Monday 22 September 2014

Joint govt effort to better unclutter lives of hoarders

New task force will work with community groups to identify and help those who hoard
By Janice Tai And Toh Yong Chuan, The Sunday Times, 21 Sep 2014

Several government agencies have come together to deal more effectively with the growing problem of elderly people who clutter their flats with numerous items they hoard.

They collect cardboard boxes, plastic bags, canned food, newspapers and umbrellas and, in the worst cases, stack them up from floor to ceiling, making it impossible to move around freely inside their flat.

The Sunday Times understands that those involved in the new task force, led by the Ministry of National Development, are the Ministry of Health, Ministry of Social and Family Development, the police, the Housing Board (HDB), Singapore Civil Defence Force (SCDF), National Environment Agency (NEA) and People's Association.

Also involved is the Institute of Mental Health (IMH), because hoarding can be a symptom of obsessive compulsive disorder or dementia.

The new task force will work with community groups to identify those who hoard, clean up their flats, which can be potential fire traps, and send them for medical treatment if they need it.

It allows the different bodies to tackle the issue "in a more coordinated and sustainable manner", a National Development Ministry spokesman told The Sunday Times.

Currently, residents are simply advised by HDB officers to remove items, the spokesman said, adding: "For compulsive cases, the HDB will work with social workers, grassroots leaders and the SCDF to provide counselling and help."

Up till now, problem hoarders were dealt with in a piecemeal fashion, said Ms Julia Lee, director of Touch Community Services' Seniors Activity Centre.

If items caused obstruction in public spaces, such as common corridors, the town council would step in. The NEA would be alerted if hoarding caused an infestation of pests, such as cockroaches. If the items were deemed a fire hazard, the SCDF would get involved.

Ms Lee said: "It is important to address hoarding, as the clutter may affect health and safety, cause conflict with family and neighbours, or is a sign of isolation and loneliness."

Voluntary welfare organisations welcomed the joint effort by the task force, given the serious problems hoarding can cause.

Doctors at IMH treated a 50-year-old woman who lived in a three-room flat in Toa Payoh that was so cluttered with junk that every time she needed to shower, she had to move items out of her bathroom.

She had a decade's worth of newspapers, old electrical appliances and umbrellas, among other things. The flat was so packed that she ended up sleeping in the corridor.

The woman has improved with treatment, and is no longer hoarding items. The town council has cleared out her flat.

Social workers from Touch, who visited 600 flats in two rental blocks in Geylang Bahru over the past two years, found 30 with significant hoarding or self-neglect.

The number referred to the IMH for hoarding has increased gradually over the years, said its consultant Rajesh Jacob, though figures are not available.

From January to last month, HDB also received feedback on 23 hoarding cases, the same number it handled for the whole of last year.

These figures are likely to be the tip of the iceberg, said those who work closely with the elderly, because cases go unreported, or those who exhibit such behaviour refuse to seek treatment.

200 pairs of scissors, knives and more...
By Toh Yong Chuan, The Sunday Times, 21 Sep 2014

Madam Ng Moey Chye had more than 200 pairs of scissors and knives, 400 paper fans, 100 bamboo sticks, 100 umbrellas and 30 trolleys.

These are things that the 83- year-old former Samsui woman had collected over 15 years, and they were piled to the ceiling of her one-room rental flat in Bukit Merah.

She could not get into her kitchen, and had to crawl to her bed on a path the width of a magazine.

Volunteers from Keeping Home Alive cleared her flat of the clutter one week ago, but it was not an easy task.

"She agreed to part with the items only after we told her we would sell them to the rag-and-bone man," said 44-year-old Fion Phua, who founded the volunteer group.

Now, Madam Ng's collection has been reduced to 32 umbrellas, 11 clocks, 10 chairs and seven trolleys.

She did not like being asked about hoarding. "My things are not dirty, no cockroaches and bedbugs," she protested. "They give me some financial security. I stopped working 15 years ago, so I need to collect things to sell."

But she admitted: "I did not get round to selling them because my leg hurts and I cannot walk much."

She still collects cardboard to sell daily, supplementing the public assistance money she gets each month.

When asked about her scissors and knives, she said: "I was a cleaner at a Jurong clothes factory. After it closed 20 years ago, the scissors were discarded, so I kept them."

Madam Ng, who never married, is glad that the clutter was cleared. "The room is now more airy and spacious," she said.

But she is not about to stop collecting things, she said.

How family can help sufferers seek treatment

Last Sunday's article ("Joint govt effort to better unclutter lives of hoarders") discussed the issue of hoarding.

Hoarding disorder comes under the spectrum of obsessive compulsive and related disorders. This implies there is some obsessive element to the condition that elicits anxiety from the sufferers when they do not hoard.

