SINGAPORE: The first time Ms Tong Ler Yee worked with a hoarder, the walkways of the woman’s home were all blocked.
The woman did everything outside her house due to the clutter, and even had to go to a nearby community centre to shower.
But she allowed Ms Tong to visit her home and expressed her wish to get it cleaned.
Then trouble began to brew.
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“It (was) very difficult for her to really make choices for what were the things she wanted to keep or what were the things she wanted to throw,” said Ms Tong, a programme executive at charitable organisation Tzu-Chi Foundation (Singapore).
The relationship soured, and her team was unable to complete the decluttering.
The experience captures some of the challenges faced by those working to tackle the issue of hoarding.
Those involved said the process goes beyond simply cleaning and fixing a home, with many hours of befriending and follow-ups also required, among other things.
A Habitat for Humanity Singapore decluttering session at a hoarder's home. (File photo: Habitat for Humanity Singapore)
Latest hoarding figures point to a continuing upward trend.
As of June last year, the New Environment Action Team (NEAT) and the Hoarding Management Core Group (HMCG) had reduced the severity of 308 severe hoarding cases and were monitoring them to prevent recurrence, the Ministry of National Development (MND) and the Ministry of Social and Family Development (MSF) said in response to CNA's queries.
However, the number of active hoarding cases that the two groups were working on had almost doubled to 450 in less than four years - it was 253 in December 2021.
Before NEAT was launched in January last year, HMCG was working on 357 active cases and monitoring 270 cases.
“The increase in cases could be due to greater public awareness in hoarding behaviour after the launch of NEAT, as well as NEAT’s efforts in coordination and identification,” said MND and MSF.
Both ministries had earlier warned that Singapore’s hoarding cases could rise due to the country’s changing demographics, including its ageing population.
“Hoarding cases are complex and long-standing,” they said, adding that the journey to support each case tends to be drawn out and typically involves repeated engagements with the hoarder and their family.
This is where NEAT comes in, bringing together members from social service agencies, community groups, trade and industry associations and government agencies to tackle the hoarding issue.
Slightly over a year after its formation, the organisations told CNA the alliance has smoothed coordination, provided access to more resources and helped them manage difficult cases.
“This alliance has brought everyone together,” said Mr Roy Khoo, treasurer of the Singapore Contractors Association Limited.
“When everyone works together, there’s a multiplier effect … it becomes one plus one equals three.”
A decluttering session by Tzu-Chi Foundation (Singapore) in a hoarder's home. (File photo: Tzu-Chi Foundation, Singapore)
The NEAT member organisations CNA spoke to play different roles in this journey, with some overlaps.
Mr Khoo’s association provides logistical support, reaching out to companies that can assist with electrical or plumbing works when a hoarder’s home needs it.
Tzu Chi and Habitat for Humanity Singapore, a branch of international non-profit Habitat, work with cases referred to them by the alliance, providing decluttering and, in the case of the former, befriending services.
And the Institute of Mental Health (IMH) serves as the “mental health specialist”, focusing on the psychiatric aspects, said Dr Chris Tan, deputy director of the Community Mental Health Team.
These are just four of the 31 organisations NEAT's members hail from and a reflection of the "whole-of-society approach” Singapore leaned into when setting up the initiative.
"In the past, it has always been individuals (and) agencies doing their fair share of work … and there wasn’t a coordinating body,” said Mr Francis Foo, national director of Habitat for Humanity Singapore.
But with better coordination through the alliance, there was a greater effort to view the issue as a community-wide and nationwide initiative, which helped tremendously, he said.
One key benefit is how members can reach out for help with cases through NEAT’s network, said Mr Foo.
Sometimes organisations cannot take on or complete cases due to time-sensitivity or the organisation’s limited resources, he added.
It is now easy for him to contact NEAT members who are better placed to handle the case.
“We are less boundary restricted. We are, as an alliance, tackling hoarding in a more systemic approach,” he said.
As NEAT’s members came together, they found that different groups were dealing with different parts of the rehabilitation process, said Mr Khoo.
“There were groups that were doing befriending, there were some groups that were doing decluttering only, then there are some groups that will deal with befriending, decluttering and the follow-up,” he said.
The alliance helped members manage the cases together, with different groups stepping in to take on the next part of the process when another completes its work, said Mr Khoo.
