Hoarding and how to approach it Statutory powers and draft guidelines

1. Hoarding and how to approach itStatutory powers and draft guidelines

2. Hoarding and how to approach it- a guide for EHOs and others Statutory powers and draft guidelines Revised from a presentation first made to the Royal Society of Medicine in May 2004 by Dr Sarah Holroyd, then Consultant Clinical Psychologist, Surrey Oaklands NHS Trust and Howard Price, Principal Policy Officer, CIEH

3. Hoarding – statutory powers • mental health powers • Mental Health Act 1983 • necessary for own or others’ health and safety and treatment cannot be provided otherwise • National Assistance Act 1948 • chronic disease, age, infirmity or incapacity • insanitary conditions • unable to devote proper care and attention and in the subject’s interest • European Convention on Human Rights

4. Hoarding – statutory powers 2 • environmental health powers from the treatment of hoarders to the treatment of hoarding • complaints of smells, unsightliness or pests may lead to a duty to investigate • investigation may lead to a duty to intervene • “health” powers and “amenity” powers

5. Hoarding – statutory powers 3 the “health” powers - Public Health Act 1936 - “filthy and verminous premises” - Environmental Protection Act 1990 - statutory nuisances, esp “accumulations” - Prevention of Damage by Pests Act 1949 – harbourage for rats and mice

6. Hoarding – statutory powers 4 the “amenity” powers - Refuse Disposal (Amenity) Act 1978 -anything abandoned in the open air - Town & Country Planning Act 1990 -adversely affecting amenity of area - Environmental Protection Act 1990 - Litter Clearance Notices

7. Hoarding – statutory powers 5 the enforcement model – appropriate? - complaint / observation / information - enforcement criteria satisfied - statutory notice (reasonable time) - compliance enforced by prosecution / work in default a rational model in irrational circumstances

8. Hoarding – statutory powers 6 pressures and constraints - the “Respect Agenda” - political pressures - Ombudsman - Human Rights Act / Convention - disability discrimination?

9. A case study The original complaint Oct 1993 – complaint of smell from accumulation in rear garden abatement notice under Public Health (Ireland) Act notice not complied with – summons issued nuisance order made – 10 days to clear up

10. A case study 2 Further complaints nuisance order ignored – further summons Oct 1994 – fine. Attempt at clearing up Feb 1997 – further complaints statutory notice not complied with court hearing adjourned – “good samaritan” steps in

11. A case study 3 Inside complaints of mice – entry to house for first time heavy infestation, rotting food etc statutory notice not complied with summons – conditional discharge and costs enforced by Work in Default – 11 skips!

12. A case study 4 Conclusion? problem recurred further court hearing in 2002 house unfit for human habitation 7 EHOs, 19 court appearances, £14,000 of work

13. The survey The subjects 77 local authorities 209 cases active during 2003 Men and women in roughly equal numbers 52% over 60y, 8% under 40y 82% living alone, 5% with partner 86% not working

14. The survey 2 The subjects 27% substance abusers 16% physical disabilities 21% family separations, mainly bereavements 37% receiving any care etc

15. The survey 3 The nature of the hoarding 50% were multiple collectors 11% undifferentiated household refuse 5% newspapers and magazines 4% clothing 4% animals Mechanical / electrical goods: 9% men, 2% women Clothing: 6% women, 2% men

16. The survey 4 The effects 33% spilt over outside the home 55% affected others 86% significantly affected habitability 70% presented significant fire hazard 59% presented serious risk of personal harm 65% contributed to infestations

17. The survey 5 The response Social services involved in 49% of cases Community health services involved in 31% of cases Landlords involved in 26% of cases Family / friends involved in 20% In 11% of cases, only EHOs were involved

18. The survey 6 The response Public Health Act - 27% of cases Environmental Protection Act - 15% of cases Pests Act used - 11% of cases Follow-up action needed in 23% of cases Rehousing in 24 cases Possession proceedings in 9 cases Animals removed in 9 cases

19. The survey 7 The outcome Effectiveness – short-term: - statutory notices, rehousing, removal of animals Effectiveness – long-term: - social / mental health services, informal support, combination

20. The survey 8 The outcome 52% of cases reported “resolved” within the year 9% had recurred already, ie within months 44% had arisen before In 60%, EHOs expected to be called in again

21. The survey 9 Conclusion Small sample of authorities – diverse range of cases Generally reflect the clinical picture EHOs’ powers provide temporary relief More hope from long-term, informal support Permanent resolution often remains elusive

22. Guidelines Why? How best to approach cases in the future Reconcile conflict between duties and more sensitive approaches Lead to higher long-term resolution rate

23. Guidelines 2 Gather as much information as possible; assess it carefully Do not make assumptions. Do not judge Rational arguments are not likely to succeed

24. Guidelines 3 Try to see the hoarding through the subject’s eyes; use neutral vocabulary Be clear about the goal and its justification Enlist help from family and friends if possible

25. Guidelines 4 Know in advance what other help is available Be aware of the likelihood of recurrence; revisit sooner rather than later Be aware of the need to refer where serious risk of harm to subject or co-habitees or animals

26. Hoarding and how to approach it The mission of the CIEH is to promote the health of people through education, training and knowledge.