They often find attachment to everyday objects in their lives, such as stationery, cooking utensils or even old newspapers. They would put forth various explanations for their need to have the items, including financial security from their "possible" sale. Sometimes, no explanations are given.

The attachment can be so severe that it is difficult for family members to remove the items as this would result in tensions with the sufferer.

Very often, the disorder builds up insidiously; one or a few items are collected daily, and these build up over time. By the time the disorder mandates attention by family members, the condition is usually fairly established. Very often, a fire or environmental hazard is apparent by the time it is noticed by the authorities.

What can family members do when faced with such a situation?

Speaking to the patient in a non-judgmental manner would be helpful. Often, there is some form of psychological insecurity that is mollified by the items they hoard. There is a sense of comfort when they see and feel the physical presence of the objects, somewhat improving their sense of self-worth.

If the family member is able to find out the underlying cause of the insecurity, then it would be a good start towards the treatment process.

It would be unhelpful at the start to challenge the sufferer on the need for the items, or even to forcibly remove them as this does not resolve the underlying problem and may make it harder for the hoarder to seek treatment.

Subsequently, it would be useful to encourage the sufferer to seek help by seeing a mental health professional, who would then recommend the necessary treatment.

Often, management of this condition is multimodal and requires the collaboration of multiple professionals.

Hoarding presents a situation that is difficult for patients, their families and their neighbours. Lending an ear and speaking to sufferers would be a start towards recovery.

Lambert Low (Dr)
Honorary Treasurer
Singapore Psychiatric Association Management Committee
ST Forum, 28 Sep 2014

* One in 50 people here will hoard in their lifetime: Study
Condition may be due to an underlying cause, classified as disorder when certain criteria met: Experts
By Neo Chai Chin, TODAY, 5 Jan 2015

One in 50 people in Singapore will display hoarding behaviour in their lifetime, said a recent study believed to be the first to establish its prevalence here.

The study also found that 0.8 per cent of the 6,616 respondents surveyed had displayed hoarding behaviour in the past 12 months.

Reports of hoarders crop up periodically in the media — the latest was that of a man who had lived in Toa Payoh and died alone more than a month ago, but whose flat filled with items and pests could not be cleared initially as his next-of-kin could not be located.

Hoarding is the acquisition of, and inability to discard, items, although they appear to have no value, leading to clutter, distress and disability.

The study, Hoarding in an Asian Population: Prevalence, Correlates, Disability and Quality of Life, was led by Adjunct Assistant Professor Mythily Subramaniam of the Institute of Mental Health’s (IMH) research division and published in last November’s edition of ANNALS, the medical journal of the Academy of Medicine, Singapore.

The respondents were surveyed as part of the Singapore Mental Health Study between December 2009 and December 2010. The question, “Did you ever have a time in your life when you repeatedly carried out any of the following behaviours — always having to save things to the point where you could not throw away things that you no longer needed or cared about?”, was key in establishing hoarding behaviour.

At 2 per cent of the adult population, the lifetime prevalence of hoarding here is lower than the 4 per cent reported in studies done elsewhere, the researchers noted. Compared with other common mental illnesses here, hoarding is less prevalent than major depressive disorder (5.8 per cent of the adult population) and obsessive compulsive disorder, known as OCD (3 per cent of the adult population).

The IMH does not track figures for hoarding as it may be a sign of an underlying condition. For instance, a patient with schizophrenia may hear voices commanding him to hoard items and he will stop hoarding if anti-psychotic medication can get rid of the voices, said Dr Kelvin Ng, associate consultant at IMH’s department of Community Psychiatry.

However, some patients with intellectual disability and autism may have idiosyncratic behaviours or obsessional interests that cause them to hoard — in these cases, there is often no treatment, said Dr Ng, who is not among the study’s authors.

The IMH classifies hoarding as a mental disorder when certain criteria, including a persistent difficulty in discarding possessions regardless of their actual value, resulting in accumulation that clutters living areas and compromises their use, are met.

The majority of IMH’s patients who hoard came to its attention through community partners such as the Housing and Development Board, grassroots organisations or family members, said Dr Ng.

He recounted a case that surfaced about five months ago through the grassroots at a multi-agency meeting. It involved a middle-aged man hoarding items to the extent that his elderly mother had to spend most of the day outside their flat and sleep on top of the items in the flat at night.

The hoarder had panic attacks when the authorities began clearing the items and IMH professionals became involved, Dr Ng said. The man later sought help at Changi General Hospital and was supported by family service centres, while the authorities slowed down the clearing of items, he said.

Other findings of the study were that hoarders without OCD had a higher quality of life than those with the condition. Hoarders without OCD were less likely to be obsessed with contamination — the persistent fear of coming into contact with things, real or imagined, that are filthy or harmful — and ordering. Among those with OCD, the lifetime prevalence of hoarding behaviour was 22.6 per cent.

The researchers did not find an association between age and hoarding.

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