Intervention
Sensible risk appraisal is essential. It must be person centred and facilitates a proportionate response to risk. Over-protective approaches can in themselves cause harm.
Research has found that service involvement is more successful where it:
- is based on a relationship built over time, at the individual’s own pace
- is person centred
- remember ask, listen, offer choice and work together, making safeguarding personal
- takes account of the individual’s mental capacity to make self-care decisions
- was open and honest about risks and options
- draws on effective multi-agency working
Under the Care Act 2014 self-neglect is in the categories of abuse or neglect relevant to safeguarding adults with care and support needs. Sometimes there is a serious risk to the health and wellbeing of an individual and all attempts to mitigate the risk have been unsuccessful. In these cases, it may be appropriate to raise self-neglect as a safeguarding concern. However, interventions on self-neglect are usually more appropriate under the parts of the Care Act dealing with assessment, planning, information and advice, and prevention (section 9 assessment).
Where it appears that an adult may have needs for care and support, we must assess:
- whether the adult does have needs for care and support; and
- if the adult does, what those needs are
This is referred to as a ‘care and support assessment’ or ‘section 9’ assessment.
It is vital to establish whether the person:
- has capacity to make decisions about their own wellbeing
- is able or willing to care for themselves
Sometimes an individual lacks mental capacity to make a decision. In these cases a best interest meeting is required to develop an action plan. An adult who is able to make choices may make decisions that others think of as self-neglect.
It is rare that a safeguarding referral is the most appropriate course of action. Other avenues of support should be explored before a safeguarding referral is considered. A referral should only be made where a person who has care and support needs, is:
- experiencing or at risk of abuse or neglect
- cannot take steps to safeguard themselves because of their care and support needs.
The legislation makes clear that adult safeguarding responses should be guided by the adult themselves. Responses should aim to achieve the outcomes that they want to achieve.
If the person has capacity to make choices around their living arrangements, their consent should be sought to make a safeguarding referral. If they do not want any safeguarding action to be taken, decisions must be fully explained and recorded and other agencies informed and involved, as necessary.
You can make a referral to us if any of the following applies:
- if all other attempts to intervene have failed and:
- if the person’s 'vital interests' are compromised – such as there is immediate risk of death or major harm
- if others are at significant risk of harm
Where a safeguarding enquiry does commence, the safeguarding process will:
- support agencies to resolve issues of immediate risk
- ensure there is a full picture
- ensure there is an agency to monitor so that the person does not slip through the gaps later
Carrying out any assessments may be difficult if the person is reluctant. The Department of Health advises that we should record all the steps we take to complete an assessment of the things that a person wants to achieve and the care and support that they need. Research indicates that intervening successfully depends on practitioners taking time to gain the person's trust and build a relationship and going at the person’s own pace.
Sometimes it is impossible to complete the assessment and the person refuses to accept care and support services. In these cases you should be able to show that you have:
- tried to complete the assessment
- made available information and advice on how to access care and support
- told them how to raise any safeguarding concerns
All your decisions, and the considerations that have led to them, should be recorded in sight of the person's wishes and their particular circumstances. You should be able to show that whatever action you have taken is reasonable and proportionate.