NEAT also brought “much-needed attention” to how hoarding is a multi-agency issue rather than a purely mental health problem, said Dr Tan.
“Before the alliance, we often worked in isolation, which was particularly challenging when patients needed both psychiatric treatment and practical decluttering support,” the senior consultant said.
NEAT’s approach allows mental health treatment to integrate better with community interventions and support, he said.
For example, if a hoarder is referred to IMH but their behaviour is assessed to be unrelated to a mental health condition, the hospital will refer them back to a social service agency for continued follow-up care.
“The alliance has created a valuable framework and also network, and we are continuously working on refining our coordination, defining clear responsibilities, and ensuring sustainability in our efforts,” he said.
NEAT's regular sharing sessions allow members to go over learning points from their cases, good practices and how they've worked together.
“It’s quite good because we would have worked more with certain groups and other groups can see what we do with them,” said Mr Khoo.
“It’s also good for us as a trade association member of the alliance to understand ... how else we can help.”
A decluttering session by Habitat for Humanity Singapore. (Photo: Habitat for Humanity Singapore)
Some hoarders Ms Tong worked with wanted house cleaning from the first befriending visit, but others took months to allow volunteers to enter their home, she said.
Gaining their consent to begin decluttering may require more time - sometimes stretching to a few more months.
Decluttering also comes with its own challenges, as hoarders might struggle to let go of their items or continue to collect things after the cleaning session.
“Maybe this round we managed to clean this area and ... we were thinking to declutter another area (next time),” said Ms Tong. “But next time when we come to the home, maybe this area is cluttered again.”
A key challenge is that hoarders often do not perceive their behaviour as problematic, said Dr Tan.
“It feels natural and acceptable to them,” he said. “Unlike other conditions where patients want to recover, hoarding patients often resist change unless there are other comorbid illnesses causing distress."
Hoarders also struggle with managing the emotions of discarding and have genuine difficulties with planning, categorisation, prioritisation and working memory, said Dr Tan.
“They struggle to make decisions about what to keep or discard, have difficulty organising items systematically, and cannot effectively plan decluttering activities,” he explained.
“This isn't something they can easily overcome simply because there's external pressure.”
Habitat for Humanity Singapore volunteers working in a hoarder's home. (Photo: Habitat for Humanity Singapore)
When working with hoarders, Habitat for Humanity Singapore tries to “pace” their decluttering sessions, said Mr Foo.
Clear boundaries are set at the start, and they begin with items that are irrelevant to the hoarder’s life, such as expired food and plastics. Anything of value to the hoarder is set aside for them to sift through together later.
But sometimes, the process is too much for the hoarder, he said. “Their mood may change and then they’ll say ‘Everybody, please get out of the house’.”
When members are unable to move forward with another case, NEAT organises case conferences to deliberate on possible next steps, said Ms Tong.
“This is actually very important. It doesn’t feel like we are working alone with the hoarder.”
NEAT’s networking sessions have also allowed her to understand what other members are doing and learn from their strategies and experience.
“Each organisation actually has their own strengths and limitations,’ she said.
While volunteer groups like Tzu Chi operate through befriending, they work closely with other members, such as the Singapore Civil Defence Force, which reminds hoarders of safety issues or fire hazards.
This allows the alliance to encourage the hoarder with internal or external motivations, she said.
Raising more public awareness and reducing stigma towards the issue are important steps forward for Singapore, said the members.
“Most patients don't actually overcome hoarding; they learn to manage it,” said Dr Tan.
Some might hoard to a lesser extent, while others manage it cyclically, hoarding and decluttering in recurring patterns, he said.
“Relapses are common, which is why we emphasise the importance of long-term management, including frequent check-ins and potentially recurrent small-scale declutter whenever the hoard increases,” he said.
“Rehabilitation requires a family, community, and whole-of-society approach.”
Hoarders are often labelled as lazy, messy, or people with poor personal habits, said Ms Tong, admitting that she also struggled to understand them at first.
But she realised that each case had its own story behind the behaviour.
Some hoarders may have traumatic experiences with loss, she said. "We had one case who was a very clean and neat person, but after her husband passed away, she started to hoard to cope with the grief."
“Many patients exhibit insecure or disorganised attachment styles, often stemming from emotional neglect or inconsistent caregiving in childhood,” said Dr Tan.
