At any moment, Lake Macquarie City Council has estimated it could have as many as 20 cases of hoarding and squalor on the books. And while squalor cases refer to conditions that have become unhygienic through neglect or the collection of waste items that pose a health and safety risk to residents, hoarding cases can be more difficult to define and negotiate.
The council has said hoarding cases in the local government area spiked during the COVID-19 pandemic and have since remained elevated, in a trend not exclusive to Lake Macquarie.
But experts say that the phenomenon is somewhat of a mystery, and while what causes it is unclear, it is a nevertheless complex and under-recognised mental illness that tends to get worse with age.
A pair of studies, published respectively in the Journal of Affective Disorders (2019) and the Journal of Obsessive-Compulsive and Related Disorders (2024), indicate that about two per cent of the general population is affected by hoarding disorder and the stigma attached to the condition tends to impede people's seeking help.
A person with hoarding disorder struggles to discard possessions, leading to so much clutter that it makes a person's home or parts of it unusable except for storage.
A 2023 study indicated that people with the disorder generally pointed to a stigmatised public image of hoarders as being "unclean, crazy, and lazy, incorporating ideas that they were 'dirty', 'unbalanced', different to 'normal people', and to be avoided".
"These stereotypes weren't always openly agreed with, but people with hoarding disorder experienced feelings of sadness, shame, embarrassment and guilt when presented with them, suggesting internalisation of stigma," researchers Rachel Prosser, James Dennis and Paul Salkovskis wrote in a co-authored review of studies in April.
"We don't exactly know what causes hoarding. It seems to be about 50 per cent genetics and 50 per cent environmental," Macquarie University hoarding expert Melissa Norberg said, adding that addressing hoarding cases needed a cross-services approach, bringing psychology, support services, professional cleaners, and legal authorities together in a joint response.
To address the local spike in cases, Lake Macquarie City Council said it had consulted with mental health, support services, government agencies and police and firefighters to develop a first-of-its-kind framework that has since won a National Environmental Health Australia award in May and is now set to be rolled out in councils across the country.
A spokesperson estimated that the framework had already helped, or was in the process of helping, the council deal with more than 40 cases of hoarding and squalor in the local area and had been flushed with recognition from other councils keen to follow their lead.
Council said in a statement that local governments had traditionally taken a regulatory approach to dealing with hoarders, but removal orders and penalty infringements were largely ignored and didn't tackle the root of the problem.
"We realised a more effective and compassionate approach would balance the well-being of people living in these conditions with the impact on the community and our regulatory requirements," council's environmental regulation manager Derek Poulton said.
"We've shifted the focus to providing pathways for individuals to seek long-term solutions with health professionals, psychological services and community groups like Samaritans and the Salvation Army, rather than just walking in and issuing fines and warnings."
"It represents a significant step in addressing a complex and challenging social, environmental, and public health issueone that will benefit not only the people living in these conditions but also the entire community."
Lake Macquarie mayor Kay Fraser said the framework had proven so successful that dozens of councils across the country were now in line to adopt it.
"Each case is different, and because of that, it's unlikely that any two cases will be treated in the same manner," Mr Poulton said.
"But this framework helps put us on the path to achieve a positive outcome for everyone involved."
