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Self-Neglect

The Care Act 2014 describes self-neglect as:

“…a wide range of behaviour, neglecting to care for one’s personal hygiene, health or surroundings, and includes behaviour such as hoarding”

Types of Self-Neglect

There are three distinct types of self-neglect:

  • Poor hydration and diet, having little fresh food.
  • Not actively seeking medical attention when needed.
  • Not maintaining personal hygiene e.g. showering, cleaning teeth or washing clothes.
  • Extreme distress or feeling ashamed / overwhelmed due to their self-neglect.
  • Extensive debts due to not managing money.
  • Very unclean e.g. toilet blocked by human waste or household cleaning not done at all.
  • Infestations of vermin or insects.
  • Neglect of household maintenance, creating hazards e.g. structurally unsound flooring.
  • Obsessive hoarding of objects or pets.
  • Not agreeing to any treatment or care relating to medical, household or personal hygiene needs.
  • Person now requires treatment for preventable conditions.
  • Aids or adaptions are refused.

Access and Prevention

Dudley Adult Social Care responds to self-neglect concerns and enquiries as soon as a referral is made via the Access (Front of House) Team who will route to:

  • Safeguarding Adult MASH
  • Access Social Work Team
  • Signpost providing Information advice and guidance.

This ensures that the initial referral is put on the correct pathway by the Access (front of house) Team and an appropriate response provided for the Adult who is self-neglecting.

Depending on the particular/presenting circumstances we can refer services users to the following Prevention pathways who need support when they are at risk of neglect:

Self-Neglect Best Practice Guidance

Dudley are signed up to the West Midlands safeguarding adult procedures, developed jointly by the region to introduce a consistent approach and practice.

The Adult Self-Neglect Best practice guidance can be accessed on the West Midlands Regional Safeguarding Information Hub

Hoarding

Hoarding is the excessive collection & retention of any material to the point that it impedes day to day functioning. This can include:

  • Inanimate objects (commonly clothes, newspapers, books, DVDs, letters & food/packaging)
  • Animals
  • Data

There are many reasons why a person hoards – they may believe an item will be useful or valuable in the future; they feel the item has sentimental value, or that if they throw it away they won’t be able to remember the person who gave it to them or the time they acquired it.

In some cases it may be a disorder that is present on its own or as a symptom of another disorder such as depression, obsessive-compulsive disorder (OCD) or attention-deficit/hyperactivity disorder (ADHD).

Someone who hoards may exhibit the following behaviour:

  • Inability to throw things away
  • Severe anxiety when attempting to discard items
  • Indecision about where to put things or what to keep
  • Distress, such as feeling overwhelmed or embarrassed about their possessions
  • Suspicion of other people touching items
  • Obsessive thoughts and actions: fear of running out of an items or of needing it for the future
  • Functional impairments such as the loss of living space, becoming isolated from family and friends, financial difficulties, health hazards in the home

Hoarding Disorders UK have the clutter image ratings available to view to assist with those who may be hoarding:

https://hoardingdisordersuk.org/research-and-resources/clutter-image-ratings/

Resources

DSPP reviewed five cases of individuals who were regarded to be self-neglecting prior to their death. All five people were considered difficult for agencies to engage with and either declined or cancelled support from services. The report relating to this review can be viewed on our SAR page.

A practitioner briefing has also been created and can be accessed via our Learning Zone

As part of this review a number of resources to assist practitioners in recognising and responding to adult self-neglect can be downloaded below:

  1. Capacity Assessment Examples
  2. Trauma Informed Practice Adults
  3. Person Centred Positive Approach
  4. Person Centred Positive Questioning

Further resources will be published when available.

Case Study

Please view the below case study around the response to someone who self-neglects and the outcomes of working within a multi-disciplinary team

Posters

DSPP have created posters for raising awareness of self-neglect. Download these below:

Video

Please view the below video on Self-Neglect for your information: