clearing clutter, changing lives

Clearing

Clutter,

Changing Lives Advocating to Expand

Options for Community Living

Learning Objectives To learn what clutter is and who it most affects

To understand how serious clutter issues intersect in older adult populations

To learn what resources are currently available in San Francisco to address clutter issues and the loneliness that accompanies them

To learn what support we can provide for elders with clutter issues to reestablish their lives in the community

To learn about building communities and opportunities for peer advocacy

Who we are.

Consumer

Driven

Peer

Support

Stigma

Elimination

Advocacy Public

Policy

Education

Training

What do we mean by “clutter”?

DSM-5: Diagnostic Criteria

A. Persistent difficulty discarding possessions

i. Regardless of the value others may attribute to

these possessions

B. Caused by strong urges to save items

C. Accumulation of a large number of possessions that

render the home or areas of the homes not useable

D. Cause clinically significant distress or impairment

E. Symptoms are not due to a general condition

Clutterers Anonymous defines clutter as,

“…anything we don’t need, want, or use that takes our time, energy, or space, and destroys our serenity. It can be outgrown clothes, obsolete papers, broken toys, disliked gifts, meaningless activity, ancient resentments, or unsatisfying relationships. We may be selective in some areas, but not in others. Objects may be strewn about or wedged in drawers; neatly stacked or stowed in storage.”

Bottom Line: Got too much stuff?

Nearly everyone in America periodically feels we have “too much stuff” and tries to simplify, organize, and de-clutter.

Each of us deals with this challenge in our own unique ways.

Sometimes we feel overwhelmed.

You are not alone.

Group activity Tell us about one thing you hold onto that

anyone else would think is junk, and why

you keep it.

Who does clutter affect?

3% – 5%

Samuels, 2008

9 – 15 Million People

Clutter issues affect approximately the

same percentage of the population as

Alzheimer’s Disease.

As with Alzheimer’s,

stigma around

Hoarding Disorder

can affect open

discussion and

willingness to seek

treatment.

Between 25,000 to

50,000 adults in San

Francisco face

hoarding and cluttering

challenges – and that

estimate may be low.

Age of Onset

Tolin, Meunier, Frost, & Steketee (2011)

Most Reported

Samuels, et al. (2008)

Clutter issues disproportionately affect

older adult populations. Why?

Elders have lived long enough to accumulate more stuff.

They have a greater likelihood of experiencing a life-altering event.

Death of a loved one

Health crisis

Loss of a job or retirement

They may have experienced downsizing, especially in conjunction with custodial care of items left behind by loved ones who have died.

Social Isolation and Clutter The vicious circle

Isolation

Depression and Anxiety

Increased Acquiring

Clutter

Many people who seek treatment cite lapsed

social connections as their primary motivation

for wanting to beat clutter.

Many people who deal with clutter are

exceptionally social and are greatly afflicted

by loneliness and isolation.

How it all started

Educate

Act Advocate

Grassroots

Consumer Housing Group

Started in mid-1990s

Challenges for low-income and

low-income housing in San

Francisco

Unintentional result was the bringing

to light the issue of hoarding

behavior or “Pack-Rat”

EDUCATE

Educate we did!

ADVOCATE

Advocacy

“The act or process of

supporting a cause or

proposal : the act or process

of advocating something”

Advocating we went!

ACT

1st “Pack Rat” Conference

1st Support Group

Hoarding Consortium

MHASF Advocacy

Information and

Referral

Community Education /

Trainings

Annual Conference

Support Groups

Educate

Act Advocate

2000 - 2006

SAN FRANCISCO

RESPONDS!

2007

San Francisco

Task Force on Hoarding

San Francisco Taskforce

on Hoarding

Launched in 2007

Members include major SF City Departments, non-profit housing and service providers, property managers and other community based organizations

Focus on increasing collaboration and multi-disciplinary solutions

Identify strategies to reduction evictions and improve quality of life

Goals of the Task Force Identify gaps and barriers in service

Assess current services and needs

Identify best practices to improve coordination of services, reduce eviction, improve quality of life

Raise awareness among the public and policy makers

Make policy recommendations

The Task Force

documented annual

costs of over $1.6

million per year to

San Francisco

service providers

($502,755) and

landlords ($663,350).

Estimate cost to San

Francisco – over $6.4

million a year

COST TO SAN FRANCISCO

RECOMMENDATIONS 8 Recommendations from the San Francisco Task

Force on Hoarding

Recommendations

1. Assessment | Crisis Team

2. Increase Access to Treatment

3. Expand Local Support Groups

4. Create a Services Roadmap

5. Evaluation Guidelines for Landlords

6. Long Term Case Management

7. Offering Training and Support

8. Ensure Overarching Coordination

How are we doing?

ICHC Advocacy

Information and Referral

Community Education /

Trainings

Consultation

Annual Conference

Support Groups

Treatment Group

City Wide Task Force

Peer Response

Team

Research

Continuum of Change:

Support & Services

Maintenance/ Continuation

Action

Group

Un-Buried

In Treasures Group

WRAP

for

Clutter

Commitment/

Structured

Therapist-led Treatment

Group

Buried In Treasures

Group

Low Threshold/Low Commitment

Drop-In

Support

Group

PRT

1:1

Peer Response Team

Peer Response

Team

Support Groups

Community Education /

Trainings

Treatment Groups

1:1 Peer Support

Linkage to referrals &

information

Advocacy

Consultation

The Peer Response Team is a group of individuals who have experienced serious problems—stress, anxiety, depression, stigma, damage to relationships, health and safety issues, eviction, isolation— when we lost control over our stuff.

