Advice about Self-Neglect and Hoarding - Moving Forwards, Post Intervention and Self-Management

What works well?

• Setting SMART goals
• Show people what is improving - praise to all
• Consistency in support
• Collaboration
• Communicating, building trust, working with the person's agreement and at their own pace, being person-centred and building a positive therapeutic relationship
• Ongoing support and reviewing of overall situation
• Build rapport as much as possible and with as many people as possible
• Use routine, return to normality - building back to normality

There are challenges for all services with providing ongoing long term support where this is needed in such cases, and it is recognised that there may come a time when consideration must be given as to how best to support an individual to ‘self management’, possibly with the support of other services or community / family supports.  

The hardest thing for someone who is self-neglecting / hoarding is often deciding to address the issue. They may not see their behaviour as a problem and so struggle to find the motivation to change. Or they may see change as too overwhelming or scary a proposition. Investing in the right tools and techniques can help individuals develop their self-management skills that are essential if you want to stay organised and focused.  

What is self-management?

Self-management can be learned. It is key to putting people in the driving seat and instilling them with a sense of purpose and motivation that affects behaviour change.   
The key question in self-management support shifts from ‘What is the matter with you?’ to ‘What matters to you?’.  

Promoting self-management and independent living

Read a practical guide to self management support.

Effective self-management requires a shared responsibility across health and social care systems and a common understanding of and commitment to self-management support.  

Self-management support allows people to play a more active role in making difficult lifestyle changes by ensuring they receive:

• the full range of support they need to manage the physical, emotional and social impact of their long term health conditions at different times during their lives; and
• the care and support planning, which is often seen as the gateway to identifying the self-management support needs that individuals have.

Self-management support is an important component of person-centred care which has 4 principles:

1. Affording people dignity, compassion and respect
2. Offering co-ordinated care, support or treatment
3. Offering personalised care, support or treatment
4. Supporting people to recognise and develop their own strengths and abilities to enable them to live an independent and fulfilling life.  

For people living with long-term health conditions, self-management support within services means:

• Involving the adult -being active partners in determining outcomes that are important to individuals and how to achieve them;  
• Getting good information - people are given access to good quality information to develop their knowledge and resilience to tap into their strengths and support systems to overcome challenges and work through problems;
• Achieving self-confidence -  to manage the impact of their symptoms and limitations so the adult can manage their own health and wellbeing, as effectively as possible;  
• Behaviour change – having access to a range of the joined up support they need within and beyond health services provides direction to better manage their own health and wellbeing on an ongoing basis; and  
• Technical skills – involves the practical knowledge individuals use in order to complete tasks e.g., learning basic skills

Each of these elements should be mixed and matched according to the specific needs of the individual to help them on the road to effective self-management.  

The lightbulb moment: That moment of  sudden insight when an individual realises they can do it and are confident and capable enough to reach their own goals and manage their own needs.  

Some things an adult may want to consider to help themselves cope with hoarding

Not all of these suggestions might work for the individual but it is okay to try a few things before they find out what works best. Find out more about how to help someone who is hoarding.

Starting to manage your hoarding

It’s not unusual for adults who are trying to cope with a hoarding problem to feel overwhelmed and that helping themselves will be too hard or take too long, or they don’t know where to start. Taking small steps can help them make good progress. For example:

• setting small goals such as throwing away one thing per day;
• try to tidy one area by setting a timer, or listening to a set number of songs;  
• schedule one hour a week for cleaning and try to plan where your items go such as in the bin or as a donation;
• make a rule that if the item hasn’t been used in the last year it will be gotten rid of; and  
• explore new activities that doesn’t involve buying or saving things e.g., walking groups or condition-specific peer support groups.

Staying Motivated

An adult who has been trying to manage a hoarding problem might feel like they are getting nowhere and need help to keep them motivated and notice how far they have come:

• track progress by taking before and after pictures of the space chosen to be cleaned;  
• make things easier by using a litter picking tool to pick things up without touching them;
• find support for related issues to takes some pressure off such as money worries, addiction or housing problems;
• celebrate wins no matter how small they seem; and
• ask for help as sometimes just having someone to talk too before or after you clear can be useful.

Coping with difficult feelings

Trying to manage hoarding might bring up a lot of difficult feelings, which can make handling practical tasks harder:   

• share feelings by talking to someone;  
• try peer support - connecting with people with shared or similar experiences can be helpful;
• note down moods and feelings in a diary – can  help spot patterns in what triggers hoarding behaviour and the reasons behind difficult feelings;
• taking time to relax as managing hoarding can be very hard work; and
• getting enough sleep and physical activity to look after general wellbeing.  

Keeping Safe

Hoarding can lead to a higher risk of fire spreading or escaping from a fire in an emergency. Make sure the place is safe. For example:

• ask the Scottish Fire and Rescue Service (SFRS) to do a safety check;
• help to stay safe around gas and electrical appliances;  
• plan an escape route and know where to go; and  
• visit the GP and consider whether there are any other health related problems related to the hoarding.

Supporting an individual’s capacity for self-management

Self-management is a process and the challenges presented to adults and the techniques for overcoming these may change at different points in an intervention.  

It is necessary for practitioners to:

• work with the adult to identify any challenges to effective self-management;  
• help the adult identify goals that they find meaningful;  
• apply self-management strategies to behaviours that they wish to change;
• plan appropriate levels of activity and identify incentives / self-reward;
• design bespoke action plans and help adult’s review and revise goals over time; and
• reflect on the self-management techniques that they have found effective

As previously outlined, an ability to assess the adult’s likely capacity to self-manage in terms of their:

• capabilities - physical and psychological resources e.g., physical skills, strength or stamina and the ability to engage in the necessary thought processes, comprehension and reasoning to perform the target behaviours;  
• physical opportunities in terms of time or social opportunities in terms of relationships and local community assets and resources; and  
• motivation or resources to build motivation such as reflecting on what they appreciate in their lives.