Concerns for self-neglect will follow the usual referral process in the first instance and self-neglect cases already allocated to a practitioner or a team should go directly to that worker or team to consider what actions are required to minimise risk to the adult or others (Appendix 9).
When attempting to work with people who are difficult to engage, and we are not being successful, it is important to give that person the impression you can help them. Find out what is important to that person and when engaging them in a conversation let them do most of the talking. Find something that motivates the adult and provide value to them first before expecting anything in return. (Appendix 10).
If the adult’s ongoing refusal means that it has not been possible to undertake an assessment fully or the conclusion of the need’s assessment is that the adult refuses to accept the provision of any care and support, multi-agency case recording should always be able to demonstrate that all necessary efforts and actions have been taken to carry out an assessment that is required, reasonable and proportionate in all the circumstances. This should include recording what steps have been taken to involve the adult and any carer and the outcomes that the adult wishes to achieve in day-to-day life and whether the provision of care and support would continue to the achievement of these outcomes.
The case should not be closed simply because the person refuses an assessment or to accept a plan to minimise the risks associated with the specific behaviour(s) causing concern. It should be demonstrated that appropriate information and advice has been made available to the adult, including signposting to alternative services or community resources, or contact with the adult’s GP.
When no further interventions can be planned
There may come a point where all options have been exhausted and no further interventions can be planned. Where agencies are unable to implement services to reduce or remove the risks, the reasons for this should be fully recorded and maintained on the person’s file. The efforts and actions taken by the agencies to assist the adult at risk should be fully recorded.
The adult at risk, carer or advocate should be fully informed of the support offered and the reasons why the support has not been implemented. The risk must be shared with the person to ensure they are fully aware of the consequences of their decisions, including the risk of death. There is a need to make clear that the adult at risk can contact the relevant agency at any time in the future for support and provide details of who to contact should be provided.
Before the multi-agency meeting disbands any ongoing needs for the individual should be clearly identified and communicated to the relevant agencies. It is important to ensure that meetings, discussion, actions and outcomes arising from each stage of the procedures are fully recorded on appropriate recording systems. This will highlight that partner agencies have exercised their duty of care in a robust manner and as far as possible.
In cases of significant risk, the role of monitoring the adult at risk, should be considered and legal advice should be sought.