In this essay, I [avoid personal pronouns in academic writing] would like to put on the Agenda the issue of ‘Hoarding and Squalor’ so as to bring awareness on the impact of this condition on the individual, families and the wider community.
I analyse the issue of ‘Hoarding and Squalor’ by using existing evidence anecdotal evidence through studies on the impact and consequences this issue at micro and macro level.
Further I will demonstrate the associated current social policies around this problem by incorporating a combination of techniques with the aim of advocating for better supports and systems. My overall aim is to bring about a change, in particular around three goals.
These goals are inclusive of Social Policy review, multi-agency approach and trans-disciplinary delivery, funding request from the State Government in particular Families and Communities Services (FACs) and Mental Health in order to work with families in a person [spelling error] cent[e]red, strength based manner to ensure sustainable results.
I incorporate Jansson’s steps of, diagnosing the context to identify contextual constraints and opportunities, softening the context to make it more amenable to a specific policy initiative and lastly activating change to get a decision maker or legislator to put an issue on the agenda of the other decision makers in the agency, community or legislative setting. (Jansson, 2003, pp. 148-165).
Diagnosing Context
What is Hoarding and Squalor
In May 2013, for the first time ‘Hoarding Disorder’ was defined, and included in a new chapter of the Diagnostic and Statistical Manual-5 (DSM-5) on Obsessive-Compulsive and Related Disorders. Hoarding is regarded as abnormal (pathological) if there has been excessive collection of items such as clothing, newspapers, electrical appliances, food packaging (with many such items appearing to have little or no value) and a failure to remove or discard them. (Snowdon, Pertusa, & Mataix-Cols, Depression and Anxiety, 2012, pp. 418-419).
Squalor describes an unsanitary living environment that has arisen from extreme and/or prolonged neglect, and poses substantial health and safety risks to people or animals residing in the affected premise, as well as others in the community. The term domestic squalor is specific to the Australian experience and is used to describe living conditions, not people. (Stark, 2014).
Animal Hoarding is an emerging problem identified by the RSPCA with reports that 20,000 animals are believed to be kept in ‘hoarding conditions’ in NSW (population 6 million), and that 200 hoarding cases were uncovered in 2012. Animal hoarding involves keeping a higher‐than‐usual number of animals as domestic pets without having the ability to properly house or care for them, while at the same time denying this inability. They typically cannot comprehend that they are harming their pets by failing to provide them with proper care. Hoarders tend to believe that they provide the right amount of care for their pets. (Nathan & Patronek, 2012) Nathanson
Table 1, in the DSM-5 sets out the diagnostics criteria for Hoarding and Squalor. (Snowdon, Pertusa, & Mataix-Cols, Depression and Anxiety, 2012, p. 418)
Why should Hoarding and Squalor be considered a Social Problem?
In examining the problem of Hoarding and Squalor, I would like to bring this to the agenda as a ‘Social Problem’ that needs the meticulous systemic intervention and the use of the ‘Constructionist Approach’.
The Constructionist Approach to social problems highlights not only social conditions but also on the definitional activities that facilitate such conditions becoming understood and reacted to as social problems. Social Problems from this point of view involve ‘interpretive processes that constitute what comes to be seen as oppressive, intolerable or unjust social conditions’ (Holstein & Miller, 1993, p. 4). This can be linked to Gestalts’ “Peeling the Onion Theory. Hoarding and Squalor is not a poor man’s condition, rather it is experienced by all classes of people. One such example is that of “The Collyer brothers”; rich and intelligent, found dead in 1947 after accumulating over 130 tonnes worth of possession in their dilapidated New York mansion. The brothers were found buried under their treasures, by police, after neighbours complained of a terrible stench emanating from the house. This further amplifies the extent of the mental health issues around the problem. (McQueeney, 2012)
Such examples prove that Hoarding and Squalor (HANS) is not a “poor condition”. The impact of Hoarding and Squalor aside from health and well-being lead to bigger issues such as homelessness, higher mortality rate, unemployment and family breakdown to name a few. Whilst these bigger issues exist on the Social Welfare agenda due to the wealth of research, it is noted that the major contributing factors such as disability and mental health are underplayed. The constructionist approach looks at these factors and all other contributing factors and systemically addresses the root of these problems.
