clearing clutter, changing lives
TRANSCRIPT
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: [email protected]
Thank you,
and please
stay in touch!