Hoarding: anyone know of any cases where the court let the person go?

[whopper]

Here's why I bring this up.

Is hoarding a mental illness that can make one involuntary committed to a hospital?

Many might think yes. Here's where you could be wrong.

1) Patients with hoarding can often times meet capacity in the sense that they can verbalize it is inappropriate behavior. (It's just that they'll continue to hoard).

If a patient has capacity, courts often-times let the person go. E.g. if a patient wants to kill someone but they have the capacity to understand the harm, the court may rule the patient's motivations are not due to mental illness, and are more antisocial in nature.

So just as a smoker can verbalize they know it's harmful despite that Nicotine Abuse is a mental illness, we're not supposed to involuntary commit someone for it who doesn't want to quit.

2) Patients with hoarding usually show no significant deficits on neurological/psychological/cognitive testing

3) There is no medication that has been accepted as effective to the degree where we are confident it will work. Don't dare say an SSRI. SSRIs haven't met the critera most courts accept for court-ordered medication treatment such as a double-blinded placebo controlled study, no FDA approval, no mention in the PDR for benefit in hoarding.

There are several legal precedents stating that if there is no treatment that can be offered, the patient is to not be involuntarily committed because as an involuntarily committed patient, the treatment providers are required to offer something valid in return for the hospitalization other than perfunctory treatments such as "milieu therapy."

While CBT has been found effective in hoarding, it is next to impossible to engage in CBT with a patient that doesn't want to participate in it.

In short, I can see a judge/magistrate with an in-depth knowledge of mental health law that critically thought the hearing out to not allow any patients to be involuntarily committed based on the above.

What I believe will happen, and is happening in the localities where I work is the judge/magistrate doesn't have as an depth a knowledge of mental health law as a board-certified forensic psychiatrist, and because of the horror of the pics they'll see from a hoarder's house, they'll commit the patient---leaving a ripe situation for a potential landmark case if there was a lawsuit for violation of civil rights.

I believe to be able to truly involuntarily commit a person for hoarding (and no other mental illnesss), without violating previous precedents, a court would have to add a new precedent not yet done in mental health law.

Now here's where you can help me. I'm currently gathering data on this phenomenon but I can only obtain data from my specific area because involuntary commitment hearings are always sealed to the public and hence will not appear on Lexus-Nexus searches.

If you have the time, please PM me or post if you see involuntary commitments for hoarding happening in your locality, or if the court is letting hoarders go because of the reasons I mentioned or other reasons, also state where you are.

I'm currently gathering data on this for possible publication. If it goes to publication, I'll likely not be able to put you as an author because I could get dozens of responses, but I could at least mention you in the thank you/assitance section.

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[F0nzie]

Never seen an actual case of hoarding except on TV. Interesting how some people will hoard in a neat obsessive kind of way while others will just stack a bunch of garbage. I've seen a case similar to the latter but the patient was psychotic and also sleeping in animal urine and feces.

 

[birchswing]

Never seen an actual case of hoarding except on TV. Interesting how some people will hoard in a neat obsessive kind of way while others will just stack a bunch of garbage. I've seen a case similar to the latter but the patient was psychotic and also sleeping in animal urine and feces.

People can be digital hoarders and you'd never know it (1s and 0s don't take up much space). I tried telling my psychiatrist about it (I told her that I was concerned she didn't know the focus of my OCD), but she didn't want to know. She said she didn't need to know the particulars. "Don't open any doors in this room that can't be closed." Still not sure what that means.

 

[OldPsychDoc]

People can be digital hoarders and you'd never know it (1s and 0s don't take up much space). I tried telling my psychiatrist about it (I told her that I was concerned she didn't know the focus of my OCD), but she didn't want to know. She said she didn't need to know the particulars. "Don't open any doors in this room that can't be closed." Still not sure what that means.

http://imgs.xkcd.com/comics/old_files.png

 

[F0nzie]

I work with the SMI population and I occasionally do home visits. Many of them have immaculate homes that make my place look like an embarrassment!

