Experts who treat and work with people who hoard say it’s best to: 
• Encourage the person to get a thorough diagnostic evaluation. In some cases, people who hoard also have serious conditions such as Alzheimer’s disease, dementia, schizophrenia or a personality disorder.
• Relay concerns independently to a psychiatrist or psychologist because the patient may not be forthcoming about the problem.
• Consider individual or group therapy by someone with experience in hoarding.
• Help the person get to therapy appointments on time and follow through with treatment. Those who treat hoarders say they are often late and distractible.
• Find a friend, relative, professional organizer or coach to help the patient begin removing his or her things rather than discarding items for the hoarder.
• Offer praise for small steps and know that it will take a long time to get rid of hoarded items.

Loved ones can be immensely helpful by supporting the person's efforts. This may include letting the person know that his actions are appreciated, commenting on improvements in clutter, even small ones, and empathizing with the person's struggle using comments such as, "I know this is really hard for you, and I think you're doing a great job." Loved ones often think that part of their job should be to throw items away. We tend to minimize this aspect of their role. This is because we believe that people with hoarding problems can best overcome the problem by doing it themselves. Obviously, some items may be large or heavy, and the person will require some physical help carrying them out. But if the loved one finds that they are discarding items while the person with the hoarding problem sits and watches, it is likely that the clutter will begin to grow again as quickly as it was removed.

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The Ottawa Community Response to Hoarding Coalition:

Those engaged in hoarding, or dealing with a family member who hoards, spoke about what had been helpful, not helpful, and what could be helpful to them regarding what and how services and supports were provided: 

• Provide more homemaker services. Not enough is provided to help;
  
  
• Cleaning companies are helpful for maintenance;
  
  
• Provide long term assistance. One individual could only get that through an on line chat room support group;
  
  
• Provide non judgmental support to family members in recognizing this is too difficult an issue for families to deal with on their own;

• Only involve support workers and professionals who are well informed about hoarding. Most were frustrated by experiences with therapists who knew little about hoarding. Professional help very important. One spoke of it as being her salvation;

• Develop a list of treatment provides knowledgeable about hoarding,

• Consider bartering with a student for assistance with housekeeping in exchange for tutoring or room & board,

• Suggest sorting items into three piles: keep, toss away, and give away. Allow the person to be in control of what is kept and discarded. Use a storage locker. One individual developed the following list of questions to ask herself during the decluttering process:

Does it lift my energy when I look at it or think about it? Do I absolutely love it? Is it genuinely useful? How much space am I willing to give up for it? What is enough? Defining what is enough = just the right amount. Does this object enhance my life? What's the worst thing that could happen if I got rid of it? Are there legal implications for holding onto it? If I got rid of it and discovered that I needed or wanted it later, could I replace it? When was the last time I used it or wore it? Does it work? If not, do I intend to fix it? If so, when? Do I like it? For clothes: Does it fit? Do you have occasion to wear it? Do I have something matching to go with it (for a shirt, pants, skirt, etc.)?

• Instead of a professional cleaner provide a clutter buddy – someone dealing with the same issues. Create a Clutterers Anonymous similar to the 12 step approach for alcoholism. This is the best way to help, according to one individual;

• Taking pictures before clean up and after clean up didn’t help one individual;

• Concentrate on solutions not how the individual got there. Don’t tell them how bad it is. Suggest a plan of attack;

• Encourage people to use a shopping list. One individual developed the following list of questions to ask herself when shopping:

• Am I going to use this object? Is it truly useful?
• Do I genuinely need this object or do I just want it? Do I already own a similar object?
• Do I already have enough of this kind of objects?
• Do I absolutely adore it?
• What will this object add to my life?
• Will this object bring me joy and increase my energy?
• Do I have space to store this object? If not, am I willing to make space for it?
• Am I willing to look after this object, maintain it, dust it?
• Can I afford to buy this object?
• If I were to move, would I bring this object with me?

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From Callahan Solutions:

There are many different forms of help for someone that hoards.  Even the well-intentioned person can sometimes unwittingly become part of an “intervention” that does more harm than benefit in the long run.

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From Ohio Health: When someone you care about is hoarding
Family members or friends are often the ones who encourage treatment and turn to professionals for advice. If someone you care about is hoarding, it's likely that badgering them to discard items, give up pets or get help won't work.

Consult a mental health or medical provider on your own for guidance. Some communities have agencies that help with hoarding problems. Check with your local or county government for resources in your area. As hard as it might be, you may also need to contact local authorities, such as police, fire, public health or animal welfare agencies, especially when health or safety is at stake.

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From Home Organization Suite 101: On Helping Hoarders

Can you do anything to help hoarders?

Unfortunately, you can’t help them until they first ask for help. Just as any addiction, hoarding is a sickness where you usually have to first hit bottom before you change.


Plan an intervention. Don’t try to confront them alone.
Call on other concerned friends and/or family members to get together at a specific time. However, just as other interventions (such confronting drug addiction, alcoholism, anorexia, etc.) you’ll probably need to surprise the hoarder, not letting him (or her) suspect the meeting is about his problem. For example, plan to have the people participating in the intervention meet at a certain time at the hoarder’s house. Knock on the door and gently tell the hoarder you’re there to help him. Then let each person take turns, expressing their concerns.

Tips

• Never take charge of the problem while the hoarder is out of town. Remember that it’s a mental problem. You may be able to haul away the junk, but unless you deal with why hoard you’ve only applied a “Band-Aid” and haven’t treated the disease.
  
  
• If the hoarder agrees he needs help, solicit a team to clean out the house. Designate four areas on the lawn: “Keepers”, “Donations”, “To Sell”, and “Garbage.”

