HoarderfireHoarding Training and Development Officer at Orbit Independent Living, Samantha Richardson, looks at the fire safety impact on individuals, families and neighbours of increasing levels of compulsive hoarding in both the UK and US:

Recently, I have been speaking with Catherin Levin, Correspondent for Fire Magazine, the leading US Fire and Rescue Services magazine. Catherine contacted me as she was researching and writing a comparative piece between the US and UK Fire Service responses to cases of hoarding, in an attempt to identify best practice from ‘both sides of the pond’.

The article begins with the story of the Collyer brothers who, in 1947, were found dead in their home amongst 130 tonnes of clutter; including books, furniture, four grand pianos and a model T Ford car - the products of many decades of hoarding. Langley Collyer died from crush injuries after one of his booby traps fell and crushed him. Homer, his older paralysed and blind brother who was dependent on Langley for care, died of starvation three days later.

The fate of the Collyer brothers may not be surprising to viewers of the recent TV programmes on hoarding, with their familiar images of rooms stacked from floor to ceiling with the individual’s collections. It may also not be difficult to imagine how easy a fire could spread once an ignition occurs and the reduced chances of those living inside escaping without injury when exits are blocked by belongings. However, the number of fires as a result of hoarding is unknown.

During her research for the article, Catherine searched the UK’s Incident Recording System and the US National Fire Incident Reporting System to find that statistics on fires related to hoarding are not recorded on either system. Without the information available directly linking hoarding to domestic fires, how do we make a strong business case for funding and resources to reduce these risks? We make estimates based on the known risks associated with fire, the socio-demographic break down of fire fatalities and the characteristics held by individuals who hoard.

The social case
Research conducted by the Department of Communities and Local Government (DCLG) in 2006 into the findings from Fatal Fire Investigation Reports revealed that certain groups were at more risk of fire.

These include (but are not limited to):
•Elderly people (63% of fires involved individuals over the age of 50)
•People with physical impairments (30%), in particular those with limited mobility, and/or mental disabilities (15%)
•Dwellings that are in poor physical condition.

In 2008, a research study into the ‘economic and social burden of hoarding’ on a sample of 864 individuals who self-identified as having hoarding issues and 665 family members found hoarding participants had a nearly three-fold chance of being overweight or obese, were more likely have a spectrum of chronic and severe medical concerns and used mental health services five times as much as the general population. (Tolin, et al, 2008)

This research reinforces the concerns of professionals. The individual’s multiple and complex needs combined with the ‘poor physical condition’ of the property increases the risks of fire in the home and therefore, reduces their ability to respond quickly once a fire has started and places them at increased risk of injury or death.

Individuals with hoarding disorder are also more likely to live alone than the general population and are frequently socially isolated - one research study found that 23.5% of participants also had a social phobia and 24.4% had a Generalised Anxiety Disorder (Frost et al, 2011). As the case of the Langley brothers highlights, individuals who hoard are often viewed as ’social recluses’ and are therefore, not brought to the attention of statutory bodies.

Similarly, within Care and Repair, we have found cases are often only highlighted during times of crisis; through hospital admissions or when aids and adaptations are required in properties due to worsening physical disabilities. A lot of the time it is, as Fire Magazine’s title aptly puts, ‘a hidden problem’.

It could be argued that in order to prevent fire fatalities individuals who hoard should be sought out and effective support offered. The emphasis here really is on EFFECTIVE support. Agencies need to work together, share information and tailor the services they offer to meet the unique needs of each individual. A ‘one size fits all’ response will not work.

The economic case
A UK report into the economic costs of fire, in 2004 , estimated the human cost of a fire fatality to be £1.375m, per person, with a serious injury estimated at £155,000. The estimated financial costs, in the UK, as a consequence of fire for the same year, which included property losses, the costs of fatal and non-fatal casualties and business disruption, were approximately £2.5 billion. Saving the life of one individual could save the public purse £1.375m (Office of the Deputy Prime Minister, 2006). However, as the Langley case highlights, injuries and death cannot just be attributed to fires in the home. Additional savings could be also made to other organisations, such as the NHS, housing providers and environmental health.

The economic and social case for providing support to people who hoard is clear, however, what is not clear is where responsibility lies.

A potential solution?
Research conducted for Fire’s article highlights the lengths some states in America are taking to reduce the risks to elderly people. The State of Massachusetts is considering making changes to current law to reclassify hoarding as elder abuse, ensuring that statutory bodies responsible for caring for the elderly not only provide appropriate and effective support but also ‘seek out’ elderly people who hoard. This change of law will mean that should an elderly person die as a result of hoarding, stating ’we did not know’ would be no defence in a case of elderly abuse.

Despite the absence of clear lines of responsibility within the UK, there is still some good work being done to improve the lives of individuals who hoard. Orbit Care and Repair has supported customers who hoard for many years. We have found that we often have more success in gaining entry to properties than Social Care and the Fire Service as clients are often suspicious of professionals in positions of authority. We do not go into their properties to tell them what to do and take their ‘stuff’ - the therapeutic relationship is far more egalitarian.

This lack of support provision was a contributory factor in the development of Orbit’s Compulsive Hoarding Frontline Worker’s Toolkit, in partnership with Coventry University. We hope that the Toolkit and accompanying training will help influence best practice and service provision across the UK over the coming years and provide individuals who hoard with the support they deserve.

Visit http://compulsivehoardingproject.wordpress.com/training/ for more information