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Sunday, May 28, 2017
May 2017 View Previous Magazine Features
 

Clutter Blindness
By: Nena Groskind

It usually starts with a complaint: Owners object to the “bad smell” coming from a neighboring unit, or they report that a resident has begun storing personal possessions in the hallway outside his front door. Perhaps the manager dropped by to deliver a notice or just to say ‘hello,’ and was appalled by the “horrifying clutter” she saw in an owner’s living room. You may be dealing with a hoarding situation. How should you handle it?
The first step is understanding that hoarding is a mental illness –designated officially as such by the American Psychiatric Association in 2013, but recognized by mental health professionals for many years before that.
The clinical definition of hoarding has three components, Marnie Matthews, MSW, LICSW, a clinical specialist in hoarding, who heads the North Shore Center for Hoarding and Cluttering, explains:
1. Excessive attachment to possessions. “It’s not the volume of ‘stuff’,” she emphasizes. “It’s the attachment to it.”
2. Clutter so excessive that dwelling spaces can’t be used for their intended purposes.
3. Some additional level of social, medical or emotional distress. “People with hoarding disorder overwhelmingly have some other type of mental health issue,” Matthews says. “Sixty percent suffer from depressive disorder, 30 percent have anxiety issues or anxiety disorder and another 30 percent have ADD. Most have a combination of some or all of these,” she notes.

A Disability, Not a Choice
People who base their understanding of hoarding on the reality television show featuring it have the wrong idea, Matthews says. Contrary to many of the situations profiled there, “people who suffer from hoarding disorder aren’t lazy or dirty” or living in squalid conditions. “Ninety five percent of our clients are nothing like that,” she says. Research suggests, and her experience confirms, “they have above average education levels and higher IQs, are creative and overwhelmingly perfectionist. Hoarding isn’t a lifestyle choice,” she emphasizes. “People don’t choose to live this way.”
Health care experts estimate that from 2 percent to 6 percent of the population suffers from hoarding disorder, but Matthews thinks that “seriously understates” the prevalence of the problem. People who have the condition don’t self-report, she notes, and many hoarding situations aren’t discovered.
Hoarding behavior doesn’t develop overnight, she emphasizes. The condition is “chronic and progressive,” usually triggered by a traumatic event or a series of traumatic events. By the time it is discovered, the condition has been evolving, and possessions have been accumulating, over a long period of time.
That’s the situation condominium associations are likely to confront. “A hoarding situation in a single-family home is troubling enough,” Jared McNabb, CMCA, PCAM, general manager at the Brook House, notes. “In a condominium, it takes on totally different dynamic. You’re not just dealing with behavior inside an owner’s unit that may be endangering that individual. You’re dealing with a situation that could also endanger the people living around them and perhaps the entire community.”
Managing a hoarding situation is every bit as complicated as the disorder itself. McNabb says. It requires “diplomacy, delicacy” and sensitivity both to the owner suffering from the disorder and to the needs of other residents of the community, who are affected by the owner’s behavior.
He speaks from first-hand experience at two condominiums he managed before the Brook House. In one, a manager investigating the source of a water leak found “horrid conditions,” including mounds of garbage that had produced a vermin infestation. In the other, the owner’s unit was “clean,” McNabb says, and the accumulated papers, books and boxes filling the unit were “piled neatly” but they completely blocked every doorway. “There was no way emergency personnel could get in or get her out.”

Diplomacy and Sensitivity Essential
In both cases, the association first contacted the owners personally and asked them to address the problem. Formal letters followed, noting the association’s authority to act if the owners didn’t. That was enough to motivate the second owner, who de-cluttered her unit, but it had no impact on the first, who also ignored a strongly worded letter form the association’s attorney. The situation was resolved without court action (which the board wanted to avoid), when a relative the woman had listed as an emergency contact stepped in. She hired a cleaning service that threw away some of the possessions, stored others and brought the unit into compliance. And did the owner maintain the unit after that?
Follow-up wasn’t an issue here, McNabb says, because “fortunately, the owner moved out about a year later.”
Had she remained, Matthews says, the hoarding cycle would almost certainly have been repeated. Clutter is a symptom of an underlying disease, she explains, and removing the clutter doesn’t eliminate the problem that caused it. She likens it to an iceberg. ‘You only see 20 percent of it above the surface; but it was the 80 percent below that sank the Titanic.”
For those who don’t understand the disorder, Matthews acknowledges, the solution to a hoarding situation seems simple: “Just throw the clutter away.” But someone with hoarding disorder “can’t just throw everything away,” she says. Some have what is known as “clutter blindness” – the risks apparent to others are invisible to them. Even if they perceive the problem, Matthews notes, they aren’t able to deal with it. “They may say they will take care of it, and they mean it,” she notes, ‘but they can’t.”