• Be sure the hoarder stands at the front door and grants the final “OK” on each item. It’s vital that he mkess the decision of what to do with his stuff. Be aware that he’ll have a hard time making up his mind, and will, most likely, not want to let go of most of his things. But gently remind him of his goal to change and find order, happiness, and peace---to reclaim his home. Ask, “Are you happy now? Do you really want to change?” Then point to the house and remind him how his house is no longer a home, but a prison if he doesn’t let go of useless items.

Finally, encourage the hoarder to seek professional help. Most often, hoarding is due to filling a void, such as the loss of a loved one. Mistakenly, they think that holding onto sentimental things will bring comfort. Hopefully, once they realize being overly sentimental does not bring happiness---that storing up stuff only brings misery, chaos, and isolation, they’ll want to change.

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From the OCF Hoarding website:

What can I do if my family member or friend seems to have compulsive hoarding?

Individuals who hoard often do not recognize that their behavior is problematic or do not view it as problematic as others do. Change cannot be imposed and raising a person’s awareness of the problem often requires time and patience on the part of others.

While the use of logic and persuasion makes intuitive sense, it is usually not effective for motivating a person to recognize that he or she has compulsive hoarding and to work on the problem. This is because individuals with compulsive hoarding often have mixed feelings about the problem. For example, they may both feel safe and comfortable with their possessions while also feeling shame and embarrassment about their number or their inability to invite others into the home. Attempting to persuade the individual that he or she has too many things and that this is leading to any number of problems (e.g., social isolation, inability to find things, safety and health problems, etc.), usually leads him or her to argue for the opposite position, namely that there is no problem and that he or she is quite comfortable and safe in the home. Instead, raising a person’s awareness and motivating him or her to work on the problem requires an approach in which the concerned family member or friend expresses empathy, elicits the perspective of the person with the problem, and helps him or her to articulate his or her values and goals. Buried in Treasures provides some guidelines for motivating change and Motivational Interviewing, Second Edition: Preparing People for Change, by William Miller and Stephen Rollnick describes in detail this approach to motivating change.

Where there is imminent danger to the person with hoarding or to others in the household and the person with compulsive hoarding is not willing or able to acknowledge this difficulty, it may be necessary for concerned family members and friends to seek outside help. Because compulsive hoarding often touches on many issues, such as mental health, personal safety, and protective issues, it is ideally handled by a coordinated effort among multiple agencies. Concerned family members or friends can find out if their area has a compulsive hoarding task force made up of multiple agencies. For areas without a compulsive hoarding task force, particular agencies can be contacted directly. If at-risk individuals are involved (i.e., children, elders, disabled people, and pets), the appropriate protective service can be contacted; where no at-risk individuals are involved, the local department of public health or the fire department can be contacted.

For individuals with compulsive hoarding who are ready to work in the home and wish the help of family members or friends, the following can be helpful:

1. Decide together on the goal of the assistance, e.g., clearing an area of the home or accompanying the person on trips to places where he or she usually acquires to help him or her to resist the urge to acquire.
2. Help the person remain focused on the task in front of him or her. People with hoarding problems often find themselves easily distracted, especially when they are trying to reduce clutter, make decisions about possessions, or resist the urge to acquire things. Family members or friends can be helpful by simply reminding the person what he or she is supposed to be doing at the moment.
3. Provide emotional support. Overcoming compulsive hoarding is hard work and many people with this problem feel misunderstood. Family members and friends can express empathy, with statements such as, “I can see how hard this is for you,” or “I understand that you have mixed feelings about whether to tackle this clutter.” Family members and friends can also be cheerleaders, for example, by praising the effort the individual is making to overcome this problem and expressing their belief in the person’s ability to make progress.
4. Help the person make decisions but do not make decisions for him or her. It is helpful to develop rules for discarding. Good questions to ask are: “Is it useful?” “Do you need it?” “Can you do without it?” “In the long run, are you better off keeping it or letting it go?”
5. Help the person with hauling. Many people with compulsive hoarding have accumulated so many things that they can become overwhelmed by the enormity of removing such a large number of items.
6. Accompany the person on non-acquisition trips. One way to overcome the urge to acquire is to encounter situations where the urge is invoked and not give in to the urge. This allows the person to experience what happens to the urge when no acquisition takes place. Usually, the urge drops off over time. A family member or friend can support the individual to not give in to the urge in the moment.

In addition to the above recommendations, the following “don’ts” are suggested:

1. Don’t touch anything in the person’s home without his or her specific permission. Individuals with compulsive hoarding have many thoughts and feelings about their possessions and often feel uncomfortable when another person — even a family member or friend — touches their things. Ignoring the person’s wishes and handling their things without their permission breaks trust and can damage the relationship with them. It can take considerable time before an individual with this problem will allow another person to handle their things.
2. Don’t argue with the person who has the hoarding problem as this produces negative feelings and slows progress. When conflict arises, take a break. Similarly, don’t work beyond your tolerance level. Overcoming compulsive hoarding is hard work for everyone involved.
3. Don’t tell the person with the hoarding problem how he or she should feel. While it can be hard to understand why the person is keeping particular things, that seem to be useless, the thoughts and feelings about these things developed for a reason. Respecting that items that appear useless in fact have great value to the person is instrumental in helping the individual to overcome this problem.

Other individuals can also be of assistance in overcoming compulsive hoarding. Cognitive behavioral therapy tailored to this problem is effective. Therapists who are not familiar with this treatment can refer to Compulsive Hoarding and Acquiring. The Obsessive Compulsive Foundation maintains information on therapists across the country who treat obsessive compulsive disorder. To find therapists in your area, visit the OCF's Online Information Desk.