Facts and Figures from the Catholic Community Services Program
Herein are some facts and figures retrieved from the Squalor conference in 2012 in Australia, that is taken from a sample of 188 clients entering the Catholic Community, Hoarding and Squalor Program in Sydney and the Newcastle-Hunter regions between 9 March 2009 and 24 December, 2011, 59% lived in public housing, 35% private and 7% in private rental. One out of the 3 clients were living with other people, exposing children and relative to health and safety risks, which impacted on their wellbeing. Clients were at high risk of eviction with 80% of public housing tenants and 60% of private renters experiencing the threat of eviction at the time they sought help from the program. Male public housing clients in Sydney were at highest risk of not being able to remain in their home on program entry (81%), compared with female clients (63%). More than 1/3 of clients had been in squalor for 5-9 years. The majority of clients seen by the program had lived in squalor for between 2-9 years (79%). Clients were at high levels of physical health and safety risks (88%). (Stark, 2014)
This sample demonstrates the concentration of Hoarding in Squalor for the vulnerable population living in Public Housing and sparsely through Owner Occupied and Private Rental. Whilst this sample is indicative of the problems prevalent for tenants, it is sadly noted that the policies around social housing are leaning towards a capitalist market economy to bring to match that of the private market. (Social Housing Reforms)
There is also a concern that persons living in owner occupied housing may fall through the gap and suffer fate such as that of ‘The Collyer brothers’, and as for the private renters, their repeated history and marked record lowers their chances of securing a rental property in the market. This further disadvantages the most vulnerable in our community and brings to attention the oppressive, intolerable or unjust social conditions’ that emerges due to lack of awareness around the seriousness on HANS.
A study initiated by FACS Housing NSW in the Maccarthur[spelling error] Macarthur Region supports the argument that there is a higher prevalence of mental health amongst tenants of Housing NSW and highlights the conflict with their policy on better pathways and tenancy agreements. “There are 20,000 housing tenancies in the District, if the prevalence is 1.5%, then we can expect for there to be 300 cases of hoarding disorder”. (Western Sydney University, 2016)
The report also highlights the density of the HANS in the Maccarthur Region as reported by staff and nil funded agencies to work with HANS.
Furthermore, whilst there is some linkage and social support for those housed with Public Housing, there is nil support for those who are in private rental or in owner-occupied housing. The agency is currently trying to collate statistics on this problem to advocate and secure funding for [NGO’s] NGOs who can further support the identified families within this region. This is proving to be challenging and is work in progress.
As research indicates Trauma informed practice is best practice when working with HANS, however, different approaches are required for different individuals. The reasoning, cognitive impairment, personality and recognition that help may be of benefit is so vastly varied that no ‘one size fits all’ approach will ever work. However one of the key factors that influence the ability to engage with people affected by hoarding and squalor is the quality of the relationship that can be built with the service provider or individual attempting to engage with the person. (Stark, 2014)
Rapport is built through alleviating the fears inherent in the person affected by hoarding and squalor, thus often a flexible, respectful and persistent presence is required. Building this relationship takes a considerable amount of time and these impacts upon agency’s resources which can in turn impact on the outcome for the individual. (Stark, 2014)
Whilst this provides a good overview of the diagnostic context, I now concentrate on Jansson’s, softening the context technique.
Hoarding and Squalor is not an isolated problem, it is a co-morbid problem and contributes to the bigger agenda issue particularly of Homelessness.
Some challenges experienced include breakdown in communication between agencies in sharing of information under the Privacy Act. The capturing of data at different points, as HANS is not an isolated issue. No funding for agencies to be trained and to work with the HANS clientele. Clients’ lack of awareness of the problem until it reaches the point of eviction or mandatory requirement. Fear of eviction, council notices and stigma that prevents clients from getting the help required.
In examining the research and being part of the HANS interagency, I am involved in the project that is looking at existing resources, funding requirements for all areas to meet the 3 goals.
The existing resources include, the HSNET, Memorandum of Understanding between Mental Health and Ageing, Disability and Health Care, Family Referral Services and multi-agency awareness by the local agencies on the issues of HANS in the Maccarthur Region.
The actions required to facilitate the use of this existing resource would be contact with HSNET and the interagency to work collaboratively towards a user friendly and client centered operating system. This may also allow clients to ask for support directly and enable the capturing of data in a centralised, reliable manner.
The site monitoring is an essential part and another agency funded by Mental Health is the Family Referral Service. This service is for all points of enquiry referrals and is quickly becoming known as the Hub for all referrals. This service may be best placed to capture and filter data due its specialised focus on mental health.
The memorandum of understanding provides opportunities to facilitate discussions on best supporting clients living in the community with HANS. It is appreciated that whilst HANS may not be high on the priority of mental health issues the consequences and research provides support to the seriousness of this social problem and justification on looking at this with multi-agency lenses.
The benefits of multi-agency approach at local level will allow for less pressure on the agencies around funding, link families with existing referral services with proper diagnosis and build capacity within the local agencies for specialised intervention.
In embracing the systemic approach, I provide a critical analysis of the following Social Policies within organisations that is embedded with values of social justice, human rights and social inclusion however, the policies contradict these values.
