Harm Reduction

What is Harm Reduction?

The WGHR uses and promotes a harm reduction approach to hoarding. Harm reduction means a focus on making the home safe, healthy, and comfortable, rather than focusing on removing all items from the person’s home. Harm reduction has been used successfully in many other public health interventions, including substance use and smoking cessation.¹

Key principles of harm reduction for hoarding:²

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First do no harm

The intervention should not do more harm than good for the person you are working with. Always start with the least intrusive intervention.

It is not necessary to stop all hoarding behaviour

The key to harm reduction is to reduce risks in the home.

No two situations are identical

Every situation is unique, therefore every intervention is different.

Change is slow

Lasting change takes time. Chipping away, bit by bit, is more effective than rushing a solution.

People may have other more pressing problems than their home environment

Sometimes the clutter in a person’s home is not the more urgent issue that needs to be dealt with.

The person with the collecting and saving behaviours is an essential member of the team

If you are a service provider or family member working with someone with cluttering tendencies, it is essential to include them in goal-setting, meetings, and other plans. They need to make the decisions about their possessions and their home.

Download these principles as a PDF.

Why Harm Reduction vs Other Approaches?

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Not Recognizing the Problem

Not everyone sees the clutter in their home as a problem. Harm reduction can be helpful in opening a conversation and setting goals around health and safety.

Ambivalence & Readiness for Change

It is normal to have mixed feelings, even when you want to make a change. Harm reduction can help set priorities and small, manageable goals that are not overwhelming. Remember, the person may not be ready for change yet.

Therapy

Therapy for collecting and saving can take a long time, and is a lot of hard work – not everyone is ready or able to do it. Many people do not have access to therapy for their cluttering behaviours.

Reactance

The harder you push, the harder the person with the hoarding behaviour pushes back.

Harm reduction changes the focus from “throw all this stuff out!” to “I want you to be safe”.

Stigma

Focusing on “hoarding” can trigger feelings of shame and cause people to decline help. Harm reduction changes the focus of the conversation to safety and comfort.

Limits to Authority

People have the right to live how they choose, and at some risk. There are no laws for good housekeeping, and we can only ask people to reduce risks. If you are a service provider or loved one of someone with cluttering behaviours, you may have an idea in your mind of what you would like their home to look like, or how you think it “should” look. Harm reduction focuses on the comfort of the person who lives in that home. They may be comfortable with much more clutter than you are.

We know it works

Research shows success in high risk behaviours (e.g. addiction), and we know large scale clean-ups do not work.

Underlying or undisclosed issue

We may not know if the person we are working with is struggling with their mental health, or has a physical limitation that has caused the clutter in their home. Harm reduction can work, regardless.

Why cleanups often fail

The WGHR does not promote doing large scale clean-ups (sometimes called “extreme cleans”). Research and experience has shown that large-scale clean-ups are not helpful for people with high levels of clutter. Here are a few reasons why:

Most people will bring more items home until it is at the same level of clutter as before the clean-up (and sometimes in a shorter period of time)
It can be traumatic for the person and cause them a lot of stress and anxiety
The experience can break trust with well-intentioned service providers, family and friends
Clean-ups can be very costly – far more than most people are able to pay for
While it may address some of the health and safety problems in the home, removing items from the home does not change the way the person thinks about their possessions, and the need to save them

There are some situations where a larger-scale clean up may be necessary for health and safety reasons. For example, if there is a significant pest infestation, it may not be possible to treat the pest problem without removing many/most of the items in the home. Every situation is different, and it is important to consider the impact on the person, weighed against the risks.

What can I do now?

You’ve looked around our website, and had a look at some of our resources and tools. Now what?

Contact the WHGR coordinator to talk about how the harm reduction approach can work in your situation, and discuss possible next steps. You can call anonymously and your information is confidential.

¹Tompkins, M.A., & Hartl, T.L. (2009).Digging Out: Helping Your Loved One Manage Clutter, Hoarding & Compulsive Acquiring. Oakland, CA: New Harbinger Publications Inc.