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Presented by:

An Introduction to

Extreme Clutter

Revised October 2025

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Housekeeping

Ie. how long is presentation, participants look after themselves and take breaks as needed, presenter promises to get people out on time, is it being recorded and will that be available to participants after, should they take notes or will they be given handouts after, how will questions be addressed and handled, during or after presentation is complete etc.

Important Points also to share with the audience:

**** If at any time you feel triggered or uncomfortable with any part of the presentation, please feel free to leave the room or shut off your camera if you are on Zoom. Myself or (another designated person) will be happy to meet with you after the presentation.

**** Please be respectful to all people attending the presentation, including the presenter.

**** Everyone is welcome to speak but we ask that you keep your comments and questions related to the presentation. Be mindful that the time you are using up affects everybody. Questions or comments beyond the scope of the presentation can be moved to the “parking lot” for a discussion after the presentation.

PRESENTER NOTE ONLY*** If a situation develops during a presentation, you as the presenter, reserve the right to cancel and reschedule the presentation.

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Land Acknowledgment

In this era of reconciliation, we acknowledge that the land we occupy has been populated by indigenous peoples for thousands of years before the Europeans settled here. We honor the ancestors of the past. We honor their legacy, their history and their traditions.

This acknowledgment is expressed in gratitude for the opportunity for us to work across the province to reciprocate our efforts to establish meaningful relationships in our ongoing effort to end abuse of all kinds including adult abuse and neglect.

In this era of reconciliation, we acknowledge that the land we occupy has been populated by indigenous peoples for thousands of years before the Europeans settled here. We honour the ancestors of the past. We honour their legacy, their history and their traditions.

In upholding our vision and mission of the BC Association of Community Response Networks we individually and collectively acknowledge the unceded territories of all First Nations in British Columbia. We respect and acknowledge all First Nations, Métis and Inuit people for their many contributions to the richness of our communities. This acknowledgment is expressed in gratitude for the opportunity for us to work across the province to reciprocate our efforts to establish meaningful relationships in our ongoing effort to end abuse of all kinds including adult abuse and neglect.

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About

the BC CRN

Provincial organization.
First piloted in 1993.
Supports development of a coordinated community response at the local level.
Provides education, materials & resources to build awareness & prevention of abuse, neglect & self-neglect.
Supports provincial, national & international initiatives.

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To empower communities and individuals through coordination, collaboration and relationship building to stop adult abuse and neglect - together.

Safe communities where adults are valued, respected and free from abuse and neglect.

Our Mission Our Vision

Mission

Vision

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Ministry of Health
Public Guardian and Trustee
CREA (Bankers, Lawyers, Aboriginal Leaders, COSCO, etc.)
RCMP and Municipal Police
First Responders
Seniors First BC
Community Gaming Grants
Other National Organizations (CNPEA, NICE, INPEA, etc.)
Community-based Senior Services Organizations

BC CRN and CRNs Key Relationships

Local CRNS

92 CRNS

in 265 communities!

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What is a CRN?

Community Response Networks are diverse groups of concerned individuals who work together to create a coordinated community response to adult abuse and neglect.

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Agenda

Stories about clutter
Definitions
Hoarding disorder
Rates, why and patterns
Relationship to abuse
Help
Community aspects and team approaches
What else?
Ask for more...

Trigger Warning: This material concerns mental health conditions information that may be traumatic or may re-traumatize viewers, depending on your experience with these issues..

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We’ll begin with two stories. First of all we meet John:

John experiences some constraints of his living conditions due to excessive possessions. John has always acquired possessions, mostly paper, clothing, and free give aways. Up to age fourteen his parents, mainly his Mom, cleaned up when his possessions started getting the way of his family's space. At eighteen he left home and over time had problems with his landlord and at work with amount and disorganization of his possessions and projects. At 22 he wouldn't let anyone into his place; had trouble with relationships, and at his Mother's urging, went to his doctor and was put on anti-anxiety medication

Over time, the severity of clutter increased as did John's social isolation. John's Mother advocated for a length of time and at age 35 John was referred for an assessment and diagnosed with Hoarding Disorder.

And now a community story…..that begs this question?

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Considerations

What do you do in a small remote rural ferry-dependent island community with virtually no services and an emerging clutter problem?

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Considerations

What do you do in a small remote rural ferry-dependent island community with virtually no services and an emerging clutter problem?

A Regional BCCRNS Mentor received a phone call recently. A trailer park and RV site on a remote British Columbia Island was managed and owned by compassionate landlords. They contacted a CRN who referred to the Mentor because the CRN did not know where else to refer…The landlord explained that the situation was 3 long time residents who they described as having many problems, but as being valued community members, all started having clutter expanding out of their trailers and RVs into common space. There are few services on the Island (1 RCMP officer, a volunteer fire department who has trouble filling its roster since the mine closed down, one half time resident doctor and 1 community nurse). The Mentor asked the landlords to contact Home and Community care in an adjacent (ferry ride away) larger community, so that a limited but coordinated approach could be developed. The response is just getting organized and the outcome is unknown.

