Self neglect
Definitions of self neglect and of hoarding
The Care Act (2014) guidance advises that ‘self-neglect’ covers a wide range of behaviour including neglecting to care for one’s personal hygiene, health or surroundings, and includes behaviour such as hoarding.
Partner agencies should think broadly on what may constitute self-neglect and what pathways may be available to address concerns.
‘Hoarding’ is only one of the behaviours that fall into this category but it is often used almost as a synonym for self-neglect
What the research tells us
Self-neglect is a spectrum of behaviours, with mental, physical, social and environmental factors interacting and affecting an adult’s ability to care for themselves.
The adult may initially be fully able to care for themselves, but as problems such as chronic illness develop, the person may gradually lose the ability to perform activities of daily living.
Reasons for self-neglect and impact on adult’s life
Reasons for self-neglect are often complex but so is the impact on the adult’s life.
Self-neglect may impact on a person’s health, wellbeing or living conditions and may have a negative impact on other aspects of their life. Without early intervention, existing health problems may worsen.
- Neglect of personal hygiene (physical factor) may lead to social difficulties and isolation (social factor), or physical/mental health breakdown and cognitive difficulties (mental factors)
- Dilapidated property or excess rubbish (environmental factor) can become infested and can be a fire risk, which is a risk to the adult, family, neighbours and others
A person-centred approach
Key to effective interventions is building relationships to effectively engage with people without causing distress, reserving the use of legal powers to where they are proportionate and essential.
Things to consider when working with people who self-neglect, for instance:
- Work at an individual’s own pace and set achievable goals (smaller steps rather than complete life changes)
- Support the person to feel ‘in control’ of their life and involve them in decisions
Balancing autonomy and protection is important. An assessment of a person’s mental state is important and mental capacity assessments are key in professional decision making.
Engaging with people who self-neglect
The nature of self-neglect cases means there is an increased likelihood that the person may refuse support when it is first offered. Initial non-engagement should not result in no further action
Consider different ways to engage the person, for example:
- Go on a joint visit with someone that the individual knows, trusts and feels comfortable with. This could be a family member, friend or another professional.
- Contact other professionals who are in contact with the person (GP, day centre workers, cleaners, etc.). They may have suggestions about how best to engage with the individual.
And remember Professional Curiosity.
Local Safeguarding Adult Reviews (SARs)
Three recently completed Safeguarding Adults Reviews (SARs) have occurred in Swindon in which self-neglect was a major point of concern.
Recommendations from these SARs place an emphasis on the importance of multi-disciplinary risk management and professionals working together at an early stage to support adults experiencing self-neglect.
The SARs for Terry, Kieran and Brenda can be accessed via the Safeguarding Adult reviews.
The National Review of 231 SARs across England identified that 45% of the cases involved self-neglect.
Below are links to guidance and resources that can support your practice:
- The Multi Agency Policy and Guidance on responding to Self-Neglect will help you to:
- define different types of self-neglect
- feel confident in identifying self-neglect
- know what you can do to support people who self-neglect
- know your responsibilities when working with someone who self-neglects
- Quick guide to self-neglect procedures
- Professional Curiosity resource pack
- Self-Neglect and Hoarding Training (Core module) half-day virtual workshop provides the essentials of good practice with people who self-neglect or hoard. Drawing on learning from research and from safeguarding adult reviews, it assists those in frontline roles to understand the needs of people who self-neglect, to recognise the risks involved, to respond appropriately at their point of first contact and to identify forward pathways for referral to other agencies.
- Self-Neglect and Hoarding Training (Specialist module) - This one-day virtual workshop draws on research evidence and evidence from safeguarding adult reviews (SARs) to explore how good outcomes can be achieved in work with people who self-neglect. It demonstrates how strong understanding of this evidence base can assist in addressing the key challenges of practice and help all agencies to work together in effective interventions.
Useful resources
SSP policies, procedures and guidance
- Adults Escalation Policy - Swindon Safeguarding Partnership
- Multi agency meeting guidance working with adults - Swindon Safeguarding Partnership
Briefings and resources - 7 minute and practice briefs
- 7-minute brief on self-neglect includes information on referrals to Risk Enablement Panel
- SSP Practice Brief – Safeguarding is for everyone – know your role
- Analysis of Safeguarding Adults Reviews from April 2017 to March 2019 - Swindon Safeguarding Partnership
- Mental capacity act - Swindon Safeguarding Partnership
- Spotlight on self-neglect hoarding webinar for delegates
- Spotlight on Self Neglect and Hoarding Newsletter - May 2023
Some useful links and toolkits regarding Capacity
Recordings
- Webinar recording - Learning from safeguarding adults reviews and audits
- Spotlight on self-neglect and hoarding
- External- short video clip (duration 3.54 minutes) about self-neglect Safeguarding Adults - Self Neglect 2020 - Bing video Durat
Useful SSP training courses
- Legal training 1 - Consent, capacity and information sharing - Swindon Safeguarding Partnership
- Legal training 2: Best interest decisions, self-neglect and liberty protection safeguards
- Identifying safeguarding concerns and making referrals (adults) - Swindon Safeguarding Partnership
- Screening, section 42 enquiries, planning meetings, adult safeguarding plans - Swindon Safeguarding Partnership
Other useful external resources
- What is Self-Neglect? - Ann Craft Trust
- Self-neglect: At a glance
- Hoarding disorder - Independent Age
- Mind - resources that explain hoarding, possible causes and how to access treatment and support for yourself or friends and family
- Raise awareness - visit help for hoarders for information, support and advice aimed at hoarders and their loved ones
- Dorset & Wiltshire Fire Service - safety at home