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Self neglect

"Don’t judge me by the chapter you have walked in on. I have a past and a future and not defined by my current situation”.  Quote from Swindon Experts by Experience.

Definitions of self neglect and of hoarding

Self-neglect is when someone may not be looking after themselves or do not let someone support them when they need help. Self-neglect can mean that the person becomes very unwell or ends up in danger of being harmed.

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 to look for

Self-neglect can mean that the person becomes very unwell or end up in danger of being harmed.

A few examples are; 

  • living in a cluttered house, which can put the person at risk of a fall, or a fire among other concerns
  • not eating or drinking enough or eating or drinking too much (including alcohol)
  • living without hot water or heating
  • not asking for medical help when needed, among other things
  • lack of self-care to an extent that it threatens personal health and safety
  • neglecting to care for one’s personal hygiene, health or surroundings
  • inability to avoid harm as a result of self-neglect
  • failure Inability or unwillingness to manage one’s personal affairs
  • lack of self-care to an extent that it threatens personal health and safety
  • neglecting to care for one’s personal hygiene, health or surroundings
  • inability to avoid harm as a result of self-neglect
  • failure to seek help or access services to meet health and social care needs
  • inability or unwillingness to manage one’s personal affairs

When families go through a tough time for example, experiencing relationship problems, financial hardship, poverty, mental health issues, addiction or bereavement, people may struggle to maintain the standards of care for themselves. It is important to have a conversation with them and to work with them and build up trust to ensure they are getting the support they need.  

Further information 

Below are two short video clips to aid understanding from other safeguarding partnerships. For local processes, please refer to Swindon Adults policies and guidance.

Why is this important?

Safeguarding Adults Reviews (SARs) recently conducted in Swindon have identified that the multi-agency response to self-neglect is a major point of concern. 

Recommendations from these SARs highlighted recurring themes, which are detailed below. 

  • Understanding of alcohol and self-neglect
  • Lack of professional curiosity
  • Ineffective multi-agency working
  • Understanding of the Mental Capacity Act in practice, including executive functioning, professional curiosity, reviewing capacity and fluctuating capacity
  • Working with complex individuals 
  • Lack of a trauma informed approach
  • Clarity around professional decision making and rationales
  • Making reasonable adjustments
  • Lack of risk assessment. 
  • Lack of understanding and use of the SSP Self-neglect policy and guidance.

Access the Safeguarding Adult Reviews on the SSP website.

What the research tells us

The National Review of 652 Safeguarding Adult Reviews identified that 60% of the cases involved self-neglect. 

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 the impact on adult 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 and trauma informed 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.

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:

  • Consider the person in their family and social context and link in with their positive relationships
  • 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). They may have suggestions about how best to engage with the individual. 

And remember be professionally curious.

Also, see our practice brief relating to trauma-informed practice learning from reviews.

The cycle of change

Prochaska & DiClemente’s model (1983) shows a variety of stages that one can expect to go through when modifying behaviour and highlights where someone may be at any given time during the process.  

This model applies to all types of desired change and individuals in their quest to stop or reduce unhealthy behaviours and adopt newer, healthier behaviours move through a series of five stages.  

It may be helpful to have an understanding of this model when assessing parental capacity to change.

See the SSP Practice Brief The Cycle of Change - Stages of Change and also The Stages of Change (Prochaska & DiClemente) – Social Work Tech.

Courageous conversations with adults

Talking to adults about self-neglect can often feel uncomfortable and challenging. 

Refer to the top tips on having courageous conversations. 

Motivational interviewing and communication skills 

Motivational Interviewing is an approach to being with people in conversations to support them to mobilise change to their behaviour. Further information can be found on motivational interviewing: what it is and how you can use it in social work.

Free face-to-face training is being delivered by professionals from the Family Nurse Partnership, SBC and some places are available to professionals from across the safeguarding partnership.

The content of this training will be relevant to professionals working with adults. 

To find out more or book a place on the Motivational interviewing and communication skills course.

In March 2024 the safeguarding partnership held a Spotlight on Child Neglect, one of the workshops delivered related to ‘Having difficult conversations’ recording. 

If you would like to access the recordings of all of the presentations please view our video archive.

Guidance for professionals when responding to self-neglect 

The SSP multi agency policy and guidance on responding to self-neglect

The multi-agency policy and guidance on responding to self-neglect - June 2024, 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

Part 1 of this document focuses mainly on the principles of support that will be offered to those that have reached a stage of self-neglect that can result in significant harm or death. 

Part 2 provides details on referrals to Adult Social Care and Adult Safeguarding, 

Appendix 2 outlines the legal framework for partner agencies in relation to self-neglect.

Quick guide to self neglect procedures

Welfare and safety plan and practitioner guidance 

All of the relevant documents can be found via the multi-agency policy and guidance on responding to self-neglect.

Useful toolkits relating to the Mental Capacity Act 

If you are concerned an adult may be at risk or is experiencing abuse and neglect, you can report a concern.

Useful resources

SSP policies, procedures and guidance

Briefings and resources - 7 minute and practice briefs

Recordings

Useful SSP training courses

Other useful external resources 

Professional response to self-neglect in Swindon

Dorset & Wiltshire Fire Service 

Live Well 

Further information is available on the hoarding and self-neglect webpage.

This short video clip (duration 15 minutes) explores the support provided by the Live Well Team to Maggie and Sandie.

Bobby Van