July 17. 2018 2:02PM

Silver Linings: Dwellings strewn with garbage and waste overshadow the mental health crisis

Part 1 of a 2-part series
By ROBERTA BAKER
New Hampshire Union Leader


Clutter, such as what ServPro found in this Manchester area home, makes living spaces difficult or impossible to navigate. (COURTESY)

Silver Linings

Silver Linings is a continuing Union Leader/Sunday News report focusing on the issues of New Hampshire's aging population and seeking out solutions. Union Leader reporter Roberta Baker would like to hear from readers about issues related to aging. She can be reached at rbaker@unionleader.com or (603) 206-1514. See more at www.unionleader.com/aging. This series is funded through a grant from the Endowment for Health.


As operations manager at ServPro of Manchester, Tim Dow has witnessed hoarding's worst extremes:

Corridors winding through garbage bags stacked to the ceiling. Human waste, dead animals and food scraps rotting beneath piles of laundry and pizza boxes.

People living inside basement tunnels surrounded by tightly packed trash, seldom emerging to eat or bathe, unable to access the kitchen or bathroom behind towers of plastic bags, old newspapers, empty milk cartons and items saved for years or decades.

"To them, everything is good and shouldn't be tossed," says Dow, whose crews don full-body protective suits and respirators when called to a suspected hoarding situation because "as soon as you start digging, everything becomes airborne."

Once, when hired by an insurance company to clean up a water-damaged basement in Bedford, Dow erected a wedding tent in the front yard to shelter water-logged odds and ends while the team hurried to disinfect walls and floors. The owner, a woman living alone, refused to allow the moldering objects, seen by her as treasured and essential, to be carted away - losing a $30,000 insurance claim. 

"She made us bring everything back down to the basement," Dow recalls. "She almost threw us off the property when we tried to remove a bag of used baby diapers." People grieve when their possessions, however useless or unhealthy, are removed, he says. 

Hoarding - the out-of-control accumulation of objects and an inability to discard them, including things others deem worthless - is a mental illness affecting at least 2 to 6 percent of the world's population, roughly 15 million people in the U.S., many of whom are 50 or older. 

"It's really paralyzing. They just can't get rid of things," says Rachel Lakin, administrator of New Hampshire's Bureau of Elderly and Adult Services. Hoarders "don't know how to assign value to something. Therefore, anything becomes valuable."

At the other end of the spectrum are seniors who amass possessions over a lifetime and don't discard much, whether from sentimental attachment or a lack of strength, energy and organizational skills needed to divest and keep house. Whatever the cause, crisis levels of clutter produce unhealthy environments that are difficult to navigate, and downright dangerous for seniors with medical and mobility issues, as well as for emergency responders trying to rescue them from overstuffed homes.

Dangerous piles

As New Hampshire's baby-boom population ages, incidents of hoarding and perilous levels of clutter are rising, drawing the attention of public safety and health officials and people who work with elders, as well as communities trying to identify problems and coordinate help before situations turn tragic. 

Hoarding complaints "are becoming more common. And it's not just seniors," says Manchester Fire Marshal Peter Lennon. "We get one every couple of weeks that draws the attention of the Fire Prevention Bureau. It definitely hinders us if we have to go in there. We've had a couple of fatalities in the city where hoarding was a factor." 

Lora Gerard is program director for the Northern New England Geriatric Education Center at Dartmouth-Hitchcock Medical Center in Lebanon. "We don't really understand how widespread it is. We don't know about it until it becomes a crisis," Gerard says.

Last July, a 60-year-old man died because firefighters were unable to reach him through burning clutter and trash and no clear pathway in or out of his Hazelton Court home in Manchester. In February 2014, a 72-year-old woman perished when firefighters couldn't extract her from her house on Bannon Street, where doors and windows were blocked by debris and household objects. 

"There's usually only one way in and out," Lennon says, "and it's a very narrow pathway." 

