Global Health Vet – A One Health approach to public health

I had the opportunity to recently attend to the event “Hoarding Forum 2012 – People Hoarding Animals and Things, Is it Capacity, Mental Illness or Life Style?”, held on June 25^th, 2012 in Los Angeles and organized by the County of Los Angeles – Department of Mental Health. In the form of a discussion forum, the aim was to bring the community together and pin point several key factors that would help us understand the drivers behind hoarding. In a true One Health fashion, one of the main speakers was Dr. Jyothi Robertson, veterinarian working for UC Davis and Oakland Animal Services in California, who addressed an audience mostly consisting of human health professionals. Through her excellent presentation, called “The Tipping Point – Understanding and Responding to Animal Hoarding”, Dr. Robertson shared her experience in managing hoarding cases as well as some of the characteristics of people engaging in such practices (Check out her website: Shelter Strategies).

Dr. Robertson’s presentation on the veterinary perspective of animal hoarding generated a lot of interest from the audience.

There are several concerns related to hoarding, including animal abuse or neglect and public health issues for the people involved. Animal abuse is illegal in the USA and perpetrators can be prosecuted if found guilty.

Hoarders of animals often have the feeling that, by adopting dogs and cats, they are saving them from harm and providing them with a better life. However, the number of animals in a house can become so high that owners may not be able to keep track of all of them anymore and the pets themselves may have little access to food/water, or veterinary care.

This can lead to situations of abuse/neglect, in which animals become emaciated, malnourished and have chronic diseases. This is exacerbated by the fact that hoarders can be reluctant to accept the unhealthy condition of their pets, in spite of the clear evidence. Unfortunately, many of these animals need aggressive treatment to survive such conditions and in some extreme cases, they may even die inside a house without the owner realizing it or willing to give them up. Furthermore, this neglect of the animals’ condition can often lead to a self-neglect of the hoarder’s own health status.

One of the main threats to public and individual health related to extreme hoarding includes threats caused by zoonotic diseases. As mentioned previously, animals can be unhealthy, which is often reflected by heavy flea or tick infestation. These vectors can carry diseases such as cat-scratch disease, plague or murine typhus capable of infecting the pet owners themselves, and also spill over to neighboring houses.

The environment inside the house can also be a source of danger through several ways. Firstly, extreme hoarders are often overwhelmed by the sheer number of animals and cannot keep up with maintaining a clean house, which can lead to a state of squallor. As a result, animal urine or feces can accumulate. High urine levels lead to increased ammonia in the air, which cause (at very high levels) direct damage to the organism, such as irritation of airways, pulmonary edema or coughing. Furthermore, this squalor is also significant health threat by reducing safety in the house or causing potential fire hazards when windows and doors are covered for example.

A panel of different stakeholders including the Fire Department, law enforcers and mental health professionals came together to discuss their approach to hoarding during a case discussion.

This hoarding forum touched on several important points regarding the hoarding of things and animals. When it comes to animals, one commonly used definition of hoarding given by Dr. Robertson includes:

• Failure to provide for the animals
• Inability to recognize effects of this failure
• Denial or minimization
• Obsessive persistence

Unfortunately, there is a high rate of recurrence of hoarding and very few success stories of long-lasting resolution. Therefore, it is important to understand and address the complex underlying problems and potential causes that may lead some people to become hoarders, such as psychological issues like depression, loneliness or low self-esteem. Some attendees advised for a step-wise approach for cleaning a hoarder’s house, focusing on following safety regulations and guidelines, which may lead to more compliance. This forum re-iterated the need for a One Health strategy if we are to successfully manage animal hoarding situations. Alongside veterinarians assessing animals’ health, the human component of hoarding must also be addressed and mental health professionals must be part of a multidisciplinary team leading to a long-lasting beneficial relationship with hoarders, who are victims themselves of the condition.

More information:

Hoarding of Animals Research Consortium

Oakley B, et al. 2011. Pathological Altruism. Oxford University Press Ed.

Shelter Strategies

The “Five Freedoms” commonly used to assess animal welfare, neglect or abuse