Other causes include an underlying fear of loss or betrayal and psychiatric comorbidities - particularly depression and anxiety - which can both contribute to and result from hoarding behaviours, he said.
“Additionally, neurobiological factors play a role, with differences in brain activation patterns affecting decision-making and emotional regulation around possessions.”
“When we see someone struggling to discard items, their brain may literally be experiencing distress signals - it's not simply a choice or a character flaw,” he added.
A decluttering session by Tzu-Chi Foundation (Singapore). (File photo: Tzu-Chi Foundation, Singapore)
Ms Amanda Tang, the communications and marketing manager at Habitat for Humanity Singapore, believes residents need to build a culture of empathy and use the right platforms to deal with the issue.
She pointed out that it takes about the same time and effort to upload a photo of hoarding on the One Service app, a government-developed platform where residents can report living environment concerns, and social media platforms like Stomp.
“But the outcome and intention is quite different,” she said. “Everybody has this shared responsibility in society to really keep their eyes out and take care of each other that way.”
“I think everyone has to chip in and do a part. It’s not just the agencies, it is everybody else - even neighbours, friends and family,” said Mr Khoo, echoing Ms Tang’s point that flagging potential hoarding behaviour so they can get help is important.
Hoarders are usually isolated from professional services and the community, making efforts to approach and engage them important, said Ms Tong.
“When they are more isolated ... it creates a cycle where the hoarding behaviour may be more severe because they try to attach their relationships to the items,” she said.
“We have to take the first step to approach them.”
Continue reading...
The woman did everything outside her house due to the clutter, and even had to go to a nearby community centre to shower.
But she allowed Ms Tong to visit her home and expressed her wish to get it cleaned.
Then trouble began to brew.
CNA Games
Show More Show Less
“It (was) very difficult for her to really make choices for what were the things she wanted to keep or what were the things she wanted to throw,” said Ms Tong, a programme executive at charitable organisation Tzu-Chi Foundation (Singapore).
The relationship soured, and her team was unable to complete the decluttering.
The experience captures some of the challenges faced by those working to tackle the issue of hoarding.
Those involved said the process goes beyond simply cleaning and fixing a home, with many hours of befriending and follow-ups also required, among other things.
A Habitat for Humanity Singapore decluttering session at a hoarder's home. (File photo: Habitat for Humanity Singapore)
CASES GO UP
Latest hoarding figures point to a continuing upward trend.
As of June last year, the New Environment Action Team (NEAT) and the Hoarding Management Core Group (HMCG) had reduced the severity of 308 severe hoarding cases and were monitoring them to prevent recurrence, the Ministry of National Development (MND) and the Ministry of Social and Family Development (MSF) said in response to CNA's queries.
However, the number of active hoarding cases that the two groups were working on had almost doubled to 450 in less than four years - it was 253 in December 2021.
Before NEAT was launched in January last year, HMCG was working on 357 active cases and monitoring 270 cases.
“The increase in cases could be due to greater public awareness in hoarding behaviour after the launch of NEAT, as well as NEAT’s efforts in coordination and identification,” said MND and MSF.
Both ministries had earlier warned that Singapore’s hoarding cases could rise due to the country’s changing demographics, including its ageing population.
“Hoarding cases are complex and long-standing,” they said, adding that the journey to support each case tends to be drawn out and typically involves repeated engagements with the hoarder and their family.
Related:
This is where NEAT comes in, bringing together members from social service agencies, community groups, trade and industry associations and government agencies to tackle the hoarding issue.
Slightly over a year after its formation, the organisations told CNA the alliance has smoothed coordination, provided access to more resources and helped them manage difficult cases.
“This alliance has brought everyone together,” said Mr Roy Khoo, treasurer of the Singapore Contractors Association Limited.
“When everyone works together, there’s a multiplier effect … it becomes one plus one equals three.”
A decluttering session by Tzu-Chi Foundation (Singapore) in a hoarder's home. (File photo: Tzu-Chi Foundation, Singapore)
The NEAT member organisations CNA spoke to play different roles in this journey, with some overlaps.
Mr Khoo’s association provides logistical support, reaching out to companies that can assist with electrical or plumbing works when a hoarder’s home needs it.
