This is a short podcast on behalf of the West Sussex Safeguarding Adults Board. I will be talking to you about self-neglect; what it is, the possible signs of and reasons for self-neglect, why is it important to recognise and respond to self-neglect concerns and the process for supporting those who self-neglect. I will also, provide some information on how to access further reading and guidance to support your practice.
Firstly, I would like to explain what self-neglect is. The term self-neglect can be used to describe a wide range of situations or behaviours. It could be someone not looking after their own health or personal care or not maintaining their home environment for so long that it becomes cluttered, dirty and/or unsafe. The Care Act recognises self-neglect as a category of abuse and emphasises the importance of working together and the need to take preventative actions to minimise risk.
The need for safeguarding processes for those who self-neglect is dependent on risk levels and so will not be required for all individuals who self-neglect. If the level of risk is lower, risks could be reduced by following another process or means of support such as referring for, or completing, a Care Act assessment, or signposting for mental health and/or health support.
Safeguarding processes may be required if there are significant risks to the individual or others. This could include risk of life-threatening consequences, such as significant fire risk, substance misuse or self-harm, a risk to tenancy or home security, non-engagement or refusal to essential treatment or support, being vulnerable to exploitation or domestic abuse, the individual’s environment presenting a high risk, such as inadequate plumbing, washing or toileting facilities and also, for those who have little or no informal support networks.
Secondly, I would like to share some of the possible signs of self-neglect. These could include:
- an excessively unclean or cluttered home, this may include issues with pests or vermin
- signs of hoarding
- an individual neglecting household maintenance
- an unkempt personal appearance
- appearing malnourished or dehydrated
- declining essential health or social care support
- and significant financial debt issues
There are many reasons why an individual may self-neglect. These reasons could include:
- physical and/or mental health problems
- substance misuse
- psychological and social factors
- diminished social networks or
- traumatic histories and life-changing events
Thirdly, I want to explain why it is important to recognise and respond to self-neglect concerns. In West Sussex we have several Safeguarding Adult Reviews where self-neglect has been identified as a theme. This tells us that this is an area of learning where improved knowledge and practice is needed. Learning identified includes the importance of:
- information sharing and collaborative working
- robust face to face assessments and risk assessments
- understanding of legislation, such as the Mental Capacity Act
- challenging and reflecting on practice
- the need for robust guidance to assist practitioners
- and the need for assessment processes to involve carers and/or significant others
Finally, I would like to tell you the process for supporting those who self-neglect in West Sussex. This is a five-stage process and reflects the Sussex policies and procedures on self-neglect:
The first stage is when self-neglect is identified. At this point there is a need to consider:
- any immediate actions required to minimise risk
- raising a safeguarding concern or requesting a social care assessment, and/or;
- arranging a multi-agency meeting.
The second stage is to identify a lead agency. If there is a Safeguarding Enquiry, this will be the Local Authority. In other cases, this could be another agency because:
- the agency is already involved
- the agency has a duty of care
- the agency holds significant information
- the individual has shown a likelihood to engage with a particular agency and/or
- their needs appear to relate to the service provided by that agency
The third stage is for the lead agency to co-ordinate information gathering. This includes, consideration of the most appropriate actions to address the concerns raised, and initial considerations about mental capacity.
The fourth stage is for the lead agency to convene a meeting under the self-neglect procedures. The purpose of this meeting will be to: consider risks and issues of mental capacity, share information between agencies and to devise a shared action plan. This meeting should involve the individual concerned as much as possible and/or their representative or advocate.
Stage 5 is to complete a comprehensive risk assessment. This can result in either outcomes being determined, and the risk addressed with support being accepted and ongoing monitoring.
Or, the outcomes being determined and the risk remaining. This will then result in, escalation of concerns, ongoing monitoring, repeat multi-agency meetings or safeguarding concerns being raised where required.
For cases where an individual is putting themselves or others at significant risk by refusing services and all options have been explored and, the level of risk is still high, a referral to the Multi-Agency Risk Management Subgroup should be considered. Details of this subgroup and how to refer are available on the Board website.
Please have a look at our Board’s website to view the Pan-Sussex Self-Neglect Procedure and the self-neglect learning briefing, which contains links to further information. On our website you’ll also find useful links to all our published Reviews, safeguarding policies and procedures, information for professionals, and further podcasts.
Thank you for your time to listen to this podcast and we appreciate you moving forwards with us to ensure we make a difference for those who we are supporting.