Self-neglect can be described as:
- an extreme lack of self-care to an extent that it threatens a person’s health, wellbeing and/or living conditions; and
- may have a negative impact on other people’s environments.
- it is sometimes associated with hoarding; and
- may be the result of other issues such as addictions.
Managing the balance between protecting adults from risk from self-neglect against their right to self-determination is a serious challenge for practitioners in the community. Part of the challenge is knowing when or how far to intervene when there are concerns about self-neglect and a person has mental capacity to make an informed choice about how they are living and the amount of risk they are exposing themselves too.
As self-neglect is often linked to disability and poor physical functioning, assistance with activities of daily living is often a key area for intervention. The range of interventions can include occupational therapy, housing, environmental health and welfare benefits advice.
Working with people who do not acknowledge there is a problem and/or are not open to receiving support to improve their circumstances, whether they have mental capacity or not, can be exceptionally time consuming and stressful for all concerned, and usually involves making individual judgements about what is an acceptable way of living, balanced against the degree of risk to an adult and/or others.
In 2009 the Scottish Government and COSLA issued guidance under Section 5(1) of the Social Work (Scotland) Act 1968 which required local authorities to adopt a common standard eligibility framework for older people. The guidance was intended to focus first on supporting those people who are in more urgent need and ensure that finite resources are targeted on ensuring the most urgent needs are met in a timely manner.
This Guidance was adapted for local use to ensure that those at greatest need are prioritised and where a person’s risk is in the emergency / high category of risk our legal duty to provide care and support should be triggered (Appendix 2). Often, people who self-neglect do not want help to change and this could lead to assessors thinking more casually about a person’s needs when determining eligibility, resulting in inconsistent approaches to support and care.
Self-neglect manifests in different ways and there is an expectation that every effort will be made to respond when neglecting to care for one’s personal hygiene, health or surroundings is hazardous to the extent that people are living in extreme conditions of squalor with the potential for profound consequences for their wellbeing and safety.
Home visits are important, and practitioners should use their professional skills and observe for themselves the conditions of the person and their home environment. Any cause for concern over the person’s health and wellbeing should be discussed with them as well as obtaining the person’s views and understanding of their situation and perhaps even that of others and their community.
Situations where adults have been admitted to hospital and there is awareness of self-neglect and hoarding in their home environment can be challenging, given demands and pressures on hospitals that mean they need to move people on and out as quickly as possible. Close working between partners and services in both hospital and community will be required, in order to ensure the best possible outcome.