WORKING IN A CROWDED HOUSE

Transcription

1 WORKING IN A CROWDED HOUSE 25 th August th Annual State EH Conference For the Crowded House Presented by Tania Reid forthecrowdedhouse@gmail.com

2 2 Topic Slides Introduction and definitions 3-13 Step 1 - What s going on? Tool time Step 2 Risk reduction Step 4 - Reduce the amount Resources and summary 52-53

3 3 In each of us, there is a little of all of us 1.Clothes 2.Cards & letters 3.Bills & Statements 4.Books 5.Magazines 6.Knick-knacks 7.Momentos / souvenirs 8.Records /tapes/cds 9.Pictures 10.Sentimental objects Hoarders and non- hoarders keep the same type of objects, hoarders just keep many more items and multiples of the same item.

4 4 Cultural attachment to objects Museums Art Galleries Antiques Gifts from others Inheritance Architecture Flags Religious icons

5 5

6 6

7 7

8 8 Hoarding behaviour defined 1. persistent accumulation of, and lack of ability to relinquish, large numbers of objects or living animals, 2. resulting in extreme clutter in or around premises. 3. This behaviour compromises the intended use of premises and threatens the health and safety of people concerned, animals and neighbours. Squalor is the accumulation of rubbish, lack of ability or intent to dispose. Can include; dead animals, animal faeces, rotting food, human waste, failure to self care and attend to personal care needs, lack of capacity to plan, loss of social skills and/or loss of inhibition.

9 9 Animal hoarding defined The accumulation of large numbers of animals that overwhelms the person s ability to provide a minimum standard of nutrition, sanitation and veterinary care (definition taken from Hoarding and squalor - a practical resource for service providers, June 2013). People who hoard are often in denial about their inability to provide appropriate care for their animals and typically believe that no-one else can care for their animals like they do ( 60% of homes have dead animals (Patronek 1999) Animal hoarding networks

10 10 In common Animal Object Cluttered environment Difficulty discarding Even when dead Squalor no Age of onset Middle years Early years One type Usually more Single person Low insight Less than object More often women no

11 11 4 underlying characteristics Core vulnerabilities depression, anxiety, family history, perfectionism Difficulty processing information attention, memory, categorisation and decision making. Intense emotional attachments human like Fear of waste, objects=memories and aesthetics

12 12 you make me happy Hoarding is an impulsive not compulsive behaviour pleasure seeking perfectionist traits homogenous attachments People Tend not to seek assistance until in their 50 years + Thought to occur in 3-5% of the population (Mogan 2012) and aims to avoid/reduce negative emotions 1. 50% have trauma history 2. Low threshold for tolerating discomfort/anxiety

13 13 When and with Hoarding usually starts in childhood or adolescence or If later in life, due to Trauma / grief and loss, frontal lobe injury - DV Mental health i.e. Depression, schizophrenia, anorexia nervosa. Anxiety/obsessive compulsive behaviours, OCD Cognitive problems, i.e. processing information, impulse control, Acquired Brain Injury, ADHD, Autism Spectrum disorder, dementia. Genetics- there is thought to be a link on Chromosome 3 Alcohol and other drugs Can co-occur with gambling Approximately 92% of people with hoarding also have another mental illness. Jeffery's et al, 2008

14 Step 1 - Tool time 14

15 15 Objects and animals create connection to others, the world stability used to regulate emotions safety - anthropomorphising identity linked to their values, real or ideal competence avoid making a mistake, experience a loss

16 16 Hoarding Connection Stability Safety Identity Competence Yes No To

17 Other values & Costs 17

18 18 Creates leverage Hoarding Other values & costs

19 19

20 20 Assess the person and the home Tools to assess person Hoarding 5 questions *Savings Inventory Revised 23 Tools to assess home (remember- there items elsewhere) Clutter image rating scale Activities of daily living hoarding scales *The Environmental Cleanliness and Clutter scale (+ squalor) HOMES multidisciplinary hoarding risk assessment

21 21 After using the tools How the person views the impact of the hoarding + the amount of items + the impact of items. = risk reduction.

22 Risk reduction 22

23 23 Most critical risk fire People who hoard aged 50+ are at particular risk and account for 24% ( ) of all preventable fire deaths. 3 major causes of fire Heater / open fire / lamp Smoking and receptacle Electrical fault The majority of deaths in preventable house fires occurs in the winter months when people increase their use of heating. Most occur when people are sleeping, between 8.00pm to 8.00am; the peak time is between midnight and 4.00am.

24 24 Especially for older people Seniors are a high risk group because: Some medications decrease mobility and hearing which can reduce a person's ability to detect and escape from fire Disabilities can make it difficult for some seniors to respond quickly to a developing fire Living alone can increase vulnerability to fire, the higher the social isolation, the higher the risk.

25 An Analysis of Hoarding Fire Incidents and MFB Organisational Response 25 To reduce fire risks From the MFB website Hoarding, a lethal fire risk. Install smoke alarms and test them Unblock exits Widen internal pathways and lower piles Check utilities are connected Remove items from proximity to electrical / heating appliances For a non-hoarding home, may get up to 3 minutes to leave, less for hoarding home.

26 26 Setting goals for harm minimisation Target safety, health (financial, physical) then comfort A plan may need to include prioritising needs of others as well as the person. Goals should be SMARTS 1. Specific 2. Measurable 3. Achievable 4. Realistic 5. Time limited 6. Safety prioritise essential and immediate over desirable and long term.