 

[Ceke2002]

Are you looking for cases just in the US? If not I'm seeing my Psych in a couple of weeks time and I could always ask him if he's aware of any cases in South Australia where someone has been involuntarily committed for hoarding. I do know we've had cases here that have made the news, but I don't recall any sort of enforced treatment being reported.

 

[MacDonaldTriad]

I had a severe hoarding patient about 10 years ago, right down to dead pets in the freezer. His/Her home was closed by the health department and he/she had no resources so the involuntary commitment held. This was probably not a data point for you in that he/she was also very depressed.

 

[smalltownpsych]

I have never been involved in an involuntary commitment proceeding for hoarding. If they don't meet criteria for suicidality, then we would have to look at being unable to care for self. That standard could be met depending on safety and hygiene concern for the messier hoarders as MacD indicated above. However, in our state, we also have to show that the treatment would have a reasonable expectation of working so that might be a little harder to argue, but the court tends to give latitude in favor of treatment verses no treatment. In other words, they would figure that doing something is better than doing nothing.

 

[javeliina]

edit

 

[javeliina]

edit

 

[whopper]

I'd be open to anything, even outside the US. Thanks

 

[nancysinatra]

Whopper this is a fascinating question. I have no data to offer, but there must be similar conditions. I would think the answer is simple, actually - the "treatment" for hoarding is actually not CBT; rather, it is to clean the house and hope for the best. That can't be done while the person is an inpatient. It's like making debtors do jail time. You could theoretically argue that the treatment is CBT, but there's no way to test it in a hospital setting.

I agree most judges would just commit the person. I am always amazed at the faith judges place in us to cure almost anything. A few weeks ago a lady came in who had some religious belief where she refused treatment for an acute medical problem AND refused to comply with a capacity evaluation, claiming she "didn't believe in psychiatry" and wouldn't speak to a psychiatrist ever. She got whisked away to court, and promptly committed to the psych ward, where we were supposed to do - what???

 

[heyjack70]

3) There is no medication that has been accepted as effective to the degree where we are confident it will work. Don't dare say an SSRI. SSRIs haven't met the critera most courts accept for court-ordered medication treatment such as a double-blinded placebo controlled study, no FDA approval, no mention in the PDR for benefit in hoarding.

There are several legal precedents stating that if there is no treatment that can be offered, the patient is to not be involuntarily committed because as an involuntarily committed patient, the treatment providers are required to offer something valid in return for the hospitalization other than perfunctory treatments such as "milieu therapy."

I think the standard is individualized/appropriate treatment, and milieu therapy is neither. If appropriate, individualized treatment is offered and the person declines to engage, I do not believe that is contradicting the legal precedent. The next step clinically would be to figure out how to get the patient to participate in treatment. However, even if the patient is not participating (in CBT for example), if he/she continues to be imminently dangerous due to mental illness and reasonable steps were taken to provide appropriate treatment, the commitment should be continued.

 

[ketosisevangelist]

Here's why I bring this up.

Is hoarding a mental illness that can make one involuntary committed to a hospital?

Many might think yes. Here's where you could be wrong.

1) Patients with hoarding can often times meet capacity in the sense that they can verbalize it is inappropriate behavior. (It's just that they'll continue to hoard).

If a patient has capacity, courts often-times let the person go. E.g. if a patient wants to kill someone but they have the capacity to understand the harm, the court may rule the patient's motivations are not due to mental illness, and are more antisocial in nature.

So just as a smoker can verbalize they know it's harmful despite that Nicotine Abuse is a mental illness, we're not supposed to involuntary commit someone for it who doesn't want to quit.

2) Patients with hoarding usually show no significant deficits on neurological/psychological/cognitive testing

3) There is no medication that has been accepted as effective to the degree where we are confident it will work. Don't dare say an SSRI. SSRIs haven't met the critera most courts accept for court-ordered medication treatment such as a double-blinded placebo controlled study, no FDA approval, no mention in the PDR for benefit in hoarding.

