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Self-neglect covers a wide range of behaviour which in general means someone is not caring for their own personal hygiene, health, safety or surroundings. It can also include hoarding behaviour, although not always. Hoarding can involve specific things, very general items, or animals – even data can be hoarded!

What is self neglect?

  • 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

The reasons for self-neglect are often complicated, although sometimes there may be a simpler reason for a change in circumstance. Someone who develops dementia, for example, may forget how to do certain household tasks, or someone with a new disability may not be able to maintain their personal hygiene in the same way as they had before.

Self-neglect will not often be taken forward as a s42 (safeguarding adults) enquiry – however supporting someone who self-neglects or hoards will usually need agencies to work together closely, in line with safeguarding adult processes. Professionals meetings should be used to help that joint working, especially where a number of risks have been identified.

Chronic self-neglect and/or hoarding is likely to have developed over many years, and it may be considered a safeguarding concern at the point:

  • where the person with care and support needs can no longer control their behaviour, so they cannot protect themselves;
  • where there is a defined high risk of harm to the individual;
  • or the physical / environmental risk to others is significant.

Safeguarding duties will apply where the adult has care and support needs (many people who self-neglect do not), and they are at risk of self-neglect and they are unable to protect themselves because of their care and support needs. In most cases, the intervention should seek to minimise the risk while respecting the individual’s choices. It is rare that a total transformation will take place and positive change should be seen as a long-term, incremental process.

https://www.scie.org.uk/self-neglect/at-a-glance

Organisations involved must look at any concerns raised to them under their existing duties and responsibilities under the law, and work together with the person to understand the underlying cause of the self-neglect or hoarding issues.

It often needs longer term involvement to build relationships, identify and work on any past trauma; and the workers involved need to come together to support the person to understand and manage any specific risks where possible.

Workers need to understand that people have the right to choose their lifestyle, balanced with their mental health or their capacity to understand the consequences of their actions.

It can often be a care or risk management issue rather than a safeguarding concern and may require a social care assessment – although it should be recognised that it will not always be appropriate to refer to the local authority straightaway. There may be initial support that other agencies can provide, especially where it appears unlikely that the person has care and support needs.

Lambeth Safeguarding Adults Board created this 3 minute video about self-neglect:

The Cambridgeshire and Peterborough Safeguarding Partnership Board have published Multi-Agency Policies and Procedures to Support People who Self-Neglect and for Working with People with Hoarding Behaviours

Published alongside the procedures is a Resource Pack which includes:

In 2020, ADASS (Association of Directors of  Adult Social Services) and the East of England SGAN (safeguarding adults network) published a learning support document. Recognising that working with adults at risk of self-neglect and/or hoarding is complex, they wanted to produce a document that supports frontline practitioners and reinforces good practice.

While this document is aimed primarily at adult social services social work practitioners and managers employed in statutory roles, its content is relevant to all professionals who may work with adults who self-neglect and/ or hoard.

Case studies are used as examples of how to work effectively with people who self-neglect and/or hoard and key points of good practice are included. These have been taken from research studies and particularly from the work of Michael Preston-Shoot, Suzy Braye and David Orr. 

ADASS Self-Neglect and Hoarding

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