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DEMONSTRATION PROJECT RELATED TO SUPPORTING INDIVIDUALS WITH SEVERE HOARDING BEHAVIOURS DELIVERED BY THE STAFF AT THE SASKATOON HOUSING COALITION ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ACKNOWLEDGEMENT: Much appreciation is extended to the Canada Post Mental Health Foundation for funding the project for one year. With its' funding, the Saskatoon Housing Coalition staff were able to explore an approach to improving our services to a very challenging group of individuals and their issues. Also our appreciation is extended to Saskatoon Health Region Mental Health and Addiction Services for being involved as the clinical partner in this project.
1. TIMEFRAME The implementation and delivery of this demonstration project occurred between October 1st, 2009 and September 30th, 2010.
2. BENEFITS The purpose of this demonstration grant was to provide an enhanced level of community outreach services beyond an existing clinical group specifically for those with severe hoarding issues. Considering the Saskatoon Housing Coalition is the only non-profit community based organization providing supportive residential services for those with chronic mental illnesses in Saskatoon, the management team wanted to learn new strategies for working with some existing clients coping with this issue.
There were 15 clients who actively participated in this program of which three clients of a potential six were from the Saskatoon Housing Coalition caseload. The clients were mostly female, some married with children and some working. The age range was from their 30s to 60s. All were struggling with not being able to control their hoarding and acquiring habits. Many of the clients had a second mental illness (i.e. depression, bi-polar disorder) that would complicate their hoarding illness. Depression is a common illness when someone is considered a hoarder as they experience hopelessness and frustration related to their situation.
This was a challenging program as clients needed to examine the reasons for their acquiring and hoarding behaviours. This meant delaing with the past and facing their anxieties. Some clients had difficulty exploring the origins contributing to their hoarding behaviours when they were completing the exercises in the workbook. Despite this, all the clients were willing to work with the outreach worker on their home environment.
The outreach worker saw some interesting changes in the clients over the course of the year. At the beginning of the program, some participants were ready to change their hoarding habits, while others were not. Through a combination of attending the clinical group and working with the outreach worker over the year, almost everyone began to change to various degrees. The outreach worker noticed there was less or no negative talk (i.e I'm so stupid for buying that). The clients started using more positive talk about what they did during the week, even if it had nothing to do with hoarding. Some clients developed a more positive outlook on life, as now they no longer felt hoarding was controlling their lives. As some clients worked through the program, they found it easier to make decisions about what to do with their stuff (i.e. if it should be kept, donated or thrown into the garbage). Other clients gained control over the amount of stuff coming into their homes. Most of the clients were willing to try ideas from the workbook, group sessions and staff suggestions.
Overall, the clietns made small to large gains with the amount of clutter in their homes. One client went from having only a part of her bed to sleep on to a full bed with no clutter. The client reported that she had been sleeping with stuff cluttering her bed for many years and it took her a while to get used to having a full bed in which to sleep on. Another client was able to stop acquring unnecessary items. She said the class helped her see what was important in her life and that she did not need to shop to fill her life.
3. LESSONS LEARNED The approach of a clinical group and community outreach services is definitely considered the best approach to assisting those with severe hoarding issues especially for those emotionally ready to address their symptoms. Staff believe that getting insightful information from the participants during the group sessions and being able to discuss this during the home visits helped in moving towards changed attitudes. The workbook was also a very helpful tool in structuring the sessions and for participants to refer to between the sessions. As we know, any behaviour changes in this targeted group is a very long process. The program staff have concerns about the clients relapsing in the next year once the funding for the community outreach services is discontinued.
One of the major oversights in planning for the program was to factor in the cost of hiring hauling companies to take large items to the garbage dump. Some of the clients could not afford to pay for hauling services and did not have family or friends with a truck.
As for the Saskatoon Housing Coalition staff having knowledge and additional skills to work with those who are hoarding and living in our apartments, the workbook will be a good reference tool to guide the staff through a process of dialogue and coaching techniques to work with current and future clients. However through this demonstration project it was observed that those who have deep rooted denial about their issue and lives in a home with major clutter throughout, a program like this will still be a challenge to produce positive outcomes for such clients. Therefore as an organization, we have determined that our residential services and related expectations may still be a very stressful living environment for a person with severe hoarding tendencies.
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