Launch of the Hoarding Taskforce Manifesto
Today we launch the Manifesto of the Hoarding Taskforce in Scotland during National Hoarding Awareness week. This Manifesto is aimed at senior leaders in national and local posts in Scotland – Ministers, MSPs, Chief Officer Groups, Integration Joint Boards (IJBs) and Health and Social Care Partnerships (HSCPs) with decision-making power and influence.
It is based on the learning of the Taskforce members over two years, engagement with over 200 stakeholders to understand issues in context. We have also engaged with the evidence, summarised in the Iriss Insight, Hoarding disorder: towards a unified approach beyond disciplines, and informed by practice specialists and experts by experience.
The Manifesto asks for leadership to drive positive change, identifies opportunities and tangible steps. This shows what we need to stop doing, and start doing instead. It argues for a preventative and whole system approach for better outcomes and cost savings, looking across disciplines, portfolios and life trajectories. This has implications for how we commission services, what data we need to collect and the learning infrastructure and cultures essential for supporting a more joined up transdisciplinary approach.
A transdisciplinary approach focuses on collaboration, co-design, and invests in training and continuous shared learning across disciplines to tackle complex real-life problems as they evolve. It’s also founded on common guidelines and frameworks, principles, knowledge and tools.
This Manifesto identifies clear asks of leaders. However, the Taskforce also offers partnership, as we believe that it is by working together that we can make a real difference. A better way is possible.
Why this matters
Hoarding Disorder (HD) is a clinically recognised mental health condition, that no single service or agency can provide all the support a person needs. HD is characterised by excessive acquisition and difficulty discarding due to a perceived need to save items regardless of use or value, with distress and impairment caused by living spaces so severely cluttered that they cannot be used for important daily living functions – such as sleeping, food preparation and washing or bathing (Frost and Hartl, 1996)
Studies suggest an overall prevalence of HD among adults of around 2.5 – 5% or 63,000-125,000 people in Scotland. That’s the same population as in Inverness or Dundee! This is also likely to be a significant underestimate given the levels of shame and stigma associated with it. Nor does this include those with chronic disorganisation (CD) (not HD) for whom decision-making and the physical process of sorting, cleaning or discarding can be utterly overwhelming without support. HD can be symptomatic of trauma or grief. CD is symptomatic of Autism Spectrum Disorder or ADHD. CD is not a mental health disorder like HD but can result in large amounts of clutter and may require support to manage.
We also know that up to 92% of those with HD have at least one other mental health diagnosis (Archer and colleagues, 2019; Harrison and colleagues, 2021) – which is why our response needs to be person-centred and trauma-informed.
The human cost of not acting
Hoarding is associated with: depression and low self-esteem; isolation and loneliness (due to stigma and shame); lack of access to services; delays to important home maintenance tasks; increased risk of death if a fire breaks out; increased risk of trips, falls and injury in the home; infestations; debt; loss of tenancy; relationship-issues; and sometimes, difficulties maintaining employment. Poor self-care is sometimes associated with HD, but more often with Diogenes syndrome aka self-neglect than HD.
For children, it can put them at risk if they live in a hoarded home, or negatively affect their school work, friendships and can create distress if they are thrust into adult caring roles too soon. Or they may be care experienced and have complicated emotional relationships with belongings or have never learned how to manage them. Plus neighbours, family and friends can be affected too. They might be worried about fire safety, or issues with vermin, or the potential impact on their property value. They might simply not know how to help or where to get help. This can create tensions in relationships, especially for those who don’t understand that hoarding is a mental health condition.
Why our current response needs to change
Crisis point is too late
Presently, our response to hoarding is crisis driven and siloed. Most often it is at crisis point that people who hoard become known to services. This may be due to a trip, a fall, needing to go into hospital, or that they are at risk of eviction, have unmanageable debt or because a safeguarding concern has been raised with social work. This normally follows decades of hoarding behaviours that usually (but not always) begin in adolescence, often as a result of traumatic life experiences. By adulthood, behaviours are entrenched and the human suffering and financial costs have accrued.
Siloed working equates to poor use of funds
We know that public finances are stretched, so we need to make the best use of it for everyone’s sake. Siloed working doesn’t help. Take the case of someone, who after decades of hoarding behaviour, is admitted to hospital. HD may only be determined at this point, and the healthcare professional assesses that their home is unsafe for them to return to.
For the NHS This results in delayed discharge or transfer to an intermediate care unit, for someone otherwise ready to return home. This generates significant financial costs to the NHS. Audit Scotland (2026) estimated that the average daily cost of a hospital bed was £618.12. For every extra week in hospital, this amounts to £4,326.84.
For local authorities there may be additional and significant costs associated with re-housing people, even if temporary, while their home is being made safe for them to return to. Or for councils and housing associations in other scenarios, where ‘the last resort’ of instigating eviction procedures has been reached, the considerable legal costs associated with this.