Residential Tenancies Act 2010 and the Housing Act 2001
The Public Housing, 3 strike review identified systemic issues arising out of the implementation of the Anti-Social Behaviour management policy, finding that the policy, did not take sufficient account of the circumstances of social housing tenants with mental health and substance misuse issues (complex needs), could be improved by adopting a more comprehensive and strategic approach that includes an emphasis on support, raised the need to review the overall role of social housing in providing affordable housing for people with mental health and substance misuse. (The University of Queensland, 2015)
NSW Mental Health Act 2007
It also indicated a need for improved data about the mental health status of new entrants as well as existing residents of social housing, a review of relations between social housing providers and mental health services, attention to housing models that will facilitate positive outcomes in terms of tenancy sustainment, mental health and social wellbeing, sufficient and suitable housing to meet the increasing demand from people with mental health issues. (Jones, Phillips, Parsell, & Dingle, 2014)
The policy needs to consider issues around mental health and provide guidelines on proper referrals and wrap around services to families to offer the opportunity for families to work through the presenting issues.
NSW Guardianship Act 1987 and the NSW Trustee and Guardianships Act 2009
The use of guardianship legislation should be considered as last resort for a person with a diagnosed decision making disability.
Guardianship is the most restrictive outcome for a person with decision making incapacity as there is limited capacity for supported decision making in this process. (Stark, 2014)
The Guardianship act whilst allows for functions of access it undermines and delays of effectiveness of Trauma Informed Care for patients of HANS.
Best Practice Framework and NSW Mental Health Act 2007
Research indicates as above that the best practice framework for clients with HANS problem is Trauma Informed practice and integrated case management framework. It is essential to bring transparency to past intervention and ongoing work with the families for improved service delivery to families and for improved practice towards interventions. The Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis is a tool that is simple and can be undertaken prior to working with families if good record keeping and information sharing processes are observed. (Human Services, 2012)
In the activating change (Jansson, 2003) I use advocacy skills to get a decision maker or legislator to put an issue on the agenda of the other decision makers in the agency, community or legislative setting. I employ the following techniques.
A letter to the editor from a public housing client, who has been served with an eviction notice due to breach of the ASB Policy in particular around the focus issue of HANS. (Attachment 1)
This letter is then copied to the Local Minister and A Current Affair News.
A signed Petition from all participating in Interagencies to the local Minister on the rising problem and lack of support around HANS in the Maccarthur region and support required;
Proposal as above to encourage Agencies aligned to Trauma Informed Care to tender for HANS funding and tender to include specific budget on planned interventions with families, Training and Education to the wider community.
Internal correspondence in the way of Briefing Note to Director, to bring awareness of FACs policy and risks associated with Homelessness due to high prevalence of HANS in the Macarthur region. (Attachment 2).
Contact the local minister with Attachment 1, 2 and evidence around existing HANS as per reports from Catholic Community Services NSW/ACT, anecdotal evidence and research by University of Sydney and Housing NSW including current voluntary work by HANS Interagency.
Build capacity within family to narrate their struggles on HANS on programs such as A Current Affair, so as to raise the profile of HANS and increase chances of this being endorsed on the agenda.
In conclusion, I have discussed and aligned the problem of Hoarding and Squalor as a “Social Problem”. Used the Constructionist Approach in drawing attention to the issues and focused on a strength based approach in using existing resources and assets in the community to address the issues. Identified the current gaps and provided sound evidence as to managing this social problem collaboratively with funding through State Governments namely FACS and Mental Health.
I believe the most powerful advocacy presented above is through the narration of the clients’ own experiences and this together with research will create a better understanding of Hoarding and Squalor as a mental health problem.
The interventions proposed is a process towards bringing awareness and changes to the lives of the people who live with this condition with dignity and respect. Please note attachments’ 1 and 2 as part of marketing the cause and raising profile.

References
Holstein, J. A., & Miller, G. (1993). Challenges and Choices. In Constructionist Perspectives on Social Problems (p. 4). New York: Aldine Transactions.
Human Services. (2012). Social Housing Advocacy and Support Program (SHASP): Interim Integrated Case Management Guidelines. Victoria: Victorian Government.
Jansson, B. S. (2003). Committing to an issue : building agendas. In 4th (Ed.), Becoming an effective policy advocate from policy practice to social justice (pp. 140-165). Belmont, Calif: Thomson.
Jones, A., Phillips, R., Parsell, C., & Dingle, G. (2014). Review of systemic issues for social housing clients with complex needs. Queensland: Institute for Social Science Research, The University of Queensland.
McQueeney, K. (2012, October 16). Daily Mail Australia. Retrieved from The ultimate hoarders: Extraordinary story of the two reclusive brothers found dead side by side under tons of junk in New York mansion in 1947: http://www.dailymail.co.uk/news/article-2217953/Homer-Langley-Collyer-Hoarder-brothers-killed-clutter-New-York-mansion.html
Nathan, Nathanson, J., & Patronek, G. (2012). How semblane? ?semblance of a benevolent mission becomes actualised as egoism and cruelty. In Pathological Altruism: Animal Hoarding . New York: Oxford University Press.