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Accumulating and Managing Possessions

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Clutter:

Possessions are disorganized and may accumulate around living areas
Clutter occurs most often in storage areas.

Collecting:

Possessions are part of a larger set of organized items.
The display is public and does not impede active living areas in the home.

Hoarding:

Possessions become unorganized piles preventing rooms from being used for their intended purpose.
This is private; there is excessive acquiring and distress with discarding.

(International OCD Foundation, 2020)

Clutter, Collecting, Hoarding and Squalor

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Normal Clutter

Disorganized within storage space.
Does not impair household / shed functioning.
Ability to discard with only minor distress.
Only acquires in a non-excessive way.

April’s Shed

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Stages of Clutter

(Steketee, Frost 2013)

Clutter Image Rating Scale

Reproduced with permission of the Licensor through PLSclear.

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Other Reasons for Hoarding

Other reasons

(Besides Hoarding Disorder)

Age

Physical limitations

Stroke

Traumatic brain injury

Dementia

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Hoarding Disorder

Definition:

Excessive acquiring and inability to get rid of possessions.
Attempts to part with items creates distress and anxiety.
Difficulties of making decisions of what to discard (sort).
Excessive clutter disrupts the ability to use living spaces.
Consequent significant impairment in social, occupational or other areas.

(American Psychiatric Association, 2013)

There are common misconceptions about hoarding as a condition. Most people have only seen somewhat sensationalized and stereotyped behaviour and consequences of extreme clutter (as in the TV Series).

Blame and stigma are commonly found in how this topic is viewed; and when the term hoarding is used, as if it is a character defect rather than a condition of which clutter is a symptom.

So what exactly is hoarding, and what is hoarding disorder?

Hoarding is having so many possessions that you cannot manage the clutter and there is a risk to safety.

Hoarding disorder is a brain based information processing condition which affects an individual over the entire life span. Excessive clutter is the physical sign that something is going on, there are also other signs in the extent of social isolation, social relations, and organizational skills. The disorder has specific diagnosis criteria.

Read slide

Excessive acquisition and difficulty getting rid of things is the key difference where hoarding comes into play.

‘Often, major clutter has developed by the time it reaches the attention of others’.

In John’s case the clutter impairs his own life and space, in the community story, clutter has spilled out of living spaces to impair communal spaces

Hoarding disorder is considered a serious mental health condition.

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Hoarding Statistics

Rates of Occurrence:

2-6% of the population have this disorder, with higher rates over the age of 60.

(American Psychiatric Association, 2019)

Estimates of Numbers:

Sunshine Coast < 600 households.
Greater Victoria < 15,000 households.

(Anderson, 2019)

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Rates of Disorder Compared

Hoarding Disorder

“3x rates of Alzheimer's disease”

“2x rates of OCD and 4x rates of bipolar disorder”

Hoarding Disorder

OCD

Bipolar

Alzheimer’s

(Psychiatric Times, 2011)

(Anderson, 2019)

Hoarding Disorder

(Psychiatric Times, 2011)

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Universal?

Does this disorder happen in other places?

(Nordsletten, Cruz et al 2018)

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Universal?

Hoarding Disorder occurs

in the same symptoms and incidence across human cultures, countries and genders.

(Nordsletten, Cruz et al 2018)

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Why Does Hoarding Disorder Happen?

This has been described as an information-processing disorder in the brain - it involves different brain connections and activations.

(Tolin, 2013)

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Influences

Genetics, brain function and stressful life events are being studied as contributing to hoarding behaviours.

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Starts early
Will worsen without intervention over the lifespan

Pattern Through Lifespan

Age 11-14

25 yrs

35 yrs

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Individual vulnerability leads to social risk
Other mental health vulnerabilities likely exist

Complexity of service provision

Risk to aging in place

Features of Disorder

Other mental health vulnerabilities may 'cluster' with Hoarding Disorder: about 75% with a hoarding diagnosis have another mental illness as well.

These include co-morbid depression, ADHD and anxiety disorders.

While medication may help with the accompanying disorders, it is not found to be effective with the hoarding disorder.

‘Often, major clutter has developed by the time it reaches the attention of others’.

