[Management of Uninhabitable Homes - Investigation of 186 Cases of Hoarding, Domestic Neglect and Squalor in Dortmund (Germany)].

OBJECTIVE

To develop an intervention concept for the management of uninhabitable homes.

METHODS

Retrospective analysis of 186 cases of the community mental health service in Dortmund (Germany) presenting with a destitute situation of the domestic environment as core problem.

RESULTS

All patients suffered from psychiatric illnesses, mainly from addiction (F1: 41%), psychosis (F2: 17%), depression (F3: 17%), and hoarding disorder (F63.8: 12%). Main socio-demographic characteristics of our sample are: middle age (45-65 years, 48%), male gender (73%), isolated situation (only 7% married, 84% living alone), normal schooling (only 4% without completion of schooling, 7% attended a school for special needs), after initial integration into employment nearly all patients suffered vocational disintegration (5% employed, 44% unemployment benefit, 7% welfare, 39% pension or invalidity benefit). Psychosocial interventions differed between the 4 main diagnostic groups: F1: treatment of dependence (rehab) and treatment of concomitant somatic diseases; F2: admission to a psychiatric hospital and implementation of guardianship; F3: mediation of conflicts with neighbours/landlords and implementation of guardianship; F63.8: direct practical help by members of the community mental health team and organisation of home help/waste disposal. In all diagnostic groups, acceptance of help was impaired due to social withdrawal, resistance and psychiatric symptoms. At 13%, compliance with help and interventions was lowest in the hoarder group (F1: 27%, F2: 26%, F3: 38%). Consequently, in this group the poor outcome categories "nothing accomplished" and "lost flat/eviction" were more frequent (44%, F1: 27%, F2: 26%, F3: 38%).

CONCLUSIONS

Concurrent to the deterioration of the domestic situation, patients suffer vocational disintegration as well as family and social isolation. Uninhabitable homes occur in the course of various severe and chronic psychiatric diseases. They don't constitute a syndrome and they are not characteristic for one specific diagnosis. It is important to recognise the underlying psychiatric disease as diagnosis influences acceptance of help, choice of appropriate interventions, outcome and prognosis. Tab. 1 shows our suggestion for a diagnosis differentiated approach, relating appearance of the home and behaviour of the patient to diagnosis, appropriate interventions and prognosis. Hard to reach is the group of hoarders. Patients with a psychotic illness and with hoarding disorder require implementation of long-term outreach help in their homes.