This covers a wide range of behaviours including neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. Safeguarding partnerships can be a positive means of addressing issues of self-neglect. The Safeguarding Adults Board is a multi-agency group that is the appropriate forum where strategic discussions can take place on dealing with what are often complex and challenging situations for practitioners and managers as well as communities more broadly. Recent research has identified ways of working that can have positive outcomes for those who self -neglect.
A Scoping Study of Workforce Development for Self-Neglect Work, Skills for Care, October 2013
Case study taken from the Department of Health Guidance - Care and Support Statutory Guidance, October 2014 - which demonstrates how agencies can work together, using a sensitive and caring approach to address the issue of hoarding.
Adults at risk from self -neglect
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).
Spotting Signs of Abuse and Neglect
Workers across a wide range of organisations need to be vigilant about adult safeguarding concerns in all walks of life including, amongst others in health and social care, welfare, policing, banking, fire and rescue services and trading standards; leisure services, faith groups, and housing. GPs, in particular, are often well-placed to notice changes in an adult that may indicate they are being abused or neglected. The role of the public and the community should not be dismissed in that they also can play a part in identifying concerns. (See Case Study below).
Findings from Serious Case Reviews have sometimes stated that if professionals or other staff had acted upon their concerns or sought more information, then death or serious harm might have been prevented.
The following case study, taken from The Department of Health Guidance: Care and Support Statutory Guidance issued under the Care Act 2014, October 2014 illustrates the important role that the community (in this case a neighbour) plays in identifying when an adult is at risk.
Anyone can witness or become aware of information suggesting that abuse and neglect is occurring. The matter may, for example, be raised by a worried neighbour (see above case study), a concerned bank cashier, a GP, a welfare benefits officer, a housing support worker or a nurse on a ward.
Primary care staff may be particularly well placed to spot abuse and neglect, as in many cases they may be the only professionals with whom the adult has contact. The adult may say or do things that hint that all is not well. It may come in the form of a complaint, a call for a police response, an expression of concern, or come to light during a needs assessment.
Regardless of how the safeguarding concern is identified, everyone should understand what to do, and where to go locally to get help and advice. It is vital that professionals, other staff and members of the public are vigilant on behalf of those unable to protect themselves. This will include:
- Knowing about different types of abuse and neglect and their signs;
- Supporting adults to keep safe;
- Knowing who to tell about suspected abuse or neglect; and
- Supporting adults to think and weigh up the risks and benefits of different options when exercising choice and control.
Awareness campaigns for the general public and multi-agency training for all staff will contribute to achieving these objectives