O'Connor, A. (2013, December 26). Public housing evictions are on the rise and families face homelessness with three strikes policy. Retrieved March 28, 2016, from ABC News: http://www.abc.net.au/news/2013-12-26/wa-evictions-feature/5170316
Snowdon, J., Halliday, G., & Banjeree, S. (2012). How to best intervene. In Severe Domestic Squalor (pp. 40 - 41). Cambridge University Press. Retrieved from http://www.eblib.com
Snowdon, J., Pertusa, A., & Mataix-Cols, D. (2012, May). Depression and Anxiety. On Hoarding and Squalor: A few considerations for DSM-5, 29(5), pp. 417-424.
Social Housing Reforms. (n.d.). Retrieved March 28, 2016, from Future Directions for Social Housing in NSW : http://www.socialhousing.nsw.gov.au
Stark, D. (2014). Beyond Overwhelmed - Identifying pathways to deliver more effective services for people and their pets affected by hoarding and squalor across NSW. Sydney: Catholic Community Services NSW/ACT.
The University of Queensland. (2015). Report on ‘three strikes’ policy for tenants in social housing released. Queensland: ISSR.
Western Sydney University. (2016). Hoarding and Squalor - Data improvement project NSW Family and Community Services, South Western Sydney District. Sydney: Western Sydney University.

Animal Hoarding
How the Semblance of a Benevolent Mission Becomes Actualized as Egoism and Cruelty
Chapter:
Chapter 8 Animal Hoarding
Source:
Pathological Altruism
Author(s):
Jane N. Nathanson
Gary J. Patronek
Publisher: Oxford University Press

DOI:10.1093/acprof:oso/9780199738571.003.0085

Attachment 1 – please note, confidentiality protected by name change.
Dear Editor
I have received an eviction notice from Macarthur Housing NSW.
My case manager has identified that this is due to the maintenance of the property and is currently discussing this further with housing due to some of the issues that I am experiencing.
I have not left the house since the death of my husband, my son occasionally visits me and checks in. I have online grocery drop offs at the door and my only constant visitor is my case manager.
Since being served with the eviction notice, I have asked for help to clear the property however apart from big brother measures, the council, housing and local agencies report that there is no funding for a skip bin, cleaners to help clean the house. Homecare is unable to work in the house as they view this as unsafe.
My case manager has referred me for counseling however, the expense for private counseling is unaffordable and the public waiting list is very long.
My request is that Housing work with me in trying to clear and maintain the property. I also am open to the local community helping me out.
Kind Regards,
JO AMBY
Copied to:
A Current Affair
The Local Minister for Ageing, Disability and Home Care and Mental Health.

Attachment 2: Internal Correspondence to Minister to highlight issues around HANS in Maccarthur Region. | Topic | Hoarding and Squalor (HANS) Issues in the Maccarthur Region | Analysis | The 3 Strike Policy is increasing the risk of Homelessness for tenants living with HANS condition. | To note by | 30 June, 2016 |

Deputy Secretary/Executive Director/District Director signature | | Date | |
Recommendation: for approval of collaborative funding by FACs and SWAHS Mental Health
Key issues
Housing NSW Pathways 3 strike policy is making families homelessness, attachment 1;
Families who are ready and engaged with FACs for support around HANs are unable to get any supports from NGO’s and FACs due to lack of funding to facilitate clean up and trauma informed care;
HANS is a multifaceted complex issue that needs the attention of multi-agency approach, FACs and Mental Health to work collaboratively in systemic and complex case management training for front line staff.
Structure by your conclusions
The reports attached, indicate the extent of the social problem in the Maccarthur Region.
Further, a study of FACs caseload indicates that 1 in 5 families living in Social Housing suffer from some form of mental health and are unsupported.
These families are at high risk of homelessness due to the 3 strike policy and lack of understanding by staff to understand the family situation and rigid policies.
Research recommends Trauma Informed Practice and funding allocated to agencies with provide opportunities of early intervention with a collaborative interagency, trans-disciplinary approach. Attached 2 (Client, JO AMBY)
Summary
Funding is requested to facilitate work with families in a strength based manner;
Work with HANS Interagency in developing System Support;
Systemic Intervention and projects to increase awareness and build capacity around HANS.
Attachments
Tab | Title | A | Catholic Care NSW/ACT Report | B | Client JO AMBY Letter |
Approval
Role | Electronic approval by | Date | [Policy officer] | Add name | DD/MM/YYYY | Director | | | Executive Director / District Director | | |