Hoarding is now in the national consciousness. This was not always so. It refers to homes where ‘conditions are so bad that many organisations have to spend a disproportionate amount of time and energy in trying to put them right, often with little result’. So wrote Duncan MacMillan and Patricia Shaw in 1966 in the first paper to be published on the disorder now officially diagnosed as hoarding disorder.Reference MacMillan and Shaw¹ These authors suggested that the disorder was related to senility but we know now it can occur at any age. But these pioneers in Nottingham were right to point out that ‘a disproportionate amount of time and energy’ was needed ‘in trying to put them right’, especially as greater knowledge of the disorder has not been accompanied by similar success in finding effective treatments. The authors of this optimistic book are a powerful combination of a get-up-and-go social worker, Elaine, who remains unfazed and energetic no matter what troubles are put in front of her, and her friend Suzanne, who is also highly organised in presenting advice in the form of easily digested tables, lists and photographs. These are hard-nosed practical people and certainly know their hoarders well; the one word they hear over and over again from their clients is that they are ‘overwhelmed’. And in responding, they abhor sentimentality, shock and hand-wringing, and get down to practical solutions that they hope will help others faced with apparently intractable clutter.

This couple never despair. Even though they encounter people who must be among the top 10% of all hoarders, who have ‘homes 70% filled, three-dimensionally’, ‘wires, car parts and cameras hung everywhere from the rafters, like claws trying to catch those who tried to pass’, ‘impassable stairs’, with ‘accompanying fruit flies, ants and silver fish’, they do not recoil. Their plan is to ‘focus on the condition of the environment being hoarded and not on applying a label’. And, my oh my, do they change these environments. The residences they tackle are veritable jungles of hazard. So they use ‘crawl space’ to get to the top floor of one house, move in on the lady who has so much blocking her hallway that she is ‘unable to open the front door more than 16 inches’, climb to the top of the stairs to the bed of a man who has no sheets so it is ‘stained with sweat and caked with dead skin’. Once in, like Hermione Grainger when facing chaos at Hogwarts, they methodically and logically sort out a list of agreed changes, get fire and smoke alarms fitted, sort out the plumbing and electricity, and complete a full range of disposals in what they describe frequently as a blitz.

The book includes a set of very useful questionnaires on hoarding that may help people already prone to clutter to avoid entering the hoarding diagnostic arena, has sensible interventions to ensure collaboration, and adds substantially to input from health professionals. It is a mine of information that should be tapped.