Objective: Who develops neglect, lives in squalor or hoards? What happens to people with such behavior, after they become known to community mental health services? Method:During an observation period of 2 years it was attempted to study all such subjects in the city of Halle/Saale. Biographic, medical, social and psychiatric variables were assessed. After a mean period of 11 months subjects were re-assessed. Results:35 people who lived in squalor or neglected conditions or who were known to hoard were assessed (60% male, mean age: 63 years). 17 subjects (49%) suffered from an organic brain disease, 14 (40%) fulfilled criteria of psychotic illness (mainly schizophrenia). In 9 cases a comorbid physical disorder contributed to the prevailing living conditions. After 11 months, for 21 subjects (60%) no amelioration of neglect, squalor or hoarding was observed, which was especially true for subjects with a psychotic illness. The results yielded some evidence that interventions, which aimed at living conditions (such as moving to sheltered accommodation), had positive effects, while this was not true for standard mental health care within community services and hospital treatment. Conclusions: Neglect, living in squalor and hoarding are frequently symptoms of underlying psychiatric or somatic illnesses. In this respect the results suggest that "standard care" proved to be of limited effect - especially for subjects with a psychotic illness.