NHS Mental Healthcare Staff Experiences of Working with Service-Users Displaying Hoarding Behaviours – A Thematic Analysis

Background: Hoarding Disorder (HD) became its own clinical entity in 2013 and, since then, it has gained more research attention. Evidence suggests that professionals responding to the complex needs of service-users displaying hoarding behaviour lack relevant expertise and highlight hoarding as notoriously difficult to treat. Multi-agency approaches are becoming increasingly popular in the management of hoarding; however, little is known about the treatment of hoarding in UK-based National Health Service (NHS) mental healthcare services. Aim: The aim of the current study was to qualitatively explore NHS mental healthcare staff experiences of working with adult service-users across the lifespan displaying hoarding behaviours. This was to gain a greater understanding of the condition, and to explore how staff respond to the needs of service-users within the context of the NHS. Method: Fifteen mental healthcare staff were recruited from six NHS Trusts in England. Semi-structured interviews were conducted, and the six steps of Reflexive Thematic Analysis were followed. Results: Five themes and fifteen subthemes were identified: (1) How staff understand hoarding behaviour: “The stuff is rarely the issue”; (2) Staff frustrations, challenges and systemic constraints; (3) Treatment approaches for hoarding; (4) Updating practice: Seeing hoarding as a diagnosis; (5) Service-users’ experiences of help. Conclusion: The results of this study highlight how mental healthcare staff attempt to understand hoarding by considering the numerous contributing factors associated with its onset and maintenance. There was ambiguity amongst staff regarding appropriate treatment for this population; however, adopting multi-agency approaches was seen to support service- users’ needs effectively. Staff reflect on the complexities of undertaking this work and consider the impact this has upon service-users and accessing help. Difficulties relating to staff role, service constraints and the lack of staff training are explored. Clinical and policy implications, including the development of best practice guidelines are discussed. Recommendations for future research are proposed.