Cluttered apartments and complicated tenancies: a collaborative intervention approach to tenant "hoarding" under the Fair Housing Act.

• Author: Ligatti, Christopher C.

"The patient considered all objects in her possession, even the most insignificant ones, such as burnt out matchsticks, cigarette butts, or candy wrappers, as parts of her ego, and discarding them as tantamount to weakening of her ego integration. Giving them away was like giving away parts of herself." (1)

1. INTRODUCTION

   While the phenomenon of hoarding (2) is not new, (3) the media scrutiny accompanying it has reached heights undreamt of even in 1947, when the living situation of the famous Collyer brothers became front-page news. (4) Along with numerous recent newspaper and magazine accounts of the problem, (5) and an increased focus from the medical community, (6) the term "hoarding" has burrowed into popular culture through ubiquitous reality shows (7) as one of those amusing extreme behaviors to which the human experience occasionally gravitates. (8) However, in discussing hoarding, it is surprising how commonly we find that we know "hoarders," either as neighbors, friends, parents of friends, coworkers, or even family members. It seems that everyone knows someone or knows someone who knows someone who could become a reality television star if only they bared their secret shame to an insatiable television audience.

   The shame of hoarding behavior is one of the prominent aspects of the disorder; one that keeps the behavior hidden, prevents treatment, keeps individuals in a state of isolation, leads to a regression of social interaction, and eventually reinforces the behavior itself. (9) In hoarding literature, the sense of shock at discovering a hoarder is palpable, whether displayed by a landlord, family member, or social worker. (10) And such shock is not altogether inappropriate. Because of the very nature of hoarding, the individual often goes to great lengths to hide the problem, or at the very least, the extent of it. Furthermore, disgust and even anger are not unreasonable considering the serious health and safety risks severe hoarding can pose, not just to the hoarder, but also to those around them. (11)

   These health and safety risks have legal implications. And as in so many areas, the issue of mental illness and independent living in safe and affordable housing must be weighed against the needs of housing providers, whether private landlords or housing authority administrators. As touched upon above and explained more fully below, the needs of these housing providers are not just economic, they do not involve merely rents or the diminution of value in a property--instead, numerous local health laws may be implicated and the safety of other tenants may also be at risk. (12) This creates a conflict above and beyond the already difficult process of finding housing for the psychiatrically disabled, a population already subject to stereotypes often as disabling as their condition. (13)

   This article will discuss the legal implications of hoarding behavior by providing a general overview of current psychiatric understanding of hoarding disorders, (14) explaining the impact of tenant hoarding on local housing laws and safety concerns, (15) surveying the Fair Housing Act (FHA) reasonable accommodation case law on eviction because of hoarding or other psychiatric disabilities, (16) analyzing how reasonable accommodations can be used to prevent unnecessary evictions and homelessness of this population, (17) and concluding by suggesting the use of collaborative services, such as those provided by local hoarding task forces, in creating reasonable accommodation plans. (18)

2. THE CURRENT MEDICAL UNDERSTANDING OF COMPULSIVE HOARDING AND THE CONFLICT OF HOARDING AND RELEVANT HOUSING LAWS

   This section surveys the medical understanding of compulsive hoarders and how their behavior conflicts with local laws related to health and public safety. Any understanding of the Fair Housing Act's application to hoarding must begin with the issue of whether hoarding is a medically recognized impairment. Further, this section seeks to explain how hoarding behavior conflicts with federal, state, and local laws and regulations regarding health and cleanliness.

