Can hoarding become a danger so threatening that intervention is needed?
Would lives have been saved if clutter had been kept down?
At what point does a once-harmless devotion to collecting anything and everything from clothes to papers become harmful?
Those are the kind of questions the Lancashire Safeguarding Adults Board has been asking as it prepared new guidance on self-neglect and hoarding which is being published this week.
The demand for such a strategy was prompted by the death in November 2016 of a Lancashire resident whose case prompted a Safeguarding Review.
In addition Lancashire’s Fire and Rescue Service came to the Board raising concerns about the fire and safety risks associated with hoarding .
The new strategy will be launched this week, with the Blackpool and Blackburn with Darwen Safeguarding Boards adopting the same framework.
The Lancashire Safeguarding Board will host two advice events advice in Preston on March 20 with agencies ranging from police, fire, ambulance, health,social services, charities and other organisations attending.
While this is a roll out being organised by a number of agencies, Safeguarding Board chairman Jane Booth believes the Board’s guidance has relevance for individuals too - especially if we are to be good neighbours and know when and how to intervene or raise an alarm before crisis calls.
Jane emphasises self-neglect can affect anyone in our community regardless of age, gender or race, although it is acknowledged those at greater risk include the elderly and those with physical or mental health problems.
She wants a wider understanding that if concerns are reported and services notified early enough it may be possible to prevent harm and further self-neglect.
Self neglect and hoarding behaviours do not just hurt an individual, but can impact on children, family and neighbours too.
Someone may be keeping up appearancs at work, holding down a job and comin home to a hidden hoarding habit they are ashamed of and which restricts their home and social life.
Jane said: "It can go unnoticed for quite a long time...Neighbours can be quite crucial. Adult social care is the place to go.”
“People might think their neighbour is looking a bit down in the mouth or isn’t looking after themselves as they used to or seems a bit strange.
But we’re very reluctant to interfere in people’s lives these days. People can get to quite a state before it comes to people’s attention.
“The other situation is some people are doggedly independent or you go into a situation where someone is not at all well, not at all mentally well and their situation is deteriorating and they won’t ask for help.”
If neighbours perceive a nuisance, for example to health caused by vermin attracted by rubbish or as fire risk it may then come to the attention of a local council's environmental services, but otherwise can go unremarked, when help could be available.
Jane hopes the new guidance will give professionals confidence to how to approach such issues.
“The strategy is supported by a ‘tool kit’ which, said Jane, will “help people take a more independent view on what’s acceptable, rather than being subjective about it”.
The kit includes photographs of a kitchen, bedroom and lounge. Each looks clean and tidy to begin with and chaos gradually overtakes each room.
The nine picture portraits of each room will enable rooms to be compared and given an appropriate Cluttter Image Rating which will inform an assessment of how great the person’s hoarding problem is.
This, stresses Jane, is important because assessments of clutter problems vary according to people’s individual judgement as to what is acceptable.
Understanding how to report a concern, it can be anonymous and if services are notified early enough, it may be possible to prevent harm and further neglect.
Jane said: “We’re all entitled to choose how we live and we’re all entitled to make bad decisions about how we live.
“But such decisions must not impact others dangerously. The issue comes when someone’s mental capacity may be impaired and they can’t see the risks they are putting themselves in.”
She acknowledges hoarders might find interventions challenging, but stresses it is important to help people who self-neglect to see there is a problem and encourage and support them to engage with services which can help them.
"It’s all about getting this balance. People who have got to the stage of self-neglecting are quite unlikely to go and self refer and say they’ve got a problem.
“They probably don’t perceive a problem and if they do there’s a stigma attached so there’s a real risk that people won’t recognise there’s an issue.
“We’re trying to promote professional awareness and community kindness - not to be a nosy neighbour but take a proper interest. We do want people to care about what might be going on.”
The following organisations offer help and support for those dealing with hoarding issues.
Hoarding UK is a charity supporting people impacted by hoarding behaviour: www.hoardinguk.org
Help for Hoarders: see www.helpforhoarders.co.uk
Hoarding Disorders UK see: www.hoardingdisorders.uk.org
Clutterers Anonymous UK atcla-uk.org
online audio support group: www.ocdaction.org.uk/support-group/online-hoarding-support-group-evening