Thanks in part to reality TV shows like “Hoarders” and “Hoarding: Buried Alive,” the issue of hoarding -- and attendant concerns about anxiety disorder and obsessive-compulsive disorder (OCD) -- has gained national prominence. For cities, it can be an extremely complicated problem.

When clutter consumes a living space, it can create health and safety hazards not only for an individual, but for neighbors as well. Addressing residents’ concerns is tricky, though, as public safety agencies must be sensitive to a person’s mental illness, and local laws are often vague.

Houston recently passed what may be the nation’s first big-city ordinance specifically addressing hoarding. After residents and homeowners’ associations there clamored for help, the city council recently passed new regulations allowing police to inspect apartments receiving hoarding complaints. The police may refer hoarders to mental health services and, as a last resort, charge them with a misdemeanor carrying daily fines up to $500.

Most of Houston’s complaints stemmed from condominiums where residents suffered ill effects of living near hoarders, says Tom Allen, a city attorney who advised the city council on the ordinance. (Right now, the measure only applies to multiunit properties.) Those ill effects have included rats breeding, bedbugs, fleas and other unsanitary conditions.

Determining just what constitutes hoarding, however, presents a challenge. Sgt. Mike Hill, who works in a city police unit responding to nuisance and other code violations, says existing fire and building codes provide a baseline, but police will handle each case individually. Their top priority is to get help for those suffering from mental illnesses. “[Hoarding] needs to be treated with the same level of compassion and concern as some of the other more recognized illnesses,” Hill says.

Multiple city departments are now working through the details of just how the new law will be carried out. Police will enforce the ordinance. The health department might be called in to assess mold or other health concerns. Public works staff may evaluate the structural integrity of units weighed down by piles of junk. The Mental Health and Mental Retardation Authority of Harris County and other outside agencies will also be key players. The city plans to begin enforcement no later than October. Allen says that if the initial law goes well, the city may look to broaden it to include single-family homes if adequate funding exists.

Jeff Szymanski, who directs the Boston-based International OCD Foundation, says some aspects of the law could have been crafted better. “We had no issue with a public safety ordinance, but to call it an anti-hoarding ordinance stigmatizes the issue.” Cleaning out homes or threatening hoarders with hefty fines fails to change their underlying behavioral issues, he says.

Some communities have developed formal hoarding task forces, a coalition of multiple public agencies that respond to hoarding cases and work to improve public education. The OCD Foundation has identified 75 communities nationwide with such task forces in place.