The challenge of defining self-neglect has proved a barrier in the development of policies and procedures and so moving towards a national definition of self-neglect might be helpful.
Previous research on self-neglect (Braye et al, 2011) was used as the basis for exploring the parameters of policy and practice in the present study and, for definitional purposes, self-neglect in the study includes adults both with and without capacity, and centers on:
- lack of self-care – neglect of personal hygiene, nutrition, hydration and/or health, thereby endangering safety and wellbeing, and/or
- lack of care of one’s environment – squalor and hoarding, and/or
- Refusal of services that would mitigate risk of harm.
However, as people who use services and practitioners observed in this research project, there is no typical self-neglect case.
Stark contrasts emerge between those neglecting themselves and those neglecting their home environments, and between different types of, and reasons for, hoarding.
Self-neglect may be a longstanding pattern or a recent change and be linked to loss, past trauma and/or low self-esteem.
People may be at risk from other people and their responses shaped by rationalisation, shame or denial.
Professional interest in an individual’s self-neglect, triggered by the level of harm or risk associated with the behaviour may be at odds with the individual’s own perception of the behaviour.
Flexibility of response, informed by an understanding of each unique case, is one key ingredient of effective practice.
Please note adults identified at risk of self-neglect may also be experiencing or at risk, from individuals who may target adults, resulting in abuse. These cases are not grounds to exit a Section 42 Enquiry.
The Care Act requires examination of the impact of self-neglect by adults; in South Yorkshire this will be managed locally but will only apply to adults in the following circumstances
- Have capacity to make the decision(s) causing concern
- The self-neglect is not a response to abuse by another person
- Results in risk(s)/harm to the individual
It is essential that capacity is kept under review for all adults managed within the self neglect processes, especially for adults who regularly misuse alcohol or drugs.
Each South Yorkshire area is developing or has their own defined policy in dealing with this subject (previously Known as VARMM).