The extent of clutter means there is increased risk of not being able to age in place

Hoarding is chronic and follows a worsening course that can:

‘lead to isolation from family and friends and negatively impact health
lead to eviction and homelessness
create a public health and safety risk
create a dangerous environment for first responders during a fire or medical emergency’

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Impact on Quality of Life

Impaired cognitive functioning may have a significant impact on overall quality of life.
Individuals may be:

Socially isolated
Unable to work
Not engaged in meaningful activity
Dissatisfied with their living conditions (e.g. due to difficulties with sanitation and clutter)

( Saxena et al., 2011, McCarty 2017)

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Impact

“Hoarding has a far greater effect beyond the individual, much more than other mental disorders.”

(International OCD Foundation, 2024)

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Relationship to Abuse

Hoarding is associated with self-neglect and raises both vulnerability and the risk of abuse.

“The hoarder's control over the personal space of all who live in the home, and the extremes to which many hoarders will go in order to defend their volume of possessions may cross the line into abusive behaviour.”

(©MindUK)

There is a relationship between trauma, adverse events, interpersonal violence and changes in relationship, loss ,and onset of hoarding.

(Fontenelle 2021, Mathes 2018)

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Housing Issues

Problems may arise with:

Aging in place
Tenancy

This is particularly critical in areas with existing housing crises.

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Two Desired Outcomes

Mental/social wellness
Public safety

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Helping Family Members

Learn what steps may help:

Learn about resources
Check language
Referrals
Advocacy

A family member is most often who gets help for the person who may have HD, so the role of family is critical. The person themselves likely lacks insights or is shamed or withdrawn and wants to keep the issue private.

Family often tries to help - but nagging, arguing, shouting or threatening does not result in reduction of the clutter and can damage family relationships. Forced clean ups do not last. (Good Therapy.org)

Learning about the disorder as involving a lack in perception, information processing and skills; may reduce family frustrations and friction. If you are dealing with this kind of situation, a good step is to educate yourself on this chronic disorder.

Fact sheets and guides from the OCD Foundation have assistance on how to talk to family members with non-judgemental language and conversation which encourages change, and language that supports without enabling.

The BC Schizophenia Society has a course called Strengthening Families which covers the impact of stigma around hoarding, how to communicate with compassionate interactions, and the impact of being a relative or friend; it also has support groups around mental illness.

.https://www.bcss.org/events-programs/family-support-groups/

The Canadian Mental Health Association often works as a broker to connect individuals and families with useful resources. CMHC North Shore has offered groups for families dealing with this issue.

Island Health offers hoarding webpage, telephone numbers, a support group, Facebook group, and a link to public safety team.

Talk to your primary health provider about referrals to Adult Mental health

If there is a primary care network in your region they may be able to coordinate services in a more wrap around approach-with access to medical services, counsellors and social workers

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A Path to Help

Get an assessment:

Adult Mental Health Services/health authority

Start cognitive behavioural therapy:

Adult Mental Health, private counsellors

https://bcacc.ca

Support Gps/training

(family/individual):

Adult Mental Health/agencies

Medications:

Talk to your doctor

Professional organizing:

https://organizersincanada.com

Self help:

“Buried In Treasures”

These steps are recommended by Dr. David Tolin: and are handy both for individuals and family or agencies to know.

Get an assessment. Your GP can help refer. This should identify if hoarding disorder is at the basis of behaviours.

This will eliminate other causes that have different treatment plans.

Start cognitive behavioural therapy (specialized to HD). There may be specialized training support groups available.

Medications may help accompanying mental health issues.

Changing behaviour and maintaining behaviour takes time, over a length of time. Support groups help retain change and build social connections.

Professional organizers who will work collaboratively with the individual may be helpful.

There are books from the viewpoint of the individual available. ‘Buried in Treasures’ offers information on thinking patterns in Hoarding Disorder and a set of evidence based steps that individuals can follow to change habits and behaviours - self help in action.

This path can be followed by the individual or family, or friends.

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Summary

Mental/emotional/cognitive wellness:

We all need to learn non-judgmental ways to interact.
Family and friends are the ones who most often seek help with this issue.
Assessment is the first step towards understanding what is going on and making a plan.
Treatment requires a number of coordinated approaches - CBT therapy, behavioral training, skills building, on going peer group support…

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Public Safety

Private vulnerability becomes community/public safety issue:

There is a longstanding relationship to clutter.
Clutter accumulates to an unsustainable level.
Social and other impairments are present.
Issues build up:

Safety
Health
Social isolation
Family
Community
Housing
... and more

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Why Pay Attention?

Individual daily functioning
Neighbourhood relations
Crises intervention
Unsafe housing

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Nature of

Effective Responses

This ‘problem’ crosses professional scopes of practice. A comprehensive and far-reaching approach is needed (more than one single agency).

(Anderson, 2019)

CRNS do not intervene but may ‘broker’.

