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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
  • Hoarding guidance sets out a framework for collaborative multi-agency working in Swindon using a ‘person centred approach’ model to support individuals demonstrating hoarding behaviours. It should be used alongside the Swindon Multi Agency Policy and Guidance on Responding to Self-Neglect
  • 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

Briefings and resources - 7 minute and practice briefs

Some useful links and toolkits regarding Capacity

Recordings

Useful SSP training courses

Other useful external resources