First National Squalor Conference Sydney 5-6 November

Catholic Community Services hosted the National Squalor Conference, the first event of its kind in Australia, in Sydney on 5-6 November. Squalor is a condition that largely remains unnoticed, that is until neighbours complain about the mounds of refuse spilling over their fence or the fire department try and extinguish a house filled with a lifetime’s collection of combustibles.

Squalor, itself a clinical red flag, falls into two categories.  The more benign variant is dry squalor, which manifests itself in hoarding that can render a house and yard unusable, blocking access and preventing egress, straining load bearing structures, creating a huge combustible fuel load, and giving rise to vermin infestations.  Wet squalor is the more malignant strain in which a combination of physical and psychological factors contributes to a resident’s failure to dispose of food stuffs, refuse, and, in extreme cases, human and animal excrement.

An estimated 1 in 350 or 190,000 people compulsively hoard nationally. One in 1,000 people in N.S.W. live in severe domestic squalor with conditions ranging from dementia, alcohol related brain damage, schizophrenia, obsessive compulsive personality disorder, to the desire to acquire possessions in an acquisitive society in which people increasingly define themselves by their possessions.  This ratio may well apply in Queensland where there’s little or no statistical information available.       

Of the documented cases of severe domestic squalor in N.S.W., 10% of households had no running water, 16% no electricity, and 20% no cooking facilities.  In one case this led to an occupant improvising a home-made barbeque on the carpeted lounge-room floor to cook.

Seventy percent of people living in severe domestic squalor had diagnosable mental disorders including:

·         Residents aged 65 or older with dementia - 40%
·         Alcohol related Brain Damage - 20%
·         Schizophrenia – 13%
·         Obsessive Compulsive Disorder 5%
·         Visual or sensory impairment 10%.

Data presented to the conference indicated that 54% of people living in squalor reside in public housing, 39% own their own residence and 7% rent privately. Seventy-eight-percent lived alone and 22% cohabitated.   Tenures other than home ownership provide levers that can be used to gradually persuade an occupant to address the root cause of their symptoms. Home owner intervention options are limited by consent.  

The causes of hoarding and squalor are multiple and may include health and psychiatric problems, dementia, frontal lobe damage, cognitive impairment, drug and alcohol abuse, or  premature ageing. Causes may be personality based such as apathy or lack of goals and direction; or functional arising from poor living skills. In some cases they are caused by trauma, or isolation from family and society.  Many people of European descent with a history of war caused privation were taught that everything has a value and hoard to manage life experiences.  In some cases people are simply lazy. 

Many hoarders are motivated by a need to attach memories to objects that they must then keep in sight. Thus, a decease relative’s train ticket assumes significance as long as it can be seen. To file it away is to lose the memory. For them, to hoard is to manage life’s experiences.  

The median age of hoarders with OCD is 35, those without 55, and those living in squalor 65.  Evidence suggests that hoarding behaviours can manifest themselves in a person as early as ten years of age yet the majority are not identified until they’re over 50.  

In N.S.W. responsibility for addressing neighbourhood complaints arising from squalor and animal hoarding fell to the local council and RSPCA respectively.

While responding to problematic hoarding and squalor is a responsibility shared by Health, social work, animal welfare, housing services, local government, fire service sectors as evident in the (NSW Squalor accord partnership agreement) the ethics of intervention are ambiguous.  At what point can society impinge upon the privacy of an individual and dictate how they should live or use their living space?  A recent complaint filed in court by an OCD hoarder arguing that repeated inspections and  threats  of eviction constituted discrimination was not dismissed and progressed to mediation setting the precedent that future claims will be considered.  Peter Shaw QC reasoned that mental health legislation can only be invoked where there is a possibility of self harm or harm to others.

While councils have legislative instruments, such as the Environmental Health Act S.A., that frame the issue of hoarding, using them can be time consuming and costly. In one instance a local council negotiated with a property owner for two years to remove refuse from his property and mow the lawn, after which time he cleared a path from the road to his front door.  Council sought legal opinion and were advised that it would cost $20,000 to obtain an order directing him to clear his through the Land and Environment Court. In some of these cases, where an outcome is difficult to achieve, the neighbours choose to sell up and move.

   According to the Melbourne Metropolitan Fire Bureau (MFB) there  are both financial and physical costs associated with hoarding. The increased fuel load lead within houses exponentially increases  the cost of responses.  A callout to an average house fire costs MFB approximately  $2,000.   The cost of attending a fire at a hoarder’s residence and remaining on site to extinguish spot fires is $34,000.  There are personal costs as well with one in four fires in the Melbourne district involving hoarding.  Despite the predominance of female hoarders 77% of fatalities male, and 19% female, oddly 4% are unknown.   The MFB have modified their response by flagging hoarding addresses based on neighbourhood complaints, dispatching two fire engines and a search and rescue team to each incident.  Similar measures should be introduced in Queensland.

The conference presented a number of solutions focussed interventions that looked beyond the short term cleanup approach which many hoarders compared to being raped or stolen from.
Professor Michael Kyrios of Swinburne University identified a gradated set of treatment goals for hoarders:
·         Improving quality of life
·         Improving mood regulation
·         Preventing acquisition and storing
·         Organising possessions
·         Recycling goods
·         Decreasing social isolation, and
·         Improving living skills.  

The processes used to achieve these outcomes include:
·         Maintaining Motivation
·         Educating a client about hoarding
·         Improving their coping and decision making processes
·         Improving their organisational Skills
·         Gradual exposure to high risk activities and to discarding, and cognitive restructuring of problematic beliefs. 

The Hon Paul Lynch MP announced  the NSW Government’s continued funding of the Catholic Community Services Severe Domestic Squalor program and Squalor Hotline, which coordinates research, education, development of assessment tools, intervention models, and data collection on over 200 referrals. According to Coordinator Susan Graham, the program grew out of research into developing best practice responses for public housing tenants facing eviction that overwhelmingly demonstrated that squalor and hoarding was a primary factor in at risk tenancies.

Improved research and anecdotal reporting of incidence of squalor, should lead to an improved understand of its prevalence and impacts upon Queensland’s aged and impaired residents.  In my opinion the conference provided not only provided a pathway through the maze but identified that there is a maze.  One that we’re yet to navigate.   

Peter Mengede, Policy Officer Queensland Shelter