We believe it is possible to regain control of your life.

We believe that non-judgmental peer support can help.

We are building a community of people affected by this issue.

We identified social connection as a key to

recovery.

We offered 1:1 In-Home Peer Support.

Not sustainable in the long term due to travel

and increased reliance on Peer Responders for

alleviating social isolation

We engage individuals and encourage them

to join an increasing variety of groups.

We provide opportunities for social

connection and community building.

Group offerings at MHASF

Drop-In Group

Treatment Group

Buried in Treasures

Unburied from Treasures

Action Group

WRAP for Finders/Keepers

Open House Group (LGBT Center)

PEER SUPPORT GROUPS Weekly at MHASF

Drop-in

Harm Reduction Approach

Over 250 have engaged since in 2009

CBT TREATMENT GROUP

Group treatment and intervention program

16 to 26 - week group therapy program

Works very well for some individuals

Continued progress after the process for some while others have some degree of relapse

BURIED IN TREASURES GROUP 15 week group over 20

sessions

Peer-Led Group

Step-by-Step textbook guide to understanding why we clutter and how to change our thinking and behaviors

22 Enrolled | 20 Graduated | 13 New to services

PCORI: GBiT vs GCBT Funded by PCORI:

Patient Center Outcomes Research Institute

Partnership with University of California, San Francisco – Carol Mathews, M.D.

3-years

PCORI (Patient-Centered Outcomes

Research Institute) Study with UCSF

Researching Therapist-led vs. Peer-led

groups

16 CBT Treatment Groups vs. 15 Buried in

Treasures Groups over 3 years

300 to 400 total participants

Bay area locations in San Francisco,

Alameda, and San Mateo Counties

PCORI Research Team

ACTION GROUP 8 Consecutive Sessions

Group for Practical Support and Help For Active De-cluttering

Great Place to Find a Clutter Buddy

23 Enrolled | 10 New to Services

Why groups?

Groups, rather than individual therapy, are becoming the gold standard for treatment of clutter issues.

Groups provide not only an optimum learning environment for new skills and strategies, but are also a way of addressing isolation.

Groups provide individuals with a way to connect with clutter buddies – another means of alleviating social isolation.

Empowerment and

Engagement

Support

Recovery

Empowerment Engagement

Community

1st annual MHASF Peer

Convening for Finders/Keepers

Future Visions

Social gatherings

Clutter buddy speed dating

Trainings in: Group Facilitation; How to Be a

Clutter Buddy; Public Speaking

Outreach through libraries, senior centers, etc.

Media campaign

Focus groups on theory, research

Resource bank

Volunteers, more Peer Responders

Future Visions:

ICHC | Peer Learning &

Healing Center

Family & Friends

Acquiring

Therapist/ Provider

Resource Group

Organizing Skills

Celebrations

SRO/Small Space Design

“Where Do I Start?”

TAY: Living on Your

Own

Narrative Therapy

1997 1st

Consortium and Public Discussion

1st Drop-in Support Group

2000 Hoarding

Consortium

Information and Referral

Services

2005 Creation of

Overwhelmed Resource Guide

2007 Institute on Compulsive

Hoarding and Cluttering

San Francisco Task Force

WE STARTED SMALL…

2008 Therapist-led

Treatment Group

2011 Peer

Response Team

Un-Buried in Treasure

2012 Conference

Expanded to two-days and training

Expansion to two CBT Treatment

Groups

2014 PCORI CBT v. BiT

Research Kicksoff

1st Peer Convening

HI/TPP Pilot Project

WRAP for Clutter

…BUT LOOK WHERE WE ARE NOW!

16th Annual ICHC Conference, Nov. 6 – 7,

Hilton San Francisco – Financial District

A Little Team Work and Cooperation

PARTNERSHIPS

MHASF in partnership

with DAAS, CBHS,

UCSF, and the wider

San Francisco

Community, has

come together to try

and address the issue.

What can you do to support

seniors on their journey of

de-cluttering?

First, do no harm.

Recognize it’s not about the stuff.

Clear the air before you clear the stuff.

Be cautious of the “helper mentality” –

we’re here to empower, not to rescue.

Maintain a non-judgmental attitude –

roll with resistance.

Help the individual to identify their resources, but always let them be in charge – it won’t work otherwise.

Support their process, even/especially if it doesn’t match your own.

Help connect them with community.

Remember that the stuff didn’t get there overnight, and it’s not going to get clear overnight.

Know that alleviating isolation and loneliness first can have a positive effect on motivation to address clutter issues.

What can your community

do?

Educate

Act Advocate

If you build it they will come…

Educate yourself & your

communities.

Advocate for services and

peer support.

Provide a safe space for

individuals to connect and

build community.

COMPARISON – 24 EVICTION CASES

NO INTERVENTION

$36,880 x 24

= $885,120

INTERVENTION

$4,316 x 24

= $103,548

DIFFERENCE OF

$781, 572

88%

Q & A

MARK SALAZAR

Community Projects Manager

ICHC Program Manager

PCORI Research Manager

JULIAN PLUMADORE Community Advocate

ICHC Trainer and Educator

PCORI Peer-Facilitator Support

Mental Health Association

of San Francisco

870 Market Street, Suite 928

San Francisco, CA 94102

Phone: 415-421-2926

Web: www.mentalhealthsf.org

Email: ichc@mentalheatlhsf.org

Thank you,

and please

stay in touch!