Commentary: Hoarding threatens public safety, but let's not forget it's a mental disorder
Neighbours reported that one of the victims was a hoarder who collected discarded items such as dolls, furniture and shoes, placing them along the corridor.
This is not an isolated incident. In January, three lives were lost after a fire broke out in a Hougang flat that firefighters had difficulty entering due to excessive items in the unit. From 2021 to 2024, there were 23 hoarding-related fires.
With lives at stake and public safety in peril, it's understandable that online reactions to the Toa Payoh Lorong 1 fire have been critical. Some have called for harsher measures against hoarding, such as forced clean-ups and fines.
But such responses miss the crucial fact that hoarding is not a lifestyle choice. It is a psychiatric disorder. This is a scenario where there are only victims.
These incidents underscore the real-world consequences of untreated hoarding disorder, and the limits of intervention when unaccompanied by mental health support.
A MENTAL HEALTH CONDITION
Hoarding disorder is characterised by persistent difficulty discarding possessions, regardless of their actual value, due to perceived emotional significance or fear of needing them in the future. This results in accumulation that compromises the usability of living spaces and poses risks to hygiene and safety.
Hoarding is not the same as collecting. While some individuals may accumulate out of material desire or habit, hoarding disorder typically reflects deeper psychological vulnerabilities, including past trauma, depression, social isolation or cognitive decline.
Shame is common, and many sufferers go to great lengths to hide their condition, often delaying help-seeking until external intervention becomes inevitable.
International studies estimate the prevalence of hoarding disorder at 2 to 6 per cent of the population, making it more common than many realise. Yet awareness remains low, and misconceptions persist. Hoarders are often portrayed as inconsiderate or defiant, rather than as individuals grappling with a mental health condition.
FORCED CLEAN-UPS CAN BACKFIRE
In Singapore, authorities have powers to enforce decluttering orders when public disamenities arise. These measures may be necessary when lives are at risk, but they do not treat the underlying illness.
Forced clean-ups are traumatic for sufferers of hoarding disorder. Possessions, even if objectively worthless, often serve as psychological anchors. Their sudden removal can provoke intense anxiety, grief or anger.
In my work in community psychiatry, I've witnessed how forced clean-ups can backfire. One patient's family emptied her apartment during her hospital stay. She experienced it as a betrayal, severed all contact with them, and quickly returned to hoarding after discharge.
The intervention addressed the clutter, but not the illness. Without concurrent treatment, individuals with hoarding disorder are likely to resume hoarding.
The standard of care involves cognitive-behavioural therapy (CBT) adapted for hoarding, often alongside medication. Therapy focuses on building rapport and insight, gradually reducing anxiety around discarding, and developing new routines.
But it takes time. Successful outcomes often require years of consistent support.
QUESTIONS ABOUT CULPABILITY
Individuals with hoarding disorder often do not recognise that they have a problem. Cognitive impairments, depression or age-related decline may complicate matters further. Trust must be established before behavioural change can begin, a process that can take years.
When treatment stalls and setbacks pile up, families and clinicians alike feel increasingly helpless. That helplessness often turns into blame, directed at the very person who's already suffering the most.
Hoarding also intersects with legal domains. When hoarding leads to a fire or public nuisance, questions about culpability arise. Courts may need to assess whether the individual was capable of understanding the risks posed by their actions or omissions. In some cases, mental illness may serve as a mitigating factor, though not necessarily as an excuse.
Best practices internationally suggest that legal interventions are most effective when paired with mental health mandates. For example, court orders requiring clean-ups may be more sustainable if they also mandate psychiatric assessment, structured therapy or case management. The goal is not just compliance but rehabilitation.
SINGAPORE'S 'WHOLE-OF-SOCIETY' APPROACH
Recognising the complexity of hoarding, Singapore has adopted a more integrated strategy through the New Environment Action Team (NEAT). Comprising agencies such as the National Environment Agency, Singapore Civil Defence Force, Agency for Integrated Care and community groups, NEAT coordinates efforts to manage severe hoarding cases in a sustainable and humane manner.
As then Minister for National Development Desmond Lee noted, addressing hoarding must go beyond 'decluttering and refreshing homes' to include behavioural change and long-term support.
This is where Singapore's community mental health services play a vital role. The Community Outreach Teams (CREST) conduct early identification and public education. Community Intervention Teams (COMIT) provide counselling and psychiatric services closer to home.
Together, these services form a continuum of care that can support hoarders throughout their recovery journey.
Still, there are limits. Even with multiple touchpoints, help cannot be imposed on someone who is unwilling or unable to engage. In such cases, enforcement, including court orders or, in extreme situations, eviction, may still be necessary. Nevertheless, it should remain a last resort, not a default strategy.
A CALL FOR COMPASSION AND COORDINATION
The tragic flat fires should not be seen as confirmation that hoarders are beyond help or sympathy. Rather, it should prompt us to strengthen the links between enforcement and mental healthcare, to improve early detection, and to educate the public on hoarding disorder.
Neighbours and family members can play a key role by flagging early warning signs to social services, rather than shaming sufferers of hoarding disorder. Social agencies must be empowered with the resources to stay engaged with complex cases over the long term.
Hoarders are not merely 'messy people'. They are often vulnerable individuals living with an untreated and poorly understood illness. If we want to prevent future tragedies, we must respond not only with firmness, but with empathy, coordination, and above all, persistence.