These scenarios create other ripple effects: the loss of a bed for another patient requiring treatment or rehabilitation; increased waiting times. It also has a negative impact on the mental health of the person with HD, who is ‘stuck’ in hospital but wants to go home, and prolonged time in hospital increases their risk of infection, and can reduce mobility and independence. Or for those within the Housing Sector, this can represent time spent tied up in courts and litigation, or time spent on eviction rather than helping people with their tenancies.
Plus, evidence shows that our crisis interventions do more harm than good
Enforced clearouts are still used prolifically as a solution to hoarding (Kysow and colleagues, 2024). But what professionals once thought were helpful, we now know, aren’t based on the evidence we have.
Enforced clearouts don’t work – 100% of people who experience an enforced clearout will regress to hoarding behaviours and more rapidly than before without any support with behaviour change (Bratiotis and colleagues, 2011). It can also result in ‘the revolving door’ of repeat clearouts. Furthermore, they are deeply traumatising and damage trust with professionals and show little regard for a person’s personal autonomy, rights and belongings. At worst, they can result in suicide.
Enforced clearouts are also very expensive and are a poor use of funds (due to failure to act earlier). The average cost of clearing a hoarded home in the UK in 2024 was between £3,500 and £4,000 with more extreme cases being as high as £25,000 (Clean Team Scotland, 2024). They represent low value care: ineffective, inefficient, and unwanted (Verker and colleagues, 2018).
Instead, we need something different to fill the service gaps
Hoarding disorder is a mental health condition, not a life-style choice and focusing on the material items alone doesn’t work. Hoarding is about what happens inside someone’s head.
We know that items are usually a solution to people’s problems and a response to trauma or loss, or the result of decisions un-made.
We constantly hear that the services or roles we need are simply ‘not there’ (and certainly not the ones that people want to engage with). We need to listen to the evidence and build ways of working that are about ‘what people need’, not just what currently exists? If it’s not person-centred and doesn’t work for people, it doesn’t work for anyone.
The evidence shows that sustainable change for someone with HD emerges through long-term, relationship-based support that emphasises trust, collaboration, emotional safety, and gradual progress over time. Only this way can a person develop lasting strategies and behaviour change.
Our Manifesto sets out what this looks like – and asks leaders to invest in a pilot that builds in an evaluation to track outcomes, expenditure, and estimated savings across the whole system to inform future expenditure at scale.
We need to seize the opportunities
The Manifesto asks leaders to help make this real by supporting the following asks:
- We need national guidelines
- We need to invest in learning
- We ask for investment in training for workers, and to support creation of a national training framework, linking levels of knowledge to roles
- We need local communities of practice at strategic and practice level to share learning, foster innovation and improvement and promote coordination and shared accountability.
- We ask you to review your policies and portfolios to ensure people with HD are included to make them visible and bring them the help they need. This would include access to mental health support.
- We challenge public bodies to get better at collecting data on HD to inform planning, improvement and future spend.
- Fund a pilot – to provide the type of service the evidence shows is needed, building in an evaluation that tracks outcomes, expenditure and estimated savings across the whole system to inform future expenditure at scale.
- We challenge leaders to set targets and expectations for a 5-10% budget shift from crisis intervention to preventative spend, funded by fewer or no enforced clearouts (enforced clearouts don’t work, are costly, and represent low value interventions and failure to act earlier).
- We need to make better use of SDS as a pathway to support for people who hoard.
- We need to commission differently:
- Commissioners should be asking that those on its procurement lists to have an appropriate level of training, matched to the role and task.
- We need to review Care Inspectorate service registration categories going forward to remove blocks to innovative and person-centred provision.
- Commissioning collaboratively for better outcomes for people.
- Support a sustainable third sector, and within this user-led organisations that provide valuable peer support.
- Engage with the Taskforce:
- Join our 2026-27 campaign to raise awareness and challenge stigmas, and continue this work.
- The Manifesto is not just an ask — it is an offer of partnership. Please take up this invitation to work with and alongside us for positive change.
Find out more
We’re keen to hear from anyone interested in engaging with the Taskforce.
We can offer partnership to help raise awareness, challenge stigmas and work towards positive change.
Email the Taskforce to start the conversation: hoarding.taskforce@iriss.org.uk
About the Taskforce
The Hoarding Taskforce (Scotland) was formed in 2024 borne of frustration and recognition that we need a better, more joined up transdisciplinary approach to address systemic failures and make best use of limited funds.
Taskforce membership spans services that come into contact with people who hoard and includes: Social Work (Adult and Child Protection), Housing, Scottish Fire and Rescue, Health and Mental Health, Environmental Health, Police Scotland, Scottish Fire and Rescue, Care Inspectorate, representatives from the third sector and independent support practitioners as well as Social Work Advisers within the Scottish Government. Health and Social Care Partnership members (Glasgow, Pan Lanarkshire and Clackmannanshire and Stirling) have also ensured that we have explored and understood the challenges in real world contexts. The Taskforce also benefits from the specialist research and practice expertise of the Hoarding Academy, and the lived experience that Clutter Chat colleagues bring.
The Taskforce’s work is coordinated by Iriss. The image on this page was supplied by the Hoarding Taskforce.