training from tenant advocates within the network of local Tenants' Advice and Advocacy Services, as well as from housing officers and workers from community housing providers. We are aware that the Community Housing Industry Australia NSW (CHIA NSW) has organised a similar workshop, and similar training also has also been run by the community housing sector in other states. Hume Community Housing Association and Evolve Housing in NSW distribute pamphlets on the issue of hoarding.

Department of Communities and Justice Housing’s ‘hoarding’ clause

It is disappointing then to see that despite this progress the current Residential Tenancy Agreement of the NSW Department of Communities and Justice Housing (DCJ Housing) retains a ‘hoarding’ clause as an additional term in its social housing tenancy agreement. Clause 46 states:  'the tenant agrees not to engage in or participate in or allow hoarding on the premises.'

This clause, in its breach, could lead to the eviction of a hoarder. Indeed, this makes little sense from a social housing landlord who should be taking a lead in demonstrating best practice. We believe the clause indirectly discriminates against a tenant affected by a hoarding disorder for the following reasons:

• Hoarding behaviour demonstrates a disability.
• Hoarding behaviour is covered under the definition of ‘disability’ in the Section 4 of NSW Anti-Discrimination Act 1977 and as such the clause is unlawful because of the operation of Sections 49B and 49N of the same Act.

Accordingly, the ‘Hoarding’ clause contravenes the NSW Anti-Discrimination Act 1977 and the Commonwealth Disability Discrimination Act 1992. We believe a tenant could be successful in an application to the NSW Civil and Administrative Tribunal for an order declaring that the ‘Hoarding’ clause is discriminatory, and thus void, because of the operation of Sections 15 and 21 of the Residential Tenancies Act 2010. This is yet untested. Another option would be for a public housing tenant to lodge a complaint with the NSW Anti-Discrimination Board and/or the Australian Human Rights Commission.

And really - there is no need for such a term. Already in NSW, all residential tenancy agreements, as required by the Residential Tenancies Act 2010, include mandatory clauses regarding cleanliness, damage and nuisance and annoyance (Clauses 13 and 14). These mandatory terms should suffice in circumstances of hoarding, although a term addressing ‘safety’ – without referring to hoarding, directly or indirectly – should address any concerns of DCJ Housing.

Since August 2011 DCJ Housing has been a signatory to the ‘Housing and Mental Health Agreement’ with NSW Health. Their commitment to - and the need to comply with - the principles and practical actions set out in the agreement identifies clearly the need for them to work to coordinate support and services at the local level when responding to people with a hoarding condition to ensure a tenancy can be maintained, especially where they consider a tenancy is 'at risk' as a result. A failure to comply would certainly be relevant when considering the 'reasonableness' of any attempt to end a tenancy because of 'breach'.

So much progress has been made in understanding hoarding as a mental health disorder, and how best to support those with the condition. We understand that supporting people with a hoarding condition can be extremely challenging - for family members and friends - and also for landlords, local Councils and other state agencies. But we have seen in NSW a number of social housing providers - including DCJ Housing - , and some local Councils, change their approach to managing the risks involved for individuals and the community. Including a special hoarding provision ('Clause 46') seems like a relic of past, something that undermines the clear steps forward taken by DCJ Housing towards best practice in this situation.

How about it, DCJ Housing ... it’s time to update the additional terms of your Residential Tenancy Agreement and remove this blot on your copybook! Indeed, this might be one of your new year's resolutions for 2021!

Useful resources: Getting support and the law

• Catholic Community Services, with Homelessness NSW and RSPCA, provides lots of useful information and resources about ‘hoarding’ on the HSRU website. 
• Catholic Community Services also provides a service to support people with hoarding tendencies who are aged over 65 years and living at home or over 50 years and at risk of homelessness. 
• City of Sydney has a resource for local residents to better understand the need for a 'whole of community' approach to addressing the issue: Understanding Squalor and Hoarding
• Victorian Government's health website has some excellent information on hoarding and squalor, including a practical resource. 
• For a summary of the legal situation in NSW, see Allan Anforth, Peter Christensen and Christopher Adkins (2017), Residential Tenancies Law and Practice New South Wales, 7th Edition, The Federation Press [2.21.3], [2.51.13]
• For an excellent discussion of ‘hoarding and the law’, see Michele Slatter, Chapter 7, ‘Law and mess’, in John Snowdon, Graeme Halliday and Sube Banerjee (2012), Severe Domestic Squalor, Cambridge University Press.

[1] See Section II: Diagnostic Criteria and Codes, Obsessive-Compulsive and Related Disorder, Hoarding Disorder, 300.3 (F42).