Tzu Chi and Habitat for Humanity Singapore, a branch of international non-profit Habitat, work with cases referred to them by the alliance, providing decluttering and, in the case of the former, befriending services.
And the Institute of Mental Health (IMH) serves as the “mental health specialist”, focusing on the psychiatric aspects, said Dr Chris Tan, deputy director of the Community Mental Health Team.
These are just four of the 31 organisations NEAT's members hail from and a reflection of the "whole-of-society approach” Singapore leaned into when setting up the initiative.
"In the past, it has always been individuals (and) agencies doing their fair share of work … and there wasn’t a coordinating body,” said Mr Francis Foo, national director of Habitat for Humanity Singapore.
But with better coordination through the alliance, there was a greater effort to view the issue as a community-wide and nationwide initiative, which helped tremendously, he said.
Members' organisations in New Environment Action Team (NEAT)
Social services agencies and community groups
- Allkin Singapore
- Ang Mo Kio Secondary School Social Move
- Blossom World Society
- Care Corner Singapore
- Covenant Evangelical Free Church
- Fei Yue Community Services
- Filos Community Services
- Habitat for Humanity Singapore
- Helping Joy
- Heng Shan Volunteer Group Singapore
- HOPE worldwide (Singapore)
- Persatuan Pemudi Islam Singapura (Singapore Muslim Women’s Association)
- SG Helping Hands
- Singapore Association for Mental Health
- TOUCH Community Services
- Tzu-Chi Foundation (Singapore)
- Keeping Hope Alive
- Montfort Care
- Lions Befrienders Service Association
Trade association and chambers
- Singapore Furniture Industries Council
- The Singapore Contractors Association
- Waste Management & Recycling Association of Singapore
Government agencies
- Agency for Integrated Care
- Housing & Development Board
- Ministry of Social and Family Development
- National Environment Agency
- National Parks Board
- People's Association
- Singapore Civil Defence Force
- Municipal Services Office, Ministry of National Development
Others
- Institute of Mental Health
One key benefit is how members can reach out for help with cases through NEAT’s network, said Mr Foo.
Sometimes organisations cannot take on or complete cases due to time-sensitivity or the organisation’s limited resources, he added.
It is now easy for him to contact NEAT members who are better placed to handle the case.
“We are less boundary restricted. We are, as an alliance, tackling hoarding in a more systemic approach,” he said.
As NEAT’s members came together, they found that different groups were dealing with different parts of the rehabilitation process, said Mr Khoo.
“There were groups that were doing befriending, there were some groups that were doing decluttering only, then there are some groups that will deal with befriending, decluttering and the follow-up,” he said.
The alliance helped members manage the cases together, with different groups stepping in to take on the next part of the process when another completes its work, said Mr Khoo.
Related:
NEAT also brought “much-needed attention” to how hoarding is a multi-agency issue rather than a purely mental health problem, said Dr Tan.
“Before the alliance, we often worked in isolation, which was particularly challenging when patients needed both psychiatric treatment and practical decluttering support,” the senior consultant said.
NEAT’s approach allows mental health treatment to integrate better with community interventions and support, he said.
For example, if a hoarder is referred to IMH but their behaviour is assessed to be unrelated to a mental health condition, the hospital will refer them back to a social service agency for continued follow-up care.
“The alliance has created a valuable framework and also network, and we are continuously working on refining our coordination, defining clear responsibilities, and ensuring sustainability in our efforts,” he said.
NEAT's regular sharing sessions allow members to go over learning points from their cases, good practices and how they've worked together.
“It’s quite good because we would have worked more with certain groups and other groups can see what we do with them,” said Mr Khoo.
“It’s also good for us as a trade association member of the alliance to understand ... how else we can help.”
A decluttering session by Habitat for Humanity Singapore. (Photo: Habitat for Humanity Singapore)
NOT ALONE
Some hoarders Ms Tong worked with wanted house cleaning from the first befriending visit, but others took months to allow volunteers to enter their home, she said.
Gaining their consent to begin decluttering may require more time - sometimes stretching to a few more months.
Decluttering also comes with its own challenges, as hoarders might struggle to let go of their items or continue to collect things after the cleaning session.
“Maybe this round we managed to clean this area and ... we were thinking to declutter another area (next time),” said Ms Tong. “But next time when we come to the home, maybe this area is cluttered again.”
