CONTENTS
1. Introduction
This procedure, created by the Buckinghamshire Adult Safeguarding Partnership, follows the Care Act 2014 and related guidance. It should be used when self-neglect or hoarding is suspected in adults at risk. Based on research, it outlines principles for staff and organisations to support well-being and lower harm.
2. Purpose
The procedure aims to prevent serious harm or even death of individuals who appear to be self-neglecting by ensuring that:
- individuals are empowered, as much as possible, to understand the implications of their actions;
- there is understanding and recognition of the complexities involved in working with self-neglecting individuals;
- effective work and practice are promoted;
- concerns are appropriately prioritised;
- organisations uphold their duty of care;
- responses are proportionate to the levels of risk to self and others.
3. Scope
This procedure is intended for professionals working with individuals who may engage in self-neglect.
It does not address risks related to intentional self-harm. If self-harm seems to result from neglect or inaction by another person or service, it may be necessary to report the situation to Adult Social Care as a safeguarding concern.
4. Understanding Self-Neglect and Hoarding
Self-neglect refers to an individual’s inability or unwillingness to adequately care for themselves, which can manifest in poor personal hygiene, unsanitary living conditions, and failure to seek necessary medical attention. Hoarding is a recognised mental disorder involving a persistent difficulty discarding possessions due to a strong desire to save them. Individuals with hoarding disorder often feel deep emotional attachment to their belongings and experience significant distress at the thought of letting them go. This can lead to living environments that become cluttered, unsafe, or unsanitary.
Hoarding and self-neglect often co-occur, but it’s important to recognise that they are not always linked. While self-neglect behaviours may be present in individuals who hoard, self-neglect is not necessarily a precursor to hoarding disorder, and hoarding can exist as a standalone issue.
4.1 Key principles for intervention
- Respect and Dignity: Always treat individuals with respect and dignity. Understand that self-neglect and hoarding are often symptoms of deeper psychological issues.
- Person-Centered Approach: Tailor interventions to the specific needs, preferences, and circumstances of the individual. Involve them in decision-making processes as much as possible.
- Interdisciplinary Collaboration: Work with a team of professionals, including social workers, mental health practitioners, medical personnel, and housing authorities, to provide holistic care and support.
- Building Trust: Establish a trusting relationship with the individual. This is crucial for effective intervention and cooperation.
5. Understanding Mental Capacity
Consideration of mental capacity is a crucial aspect of working with people who self-neglect. Application and familiarity with the Mental Capacity Act (MCA) 2005 and its Code of Practice is important. Where there are concerns regarding mental capacity, it is essential to assess whether people who self-neglect can:
- understand, retain, use and weigh relevant information, including information about the consequences of any decision (mental capacity); and
- implement their actions (executive capacity).
The assessment should consider:
- does the adult understand they have a problem with self-neglect and the risks associated with this?
- can the adult retain the information given to them?
- is the adult able to weigh up the alternative options? e.g. being able to move around their accommodation unhindered, being able to sleep in their bed, cook in their kitchen?
- can the adult communicate their decision?
Assessments should consider whether there are any concerns about possible duress and whether the individual is being influenced or exploited by others who may not have their best interests at heart.
It is essential to apply the empowering principles of the MCA. It is essential that all mental capacity assessments are clearly documented in case records.
Where the individual has mental capacity but is not able to exercise choice as a result of duress or exploitation, legal advice should be sought regarding an inherent jurisdiction application to the High Court.
When a person is assessed as lacking capacity, a Best Interests decision should be made on their behalf and the least restrictive option should always be preferred. The person remains involved as far as possible.
Mental capacity assessments are both time and decision specific and should be considered and/or repeated as risk changes and in relation to each individual decision/risk.
The person should be supported to make an informed decision. This means that professionals will need to take time explaining the likely consequences of all courses of action.