Hoarding disorder is linked to anxiety and trauma, including conditions such as post-traumatic stress disorder and obsessive-compulsive disorder, and is slightly more common among women, research states. Dementia can bring on the illness in someone who never experienced it at a younger age, and can turn cluttering into hoarding, mental health experts say.

"Some people have collections, and that's perfectly normal behavior. Or if you have clutter that's not affecting you or anyone around you, it's no big deal," Gerard says. "But when it starts to interfere with life in a significant way, and you can't use rooms as intended, there's only one seating area in your whole home, and you can't sleep in your bed or you've become socially isolated because you're afraid to have people over," hoarding has become a serious problem.

Hoarding increases the risk of falling, strains relationships with family and friends, and leads to isolation - resulting in more anxiety and depression, she adds. 

Beyond shame

Getting rid of the clutter solves only part of the problem, says Phil Alexakos, chief of environmental health and emergency preparedness for the Manchester Health Department, which does on-site health and safety assessments and mitigates imminent dangers such as rotting food and human and animal waste.

"This isn't something that's fixed with an order to clean," Alexakos said. "It's a mental health condition, and we need to treat it as such."

Karen Sutkus, environmental health specialist for Manchester, says, "For anyone who's been through hard times, you can understand the thought process. It's hard for them to get rid of it, whether there's perceived value or not. The solution has to come out of concern, not enforcement."

One of the barriers to diagnosis and treatment is the cultural stigma around hoarding, and the embarrassment that keeps it out of sight. Media reports have boosted public awareness, but television reality shows, which feature aggressive interventions and trash and belongings hauled out by the leaf-bag and truckload, give misleading impressions, and advertise a SEAL Team Six approach that doesn't solve the problem. Hoarding is best approached in baby steps, and by helping hoarders to take control of their belongings, experts say.

"What you're up against is a lot of shame," says Jennifer Kinsey, a social worker at Seacoast Mental Health in Portsmouth and director of REAP, a short-term referral, education, assistance and prevention program for New Hampshire's older adults. "People are hoarding for emotional reasons. If you are abrupt and rash, it's too hard on them."

A hoarder's "relationship to possessions is very different. It's almost like an attachment to child or pet," says Gerard, who leads a workshop for hoarders and clutterers through the Aging Resource Center at DHMC. For one woman whose parents and spouse were abusive, "her stuff was a protective layer between herself and the outside world. Discarding a costume becomes like discarding yourself."

Health officials say public education about the illness, training of workshop leaders, and a coordinated community approach are needed to reach at-risk seniors who suffer privately and silently because they are ashamed, and afraid of losing their possessions, independence or homes through eviction or condemnation.

Responding to complaints

Anti-hoarding task forces in Rutland and Burlington, Vt., reach seniors known or suspected to be surrounded by unsafe clutter, but few such groups exist in New Hampshire, where most available resources target the opioid crisis, public and mental health workers say. 

Every one of the state's 234 municipalities has a health officer who can respond to hoarding complaints, but only 25 percent have written nuisance codes that can be enforced to mitigate a problem, according to estimates. It can take months or years to clean up a property if the owner resists and ignores written warnings leading up to a court order, public health officials say. 

"Sometimes they can't afford to move the material or they just don't want to," says Matt Cahillane at the N.H. Department of Health and Human Services, who serves as environmental health adviser to municipalities grappling with hoarding situations. "Citizens have a right to accumulate belongings up to the point that they infringe on the rights of others or affect public health or even property values. It can be very costly and troublesome for a family and community" to address. 

Coordinated efforts between town officials and social service providers need to determine what's going on and find ways to resolve it economically, he says. "Do we need a hoarding task force, or something else that might get to the root of the problem?"

Kim McNamara at the Portsmouth Health Department says it's not always a mental health issue. "Sometimes there's a physical disability. Sometimes what they need is a dumpster and they can't afford one," she says. "It takes a community solution, but it always depends on the situation."