Self-neglect is a behavioural condition where an individual persistently neglects to care for personal hygiene, health conditions or surroundings, including hoarding.
There are three broad approaches to addressing self-neglect cases depending on the individuals involved, the issues and the level of risk.
- Single agency response
- Formalised multi-agency
- Section 53 of the Adult Support & Protection (Scotland) Act 2007
Potential indicators of self-neglect might include:
- persistently neglecting to care for one’s personal hygiene, health conditions or surroundings, including hoarding;
- poor diet and nutrition or food that is mouldy and unfit for consumption;
- inappropriate and / or inadequate clothing;
- failure to seek help or access services which can reasonably be expected to improve the adult’s quality of life;
- hazardous or unsafe living conditions which pose a fire risk, and access difficulties;
- unsanitary or unclean home environment, filthy and verminous causing a health risk;
- inability or unwillingness to manage one’s personal affairs;
- self-endangerment through the manifestation of unsafe behaviours;
- social exclusion leading to a fear and uncertainty over asking and receiving assistance;
- the conditions in the property cause potential risk to people providing support or services; and
- Animal/s with potential insanitary conditions and neglect of animals’ needs.
Extreme self-neglect can be known as Diogenes Syndrome. It may, in a minority of cases, be appropriate to refer an individual for Mental Health Assessment.
Section 53 of the Adult Support and Protection (Scotland) Act 2007 recognises self-neglect as a category of harm and under S4 of the 2007 Act we have a duty to inquire when a person who is self-neglecting meets the three-point test. See also the revised national Code of Practice for Adult Support & Protection (July 2022) (CoP).
The Act defines adults at risk as people aged 16 years and over who:
- are unable to safeguard their own wellbeing, property, rights or other interests; and
- are at risk of harm; and
- because they are more affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected.
The local authority is the lead agency under Section 4 of the Adult Support and Protection (Scotland) Act 2007, if adult support and protection is being considered.
However, the inclusion of self-neglect in statutory guidance does not mean that everyone who self neglects need to be protected under the legislation. Adult Support and Protection duties will apply where the adult has care and support needs and they are at risk of self-neglect and they are unable to protect themselves because of their care and support needs.
NB The CoP (p70) notes the following as an example of circumstances where a medical examination should be considered, as part of an ASP inquiry:
- the adult appears to have been subject to neglect or self-neglect and is ill or injured and no treatment has previously been sought.
There are two types of self-neglect:
- active - intentional neglect - occurs when a person when a person makes a conscious choice to engage in self-neglect; and
- passive – non-intentional - occurs because of health-related conditions that contribute to the risk of developing self-neglect.
While evidence of self-neglect may not prompt a formal Adult Support and Protection response, dismissing self-neglect as a ‘lifestyle’ choice is not an acceptable solution in a caring society.