   1. The Proper Medical Classification of Compulsive Hoarders

      Compulsive hoarding as a medical impairment has only recently gained any form of widespread recognition. No "hoarding disorder" appears in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), although such a disorder has been proposed for inclusion in the next version of this Manual, DSM-V. (19) Current debate continues between those who believe hoarding is a symptom of another disorder such as Obsessive Compulsive Disorder (OCD), (20) or is either a completely separate disorder or at least a subgroup of OCD. (21) Psychologists have found that roughly one quarter of OCD patients also suffer from compulsive hoarding symptoms. (22) Overall, epidemiological studies have found that between two to five percent of all adults suffer from compulsive hoarding symptoms. (23)

      The clinical definition of hoarding, developed in the mid-1990s, is widely accepted as consisting of three main features: "(1) the acquisition of, and failure to discard a large number of possessions that appear to be useless or of limited value; (2) living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed; and (3) significant distress or impairment in functioning caused by the hoarding." (24) This ineffective use of space results in the compulsive hoarder being unable to use entire rooms and interferes with basic activities such as cooking, cleaning, sleeping, and moving throughout the home. (25)

      While hoarding may be related to other conditions such as depression and anxiety disorders, (26) hoarding is also, in some ways, more complicated to treat, as studies have shown that selective serotonergic medications (SSRIs) do not help hoarders as much as others suffering from mental illnesses like OCD. (27) In addition, cognitive-behavior therapy alone does not always have a successful outcome. (28) The strength of an individual hoarder's feelings of attachment to his or her possessions cannot be overemphasized. Multiple sources describe the feelings of hoarders, to whom the discarding of unnecessary items is "equivalent to a part of oneself dying or abandoning a loved one." (29) While this is clearly an objectively unreasonable feeling, it is equally clear that subjectively, these feelings carry great weight for the individuals. (30)

      Like many who suffer from psychiatric illness, those engaging in hoarding behavior are often thought of or portrayed as suffering from some sort of character flaw or weakness, rather than a recognized disorder. (31) Admonitions that such persons should "get over it" or "just clean up" may even be counterproductive. (32) For this reason, when housing laws are implicated, it is difficult for any landlord to confront a tenant regarding hoarding behaviors and reach an effective solution. Too often the intersection of housing and hoarding leads inevitably to eviction. (33)

   2. Federal, State, and Local Laws and Regulations Implicated by Hoarding

      In most cases, compulsive hoarding behavior will create conditions that violate federal, state, or local laws. While this issue typically arises in apartment buildings or other rental housing, hoarding behavior by individuals who own their own homes also may lead to fines or even nuisance proceedings. (34) The terms of rental housing, landlord tenant laws, as well as private leases, impose certain responsibilities or duties upon tenants. Typically, these include disposing of waste in a timely manner, not defacing, destroying, or impairing any part of the premises, not disturbing the peaceful enjoyment of neighbors, and abiding by all building and housing codes. (35) Furthermore, state public-health codes that apply to rental housing make unsanitary conditions, as defined by those codes, an offense. (36) In most cases, these codes consider unsanitary conditions to include improper storage of garbage, presence of pests, and fire hazards such as blocking access to and storing large amounts of material near stoves or heaters. (37) In addition to an eviction action, hoarding behavior can lead to fines or even condemnation of property. (38)

      Furthermore, most forms of subsidized housing, whether publicly or privately owned, have similar requirements relating to health and safety. This issue is especially important because subsidized housing is often last-chance housing--the only thing standing between individuals or families and homelessness. (39) Federal regulations require such provisions be included in leases between the tenant and the housing provider, (40) and for some forms of subsidy, require annual inspections to make sure the unit meets Housing Quality Standards. (41) Violations of these provisions are grounds for lease termination, and can lead to termination of assistance. (42)

      These legal provisions are based on legitimate health and safety concerns. First responders must be able to gain access for themselves and necessary medical equipment, and, naturally, blocked egress is a substantial recurring issue in many hoarding situations. (43) Furthermore, rotting or moldy food--and resulting insect or rodent infestations--create unhealthy conditions not just for the hoarder but also for other tenants in the building. (44) In addition to fines, evictions, and possible condemnation, such violations can prevent tenants from escaping a burning building or first responders from being able to locate tenants who need medical assistance. (45) Furthermore, the general filth resulting from hoarding conditions can permanently affect the hoarder's health, the health of his or her family, and even the health of other tenants in a multifamily building. (46)

3. FAIR HOUSING ACT BACKGROUND

   The preceding discussion makes clear that hoarding behavior by tenants--while a disorder in its own right or a symptom of another...