A key challenge is that hoarders often do not perceive their behaviour as problematic, said Dr Tan.
“It feels natural and acceptable to them,” he said. “Unlike other conditions where patients want to recover, hoarding patients often resist change unless there are other comorbid illnesses causing distress."
Hoarders also struggle with managing the emotions of discarding and have genuine difficulties with planning, categorisation, prioritisation and working memory, said Dr Tan.
“They struggle to make decisions about what to keep or discard, have difficulty organising items systematically, and cannot effectively plan decluttering activities,” he explained.
“This isn't something they can easily overcome simply because there's external pressure.”
Habitat for Humanity Singapore volunteers working in a hoarder's home. (Photo: Habitat for Humanity Singapore)
When working with hoarders, Habitat for Humanity Singapore tries to “pace” their decluttering sessions, said Mr Foo.
Clear boundaries are set at the start, and they begin with items that are irrelevant to the hoarder’s life, such as expired food and plastics. Anything of value to the hoarder is set aside for them to sift through together later.
But sometimes, the process is too much for the hoarder, he said. “Their mood may change and then they’ll say ‘Everybody, please get out of the house’.”
When members are unable to move forward with another case, NEAT organises case conferences to deliberate on possible next steps, said Ms Tong.
“This is actually very important. It doesn’t feel like we are working alone with the hoarder.”
NEAT’s networking sessions have also allowed her to understand what other members are doing and learn from their strategies and experience.
“Each organisation actually has their own strengths and limitations,’ she said.
While volunteer groups like Tzu Chi operate through befriending, they work closely with other members, such as the Singapore Civil Defence Force, which reminds hoarders of safety issues or fire hazards.
This allows the alliance to encourage the hoarder with internal or external motivations, she said.
“EVERYONE HAS TO CHIP IN”
Raising more public awareness and reducing stigma towards the issue are important steps forward for Singapore, said the members.
“Most patients don't actually overcome hoarding; they learn to manage it,” said Dr Tan.
Some might hoard to a lesser extent, while others manage it cyclically, hoarding and decluttering in recurring patterns, he said.
“Relapses are common, which is why we emphasise the importance of long-term management, including frequent check-ins and potentially recurrent small-scale declutter whenever the hoard increases,” he said.
“Rehabilitation requires a family, community, and whole-of-society approach.”
Related:
Hoarders are often labelled as lazy, messy, or people with poor personal habits, said Ms Tong, admitting that she also struggled to understand them at first.
But she realised that each case had its own story behind the behaviour.
Some hoarders may have traumatic experiences with loss, she said. "We had one case who was a very clean and neat person, but after her husband passed away, she started to hoard to cope with the grief."
“Many patients exhibit insecure or disorganised attachment styles, often stemming from emotional neglect or inconsistent caregiving in childhood,” said Dr Tan.
Other causes include an underlying fear of loss or betrayal and psychiatric comorbidities - particularly depression and anxiety - which can both contribute to and result from hoarding behaviours, he said.
“Additionally, neurobiological factors play a role, with differences in brain activation patterns affecting decision-making and emotional regulation around possessions.”
“When we see someone struggling to discard items, their brain may literally be experiencing distress signals - it's not simply a choice or a character flaw,” he added.
A decluttering session by Tzu-Chi Foundation (Singapore). (File photo: Tzu-Chi Foundation, Singapore)
Ms Amanda Tang, the communications and marketing manager at Habitat for Humanity Singapore, believes residents need to build a culture of empathy and use the right platforms to deal with the issue.
She pointed out that it takes about the same time and effort to upload a photo of hoarding on the One Service app, a government-developed platform where residents can report living environment concerns, and social media platforms like Stomp.
“But the outcome and intention is quite different,” she said. “Everybody has this shared responsibility in society to really keep their eyes out and take care of each other that way.”
“I think everyone has to chip in and do a part. It’s not just the agencies, it is everybody else - even neighbours, friends and family,” said Mr Khoo, echoing Ms Tang’s point that flagging potential hoarding behaviour so they can get help is important.
Hoarders are usually isolated from professional services and the community, making efforts to approach and engage them important, said Ms Tong.
“When they are more isolated ... it creates a cycle where the hoarding behaviour may be more severe because they try to attach their relationships to the items,” she said.
“We have to take the first step to approach them.”
Continue reading...