There are several legal precedents stating that if there is no treatment that can be offered, the patient is to not be involuntarily committed because as an involuntarily committed patient, the treatment providers are required to offer something valid in return for the hospitalization other than perfunctory treatments such as "milieu therapy."

While CBT has been found effective in hoarding, it is next to impossible to engage in CBT with a patient that doesn't want to participate in it.

In short, I can see a judge/magistrate with an in-depth knowledge of mental health law that critically thought the hearing out to not allow any patients to be involuntarily committed based on the above.

What I believe will happen, and is happening in the localities where I work is the judge/magistrate doesn't have as an depth a knowledge of mental health law as a board-certified forensic psychiatrist, and because of the horror of the pics they'll see from a hoarder's house, they'll commit the patient---leaving a ripe situation for a potential landmark case if there was a lawsuit for violation of civil rights.

I believe to be able to truly involuntarily commit a person for hoarding (and no other mental illnesss), without violating previous precedents, a court would have to add a new precedent not yet done in mental health law.

Now here's where you can help me. I'm currently gathering data on this phenomenon but I can only obtain data from my specific area because involuntary commitment hearings are always sealed to the public and hence will not appear on Lexus-Nexus searches.

If you have the time, please PM me or post if you see involuntary commitments for hoarding happening in your locality, or if the court is letting hoarders go because of the reasons I mentioned or other reasons, also state where you are.

I'm currently gathering data on this for possible publication. If it goes to publication, I'll likely not be able to put you as an author because I could get dozens of responses, but I could at least mention you in the thank you/assitance section.

You need a certificate of occupancy from the city to be able to be granted the privilege of receiving electric and gas utilities.

If there is a standing fire hazard, the city (code enforcement officer) will tell the homeowner they are out of city code(aka in violation)

Check with municipal code enforcement departments.

Best luck.

Look

 

[dl2dp2]

I have treated a hoarding patient on an outpatient basis with CBT. The results were not as impressive as I had hoped. The patient was later referred for group/individual CBT at a specialist clinic, but still did not recover.

Nevertheless, I would imagine that unless the patient is suicidal/psychotic, it would be very hard to involuntarily commit a patient ONLY because of hoarding--one would have to make an argument for inability for self care, which is always difficult. I do not KNOW of anyone being hospitalized for hoarding, have never seen someone on an inpatient unit solely for this reason. Although I have seen patients involuntarily committed because of delusional disorder (i.e. hoarding because of a delusional belief, i.e. imminent apocalypse, and therefore he needs to store up his supplies to such an extreme that caused a leak in the floor, and then landlord complains.)

I think differential diagnosis is an important consideration. There is an argument to be made in court that a trial of antipsychotic could be efficacious, then there's a cause to involuntary admit, IMHO. On the other hand, I don't see this as being particularly different from other mental health court cases, as the judge is always in principle ruling based on his/her impression of the patient's mental state, and there's always some ambiguity--even an SMI patient usually has SOME insight. Although in my experience (echoing nancysinatra above), the judge rarely actually listens to the patient, more or less because the judge basically processes > 20 SMI patients a day and just defers to the doctor's judgement.

Just as an aside, hoarding disorder is now officially a DSM-5 diagnosis, as part of obsessive-compulsive and related disorders.

 

[whopper]

There is an argument to be made in court that a trial of antipsychotic could be efficacious, then there's a cause to involuntary admit, IMHO.

IMHO it shouldn't work. The legal criteria for forced-medications requires that the medication be appropriate for the disorder. There isn't good data that any medication treats hoarding. Case studies do not meet the scientific criteria required by many states and federal law.

Now if someone had a hoarding problem due to psychosis, that's different but I'm talking about hoarding in and of itself.

Now this is on the argument that the judge does it the way it's supposed to be done. A problem here is I've seen judges who haven't read the prior cases where forced-meds were involved and don't really know the criteria. Judges are just like doctors. Some are terrible and make it up as they go along. A typical judge is some guy that couldn't make it as a lawyer and got into their position because their college roommate is in the city council and got them their position.