Why the UK Needs a National Hoarding Strategy: Moving Beyond Outdated Approaches to Compassionate, Person-Centred Care

On 22nd October, Parliament debated the need for national support guidelines for people who hoard, rather than using outdated reasoning or conflating hoarding with other mental health conditions. While the debate resulted in an acknowledgement about the need for hoarding-specific support, no national strategy will be formulated, citing existing plans for expanding mental health support more generally as a part of the NHS’ 10 year plan. I’d like to argue that hoarding support, while having intersections with other mental health conditions, would still benefit from a national strategy and how it would best serves people and communities to treat hoarding as its own distinct condition requiring specialised, person-centred intervention strategies.

I started Clear Path Support as a member of the community as I found that Leeds, although containing many wonderful organisations offering mental health services, there was a dearth of emotional support for people struggling with their possessions. When I expanded my research to the rest of the UK, I found pockets of areas covered by grassroots initiatives, but I found much more practical support for decluttering. Time and again participants of Clear Path have told me that it would be incredibly traumatic to have their possessions removed with little to no say in the process, and without an improved self-understanding or self-compassion, the problem would likely return all too quickly. Hoarding, compulsive acquiring and problems with clutter have for too long been treated as a way of life, a sign of apathy or lack of self-control, and it is from this preconception that has given way to stigma and misguided approaches to intervention.

In reading the parliamentary debate transcript, Paulette Hamilton MP argued that existing legislation used in cases of hoarding are outdated and not fit for purpose and actively harm individuals while perpetuating stereotypes. The Public Health Act 1936 describes “filthy or verminous premises” to describe people’s belongings, and gives authorities the power to force property clearances. This approach takes the person at the heart of the matter and treats them as a practical or environmental problem, negating the person’s lived experience of their attachments to possessions in their home. For many the prospect of clearing feels like a Sisyphean task, and the coercive nature of forced clearances contradicts evidence-based approaches to support and opens people up to re-traumatisation. Without compassionate and person-centred support, people can also be left in a state of psychological desperation, when historically behaviours that perpetuate hoarding have served as a coping mechanism for emotional distress, trauma, or feelings of scarcity. When possessions are forcibly removed, individuals lose not only their belongings but also their sense of control and safety, leaving them vulnerable to psychological crisis without the tools or support to rebuild healthier coping strategies.

A national hoarding strategy would create consistency and clarity around support for hoarders while ending the ‘postcode lottery’ that the existing environment has created. It would allow a combined and consistent multi-agency approach that could work holistically with the person while acknowledging their humanity. A compassionate approach more aligned with mental health support rather than punitive measures or treating people as problems to be solved through enforcement would ensure that interventions prioritise the individual's dignity and autonomy while still addressing legitimate concerns about wellbeing and safety.

The language of health and safety risks with regard to the physical environment and ‘the hoard’ have too often been used as a stick to beat people with. While safety of the hoarder and local community are paramount, the condition of a person’s living environment is a symptom that should be treated as an outward manifestation of underlying distress. Even if a person’s insight is low, I argue that hoarders, communities, and property can be safeguarded without the need for forced clear-outs and factoring in the building of an emotional regulation skillset. People are often aware of the health and safety risks that are created by hoarding, but difficulties with emotional regulation, beliefs about the value or necessity of possessions and a scarcity of alternative coping mechanisms mean that even when aware of the risks, decisions can be biased towards the value of saving versus the perceived risks of discarding. By spending time with someone and gaining a deep, empathetic understanding of their relationship with their possessions, support workers can help individuals develop awareness of these cognitive patterns and gradually build capacity for change at a pace that feels manageable rather than catastrophic. This pace need not cause further endangerment if harm reduction measures are employed alongside emotional support work, something which a national hoarding strategy could prescribe.

Currently professionals from various sectors have competing priorities when encountering people who hoard. Housing associations will focus on the property conditions; environmental health will be focussed on pest control and cleanliness; community nurses require adequate space for direct care tasks; mental health practitioners attend a client’s mental wellbeing, the list goes on. The way the conversation with the individual at the centre begins is a postcode lottery and depends heavily on which agency makes first contact. This fragmented approach means that the emotional and psychological needs of the person who hoards may be entirely overlooked depending on the first agency to become involved.

Even when mental health services begin working with a person, the status quo of offering CBT is inadequate. On average, symptoms are reduced by around 25% through CBT, but around one third of participants drop out before completion. A national hoarding strategy that focussed on deep, non-judgemental therapeutic relationships while respecting a person’s autonomy and individuality, which helped a person to manage distress and improve their self-esteem and which provided in-home assistance could enhance CBT outcomes in a way that fosters longer-term change.

In response to the questions raised by MP Paulette Hamilton, Parliamentary Under-Secretary of State for Health and Social Care Dr. Zubir Ahmed cited the NHS’ 10 year plan as addressing hoarding through broader mental health expansion rather than a dedicated strategy. While I commend the ambition of the plan’s holistic approach that will bring agencies together and improve data integration and early identification, however without a national strategy it’s possible that the support someone receives when approaching the NHS for support with hoarding will depend on the local priorities of Integrated Care Boards and the awareness of individual practitioners. However, the ambition of the NHS 10-Year Plan could still provide fertile ground for a national strategy if hoarding is explicitly recognised within it. Integrating lived experience, funding community-led pilot schemes and developing shared guidelines across health, housing, and social care could ensure that hoarding support becomes a consistent part of early intervention pathways.

A national hoarding strategy is a necessary step towards recognising hoarding as a distinct condition that requires specialised, compassionate intervention. Without it, we risk perpetuating a fragmented system that treats people as problems rather than individuals deserving of dignity, autonomy, and evidence-based support. The time has come to move forwards, and I was delighted to see hoarding being brought into the spotlight in parliament. A coordinated national framework that prioritises the wellbeing of those who hoard while safeguarding communities through harm reduction and person-centred care would represent a turning point in how we understand and respond to hoarding.