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Commentary: Hoarding threatens public safety, but let's not forget it's a mental disorder
SINGAPORE: In late July, a fire broke out at a flat in Toa Payoh Lorong 1, claiming two lives. Neighbours reported that one of the victims was a hoarder who collected discarded items such as dolls, furniture and shoes, placing them along the corridor. This is not an isolated incident. In January, three lives were lost after a fire broke out in a Hougang flat that firefighters had difficulty entering due to excessive items in the unit. From 2021 to 2024, there were 23 hoarding-related fires. With lives at stake and public safety in peril, it's understandable that online reactions to the Toa Payoh Lorong 1 fire have been critical. Some have called for harsher measures against hoarding, such as forced clean-ups and fines. But such responses miss the crucial fact that hoarding is not a lifestyle choice. It is a psychiatric disorder. This is a scenario where there are only victims. These incidents underscore the real-world consequences of untreated hoarding disorder, and the limits of intervention when unaccompanied by mental health support. A MENTAL HEALTH CONDITION Hoarding disorder is characterised by persistent difficulty discarding possessions, regardless of their actual value, due to perceived emotional significance or fear of needing them in the future. This results in accumulation that compromises the usability of living spaces and poses risks to hygiene and safety. Hoarding is not the same as collecting. While some individuals may accumulate out of material desire or habit, hoarding disorder typically reflects deeper psychological vulnerabilities, including past trauma, depression, social isolation or cognitive decline. Shame is common, and many sufferers go to great lengths to hide their condition, often delaying help-seeking until external intervention becomes inevitable. International studies estimate the prevalence of hoarding disorder at 2 to 6 per cent of the population, making it more common than many realise. Yet awareness remains low, and misconceptions persist. Hoarders are often portrayed as inconsiderate or defiant, rather than as individuals grappling with a mental health condition. FORCED CLEAN-UPS CAN BACKFIRE In Singapore, authorities have powers to enforce decluttering orders when public disamenities arise. These measures may be necessary when lives are at risk, but they do not treat the underlying illness. Forced clean-ups are traumatic for sufferers of hoarding disorder. Possessions, even if objectively worthless, often serve as psychological anchors. Their sudden removal can provoke intense anxiety, grief or anger. In my work in community psychiatry, I've witnessed how forced clean-ups can backfire. One patient's family emptied her apartment during her hospital stay. She experienced it as a betrayal, severed all contact with them, and quickly returned to hoarding after discharge. The intervention addressed the clutter, but not the illness. Without concurrent treatment, individuals with hoarding disorder are likely to resume hoarding. The standard of care involves cognitive-behavioural therapy (CBT) adapted for hoarding, often alongside medication. Therapy focuses on building rapport and insight, gradually reducing anxiety around discarding, and developing new routines. But it takes time. Successful outcomes often require years of consistent support. QUESTIONS ABOUT CULPABILITY Individuals with hoarding disorder often do not recognise that they have a problem. Cognitive impairments, depression or age-related decline may complicate matters further. Trust must be established before behavioural change can begin, a process that can take years. When treatment stalls and setbacks pile up, families and clinicians alike feel increasingly helpless. That helplessness often turns into blame, directed at the very person who's already suffering the most. Hoarding also intersects with legal domains. When hoarding leads to a fire or public nuisance, questions about culpability arise. Courts may need to assess whether the individual was capable of understanding the risks posed by their actions or omissions. In some cases, mental illness may serve as a mitigating factor, though not necessarily as an excuse. Best practices internationally suggest that legal interventions are most effective when paired with mental health mandates. For example, court orders requiring clean-ups may be more sustainable if they also mandate psychiatric assessment, structured therapy or case management. The goal is not just compliance but rehabilitation. SINGAPORE'S 'WHOLE-OF-SOCIETY' APPROACH Recognising the complexity of hoarding, Singapore has adopted a more integrated strategy through the New Environment Action Team (NEAT). Comprising agencies such as the National Environment Agency, Singapore Civil Defence Force, Agency for Integrated Care and community groups, NEAT coordinates efforts to manage severe hoarding cases in a sustainable and humane manner. As then Minister for National Development Desmond Lee noted, addressing hoarding must go beyond 'decluttering and refreshing homes' to include behavioural change and long-term support. This is where Singapore's community mental health services play a vital role. The Community Outreach Teams (CREST) conduct early identification and public education. Community Intervention Teams (COMIT) provide counselling and psychiatric services closer to home. Together, these services form a continuum of care that can support hoarders throughout their recovery journey. Still, there are limits. Even with multiple touchpoints, help cannot be imposed on someone who is unwilling or unable to engage. In such cases, enforcement, including court orders or, in extreme situations, eviction, may still be necessary. Nevertheless, it should remain a last resort, not a default strategy. A CALL FOR COMPASSION AND COORDINATION The tragic flat fires should not be seen as confirmation that hoarders are beyond help or sympathy. Rather, it should prompt us to strengthen the links between enforcement and mental healthcare, to improve early detection, and to educate the public on hoarding disorder. Neighbours and family members can play a key role by flagging early warning signs to social services, rather than shaming sufferers of hoarding disorder. Social agencies must be empowered with the resources to stay engaged with complex cases over the long term. Hoarders are not merely 'messy people'. They are often vulnerable individuals living with an untreated and poorly understood illness. If we want to prevent future tragedies, we must respond not only with firmness, but with empathy, coordination, and above all, persistence.