What Not to Do
So what should associations do when they confront a hoarding situation? The more important question, Matthews suggests, is what should they not do, and aggressive intervention (“we’re going to do this for you if you won’t do it yourself”) is probably the “least effective” response “and one of the most damaging things you can do.”
Trauma is both a major cause of hoarding behavior and a trigger that can exacerbate the behavior. The “full clean-out” initiated by the relative in McNabb’s example would be extremely traumatic for a hoarding sufferer, Matthews says, and could make an existing hoarding situation even worse. “You’ve created a [potential] hoarding trigger, but you haven’t taught the skills and strategies the person needs to manage their condition.”
There are legal as well psychological arguments against aggressive intervention by a condominium board, Matthew Gaines, a partner with Marcus, Errico, Emmer & Brooks, observes. “You can’t just storm the gates,” he cautions. A board would need a court order before doing anything inside an owner’s unit.
In dealing with a hoarding situation, “You want to be proactive” Gaines suggests. “You want to smell it out, literally and figuratively before it gets too bad.” But at the same time, he emphasizes, boards have to recognize that hoarding “is a severe mental condition. You have to treat owners suffering from it [sensitively] and with respect.”
One thing boards should not do is fine owners who fail to respond to a board order to de-clutter their home. “Fines won’t make the disability disappear,” Gaines notes, and boards levying them would be “flirting with discrimination. They would be punishing someone for having a disability.”

Fair Housing Implications
Because hoarding meets the definition of an emotional disability under both federal and state Fair Housing laws, boards may be required to offer a reasonable accommodation for it, and it’s not clear what that might be. Some attorneys fear a court might decide it would be reasonable to allow an owner to store overflow clutter in a back yard or other common area, where it wouldn’t pose a health and safety risk. “That wouldn’t shock me,” Richard Brooks, a partner in Marcus, Errico, Emmer & Brooks says. It is not much different, he suggests, from requiring an association to permit the installation of an outside wheelchair ramp that would otherwise be prohibited by the architectural standards.
Matthews says she’s never seen a court issue an order like that in response to a hoarding situation. More common and more helpful, she says, are orders requiring a plan to deal with the clutter and a reasonable amount of time to implement it. That is consistent with the multidisciplinary, multi-faceted approach she uses in working with hoarding sufferers and with the public agencies (health and building departments) and private entities (condominium associations ) trying to deal with them.
Her starting point is a team that includes some or all of the following: A mental health professional, a property manager (in a condominium or apartment setting), and a local code enforcement official, a representative from a social service agency, a clean-up service and the resident. “The number one person on the team is the resident,” Matthews emphasizes. If he/she isn’t involved in the process, it isn’t going to work.” The selection of the clean-up service is also important, she says. “They have to understand how to deal with hoarding situations.”
The ideal strategy, she says, is one that allows the professionals involved to work with the hoarding sufferer over a period of “several weeks or even months. But that is not usually possible,” she acknowledges. Most hoarding situations involve health and safety concerns that require what she terms a “harm reduction” response. The focus is on making the environment safe, accessible and usable. You hope, as part of the process, the individual will obtain the mental health treatment they need, Matthews says, but the immediate priority is “creating a safe environment. We’re not trying to cure the behavior; we’re trying to reduce the risks.”
That’s how she initially approaches the resident – not by saying, “You have to get rid of all this stuff,” but by pointing out, “It’s really hard to open your front door and that could be dangerous. Would you like for us to help make this safer for you?”

A Checklist and a Plan
A key component of her program is a uniform inspection checklist [SAMPLE SIDEBAR] she has developed that defines minimum safety and sanitation standards. The checklist provides benchmarks association managers or public health officials can use to measure progress and assess compliance. Equally important, Matthews says, it sets concrete goals for the resident, breaking down what seems an overwhelming task into manageable segments. Based on the checklist, she creates a plan prioritizing the clean-up work and a timetable for meeting the goals.
When she is working with condominium residents, Matthews says, association boards and managers sometimes want to turn the entire process over to her. “But we definitely want them to be on the team with us. We need them to provide leverage and ensure accountability.”
The approach Matthews outlines – a team, a plan and a timetable anchored by the checklist─ works. She has several success stories. One of them involved an apartment tenant who had been in and out of Boston Housing Court since 2008 and was now facing a last chance – either clean out her apartment or be evicted. Using the ‘harm reduction’ strategy and the checklist, a team, including the tenant, went to work. The apartment subsequently passed inspection and has passed every inspection since, Matthews since. Eighteen months later, the tenant, who was facing imminent eviction, is still in the apartment.
Another positive outcome resulted from a presentation at which Matthews explained her uniform checklist. The audience included an official from a local public health department, who had been working for more than five years with a homeowner in an effort to resolve a serious hoarding problem. Nothing had worked, Matthews recalls, and the inspector was on the verge of condemning the home. He took the checklist with him when he left and inserted it in a letter to the owner, informing him that the home would be condemned if the health and safety issues weren’t resolved. Two weeks later, Matthews says, the house passed the inspection. “It wasn’t house beautiful,” she says, “but it was safe and functional.”

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