27 27

28 28 6 step program (Barber 1991) Step 1:Clear the air Step 2: identify legitimate client interests Step 3: identify non-negotiable aspects of intervention Step 4: identify negotiable aspects of intervention Step 5: negotiate the plan Step 6: agree on criteria for progress

29 29 Step 1 Clear the air Focus on safety and legal requirements and clearly state the overall goal Don t argue Ask the client how they feel about being told to change their behavior in their own home What are their + and -? Always maintain a non-judgmental approach

30 30 Balancing support and monitoring. Often we have both roles which can be conflictual. We all want to support people to reduce the risks but have duty of care to monitor, assess and report hoarding risks. they say we often err to one or the other, we will either be mostly supportive or mostly monitoring

31 31 Step 2 Identify client concerns What are their concerns/fears? What has been their experience of change? Privacy and consent concerns? Financial impact? Social network impact? Who will visit and how often? Acknowledge that change can be a slow & difficult process, even for those want to change. Reinforce that this process will be negotiated where ever possible

32 32 Weighing up Ask clients to talk about their Reasons to change Reasons not to change

33 33 Step 3 identify the Openly discuss the goals of an intervention and acknowledge that your goals may be different from the theirs. Be as specific as possible Clutter Image rating scale? Help the client to set small, achievable goals that are meaningful to them trying to get the client Acknowledge that the client may not agree with the goals that have been set for them.

34 34 4.Identify the negotiable How will the goals be achieved? Using harm minimisation as a priority, if possible include areas of the home that the person wants to change If possible, be flexible about the timelines imposed. Who would they like to assist them? Can the agency provide/advocate for financial support to assist with the sorting / removal or rewards for success? Can the agency provide/advocate for the person to access alternative sources of interest.

35 35 5. Negotiate a plan Agree on a plan, and put it in writing. What is to be done, by who and by when? Set small goals to achieve and maintain Focus on the progress and effort the client has made, and encourage your client when they experience success, even if that success seems small or temporary a lot of small successes can lead to more permanent change than big, dramatic changes

36 36 And when they get stuck Use values to motivate. Remind residents that if they continue to NOT to acquire, or not to sort or discard, they are choosing their things over family, $, relationships, or secure housing. The cost of this of doing nothing is not nothing.

37 37 Reduce the anxiety Prediction and testing How would you feel if you didn t acquire/discarded item x? How bad would you feel? 0 10 scale How long would it take to get over that feeling? What negative thing would happen if you didn t acquire/discard it? How long would take to recover from this? Then don t acquire/discard the item and test if the prediction was right. Record anxiety/sadness/grief every day over a week. What can be learnt from this?

38 38 Time after time Day 1 Day 2 Day Felt anxiety over time

39 39 6. Agree on progress criteria How will both parties know if a goal has been achieved? How will this be sustained? What will happen if a goal isn t achieved? When will authority bodies be satisfied and cease/reduce involvement

40 40 1. Clear the air

41 41 2. Identify client concerns

42 42 3. Identify the

43 43 4. Identify the negotiable

44 44 5. Negotiate a plan

45 45 6. Agree on progress

46 Step 4 - reduce the amount 46

47 47 After that - Reduce the amount Acquiring Sorting Discarding Use the person s values and experience to direct reduction. Older people = physical health/ mental health chance of success

48 48 Persistent accumulation Is it? Active or passive acquisition Gift recipients / inheritance Network of collecting

49 49 Addressing accumulation Ask the person to keep a diary of 1. What did they acquire? 2. From where? 3. When? 4. If they spent, how much? 5. How were they feeling at the time and afterwards.

50 50 Where to start sorting and discarding? Choose an area a) frequency b) emotional content c) values d) Create rules

51 51 Making decisions and rules to discard Does this fit with my values? How many do I need to keep? Do I have something similar? I will discard all receipts that are x years old. Can I manage without it? Is this one of the best ways to remember x person/event? If it is broken, how likely is it that I will repair it and is this the best use of my time? Does this relate to my values? Do I have a specific place/purpose for this? Do I really have time to use, review or read it? Have you done this in the past year? (past behaviour is a good indicator of future behaviour). Could I get it again, if I really needed it?

52 52 Summary Values, reducing anxiety and collaboration in planning are the keys to safer homes. People with hoarding behaviours have usually been practicing these thoughts and behaviours for years, it takes time to learn and practice new ways of being.

53 53 Resources Department of Health Discussion Paper on Hoarding and Squalor, February Department of Health Hoarding and Squalor, a practical resource for service providers, June 2013 Compulsive Hoarding and Acquiring, 2007 Workbook and Therapist Guide, by Steketee and Frost Digging Out, 2009 by Thompkins & Hartl. The Hoarding Handbook, 2011, Bratiotis & Schmalisch Children of Hoaders, How to minimise conflict, reduce clutter and improve your relationship, Nezrioglue, F and Donnelly, K, 2013, Harbinger Press Buried in Treasures, 2007, Tolin, Frost & Steketee Stuff, 2010, Frost & Steketee Lessons in letting go, 2010, Grant. DVD Working with People with Hoarding Behaviours 2010 DVD My Mother s Garden, 2008 Lester. An Ordinary House, 2014 by Tania Reid