Self-neglect

Health and social care practitioners often find it difficult to respond to self-neglect. If we fail to engage with individuals who are self-neglecting it may have a serious impact on their health and wellbeing and that of others.

As a public authority, we are expected to act fairly, proportionately, rationally and in line with the principles of:

  • the Care Act 2014
  • the Mental Capacity Act (2005)
  • the Mental Health Act (1983) where appropriate

This guidance should be read in context of the Lincolnshire Safeguarding Adults Board multi-agency policies and procedures.

The is also LSAB's Self-Neglect e-learning training.

If hoarding is present in the property, please review the hoarding guidance and undertake:

  • the clutter scale assessment
  • appropriate risk assessments
  • identify referrals (including a referral to the Fire and Rescue Service where Clutter Rating is 4 or above)

Application of the protocol

This protocol applies to all agencies supporting the Lincolnshire Safeguarding Adults Board (LSAB) multi-agency self-neglect protocol.

There is an expectation that everyone in partnership with the protocol engages fully.  This will achieve the best outcome for the individual while meeting the requirements and duties of their own agency or board.

Definition and characteristics of self-neglect

There is no one accepted definition of Self-neglect; the Care Act 2014 defines it as:

“Self-neglect- this covers a wide range of behaviours neglecting to care for one’s personal hygiene, health, or surroundings and includes behaviour such as hoarding.”

The characteristics of self-neglect are:

  • living in very unclean, sometimes verminous circumstances, such as living with a toilet completely blocked with faeces
  • neglecting household maintenance, and therefore creating hazards within and surrounding the property
  • portraying eccentric behaviour or lifestyle
  • obsessive hoarding (see LSAB hoarding guidance)
  • poor diet and nutrition, for example evidenced by little or no fresh food in the fridge, or what is there being mouldy
  • declining or refusing prescribed medication or other community healthcare support
  • refusing to allow access to health or social care staff in relation to personal hygiene and care
  • refusing to allow access to other organisations with an interest in the property, such as utility companies (water, gas, electricity)
  • repeated episodes of anti-social behaviour – either as a victim or perpetrator
  • being unwilling to attend external appointments with professional staff whether social care, health or other organisations (such as housing)
  • poor personal hygiene, poor healing or sores, long toenails
  • isolation

This list is not exhaustive. An individual may be considered as self-neglecting and may be at risk of harm when they are:

  • unable or unwilling to provide adequate care for themselves
  • not engaging with a network of support
  • unable or unwilling to obtain necessary care to meet their needs
  • unable to make reasonable, informed or mentally capacitated decisions due to mental disorder (including hoarding behaviours), illness or an acquired brain injury
  • refusing essential support without which their health and safety needs cannot be met and the individual lacks the insight to recognise this

We must be mindful that poor environmental and personal hygiene may not necessarily be as a result of self-neglect. A full holistic assessment is required.  All other factors should be considered, for example:

  • cognitive impairments
  • poor eyesight
  • financial constraints

People experiencing self-neglect may feel embarrassed about their situation.  They may lack the confidence to come forward and seek support.

It is important that practitioners use all of their communication and assessment skills if self-neglect is suspected to develop the therapeutic relationship. Common reasons for declining support include:

  • fear of losing control
  • pride in self-sufficiency
  • sense of connectedness to their surroundings
  • mistrust of professionals

Common responses by those self-neglecting:

  • I can take care of myself
  • I do my best to make ends meet
  • I prioritise and let other things go

Continuity of carers and robust information sharing, both internally and externally, is key to ensure a rapport is built between professionals and the individual. Clear care planning and case management is central to ensuring meaningful contacts.