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Current Approaches

Countering the effects of hoarding:�

Effective approaches:

Collaborative community approach/safe-guarding
HEAT, HART, health authorities teams

Combined assessment and best practices (UBC)

Interventions and understanding at all levels:

Individual/ Interpersonal
Institutional/ Society (stigma)

Because there may be risks of fire, environmental health, structural building issues and other aspects to a situation where there is excessive clutter, a number of agencies will be involved resolving issues. In some areas there are teams assembled to work together, possibly with mental health services – and support for individuals and their families to mitigate the risks and restore safety both for individuals in their residences and for the neighborhood/building.

The HEAT (Hoarding Education and Action Team) team, Victoria, and the HART (Hoarding Action Response Team) team in Vancouver are examples.

https://van311.ca/services/hoarding.

https://vancouver.ca/people-programs/home-action-response-team.aspx

www.islandhealth.ca/heat

UBC has developed a joint assessment tool to combine the elements needed thereby eliminating the need for use of individual professional centered assessments. UBC Centre for Collaborative Research on Hoarding also has guidelines on how to do compassionate and less intrusive and most effective clean outs

https://hoarding.psych.ubc.ca/knowledge-exchange/

Countering the effects involves all levels of society-it is not simply an individual problem or challenge.

Individual (internalized) , Interpersonal, institutional and societal attitudes need to shift to prevent stigma from entering into interactions with persons with this condition.

(For a resource to see how stigma operates and how it can worsen someone’s health status – see Teresa Tam -Addressing Stigma: Towards a More Inclusive Health System.

Public Health Agency of Canada. (2019). The Chief Public Health Officer's Report on the State of Public Health in Canada 2019: Addressing Stigma Towards a More Inclusive Health System. Ottawa, ON: PHAC. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/addressing-stigma-what-we-heard/stigma-eng.pdf )

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Additional

Team Members

RCMP
Fire services
EMT/paramedic
Adult mental health
Adult abuse lead
Environmental health
Property use inspector
Bylaw officer
SPCA
Non-profits
Landlords

Have specialized numbers, web pages, and teams who offer assessment and support.

Situations may require intervention from agencies, formal and informal, and long-term support - possibly from peer support groups.

The list on the right is of providers who may get involved.

This requires coordination.

Health Authorities

and Cities

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Team Action

Joint casework has its own set of demands:

Different assessment for each profession
Communications amongst professionals must be effective

(Kysow and Bratiotis et al, 2020)

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Hoarding Disorder | HealthLink BC

Vancouver Coastal

Contact VAN 311 (Vancouver). Report online.

https://van311.ca/services/hoarding.

https://vancouver.ca/people-programs/home-action-response-team.aspx

Island Health

Phone: 250-361-0227 (Victoria)

Email: heat@islandhealth.ca

Website: www.islandhealth.ca/heat

Other Health Authorities / Contact Mental Health Services

UBC Knowledge Exchange

https://hoarding.psych.ubc.ca/knowledge-exchange/

Contact Information

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How CRNs Can Help

Contribute members who know how to collaborate to multi - agency approaches (outside of CRN table)
Incubate team development until independent
... and more!

CRNS (also known as Community Response Networks belonging to the BC Association of Community Response Networks) are positioned to have an overview of community-level trends. They can alert more siloed agencies as to trends over time (numbers, types of situations, impacts) because CRNS have many fingers out into the community.

Individual members of the CRN, such as the RCMP, or health workers, may do work on extreme clutter as part of their assigned employment duties.

What CRNS offer is the way to coordinate multi-agency initiatives - they already do for issues of abuse, neglect and self neglect (and hoarding can be seen as a type of self-neglect). Self organized networks of providers focused on complex issues, are seen as effective prevention; countering such situations.

They do this in ways which reflect the realities of urban, suburban or rural / remote communities

CRNS already routinely build protocols with other agencies as to how to manage referrals, reports, expectations of the amount and timeliness of services and follow up.

CRNS can develop pathways for connection in small communities with regional (possibly specialist teams) resources.

And CRNS can do education on coordination, or community issues. Or help problem solve

i.e. apply to local community foundations for ongoing funds to support disposal costs for de-cluttering or services from professional organizers. And they can help with practical steps like listing where items can be disposed of.

There is a separate presentation available aimed at Coordinators and CRN Members, which looks at the details of how CRNS can be useful.

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Summary

Coordinated community level approach:

It is hard to deal with this condition for both the individual and those offering support/practical help.
The desired outcome is harm reduction and tenancy protection.
Practical clean up/safety require a multi-agency/coordinated person-centered care approach.
Results are not immediate.

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Harm Reduction

Harm reduction as an outcome is a reasonable expectation.

For the individual and for the living conditions.

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Ask for More

Fact sheet
Infographics
Resource guide
Reference list

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Questions?

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Thank you!

BC Association of Community Response Networks

#505-8840 210 Street, Box 349

Langley, BC V1M 2Y2

Website: bccrns.ca

Email: programs@bccrns.ca