Seven-minute briefings
Self-neglect and hoarding
1 What
Self-neglect is defined as covering a wide range of behaviours – neglecting one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. Examples of self-neglect include:
Lack of self-care - neglect of personal hygiene, nutrition, hydration, health, thereby endangering safety and well-being.
Lack of care of one’s environment – squalor and hoarding, rRefusal of services that would lessen the risk of harm
2 Background
The Care Act (2014) statutory guidance – selfneglect is included as a category under adult safeguarding.
Article 8 of the Human Rights Act 1998 gives us a right to respect for private and family life. However, this is not an absolute right and there may be justification to override it, for example, protection of health, prevention of crime, protection of the rights and freedoms of others.
Mental Health Act (2007) s.135 – if a person is believed to have a mental disorder and they are living alone and unable to care for themselves, a magistrate’s court can authorise entry to remove them to a place of safety.
Mental Capacity Act (2005) s.16(2)(a) – the Court of Protection has the power to make an order regarding a decision on behalf of an individual. The court’s decision about the welfare of an individual who is self-neglecting may include allowing access to assess capacity.
Public Health Act (1984) s.31-32 – local authority environmental health could use powers to clean and disinfect premises but only for the prevention of infectious diseases.
The Housing Act 1988 – a landlord may have grounds to evict a tenant due to breaches of the tenancy agreement.
3 Why it matters
Without early intervention, existing health problems may be made worse. Neglect of personal hygiene may mean that the person suffers social difficulties and isolation, physical and mental health breakdown. Dilapidated property or excess rubbish can become infested and can be a fire risk, which is a risk to the adult, family, neighbours and others.
The inclusion of self-neglect in the Care Act statutory guidance with regard to safeguarding focused attention on the issue has led local authorities to develop new approaches to working with people. In some cases, where the adult has care and support needs, safeguarding responses may be appropriate. However, the inclusion of self-neglect in statutory guidance does not mean that everyone who selfneglects needs to be safeguarded.
4 Information
Multi-agency – work with partners to ensure the right approach for each individual
Person centred – respect the views and the perspective of the individual, listen to them and work towards the outcomes they want
Acceptance – good risk management may be the best achievable outcome, it may not be possible to change the person’s lifestyle or behaviour
Analytical – it may be possible to identify underlying causes that help to address the issue
Non-judgemental – it isn’t helpful for practitioners to make judgements about cleanliness or lifestyle; everyone is different
Empathy – it is difficult to empathise with behaviours we cannot understand, but it is helpful to try.
5 Information continued
Patience and time – short interventions are unlikely to be successful, practitioners should be enabled to take a long-term approach
Trust – try to build trust and agree small steps
Reassurance – the person may fear losing control, it is important to allay such fears
Bargaining – making agreements to achieve progress can be helpful but it is important that this approach remains respectful
Exploring alternatives – fear of change may be an issue so explaining that there are alternative ways forward may encourage the person to engage
Always go back – regular, encouraging engagement and gentle persistence may help with progress and risk management.
6 What to do
Try and find out what the adult wants. Share concerns with any agency involved. Think family – is anyone else at risk because of the self-neglect? A multi-agency meeting may be required to share information and decisions on how best to intervene and support to assess the level, aspects and management of risk. Practitioners must always seek consent of the adult before taking action and sharing information. If this is refused you must consider that information can still lawfully be shared if it is in the public interest to do so. This may include protecting the adult from harm.
Contact Adult Social Care, First Point of Contact 01709 822330 to discuss your concerns.
7 Questions
How would you recognise the signs of self-neglect and hoarding?
Have you read the RSAB Adult Safeguarding Policy and Procedures and Self Neglect and Hoarding?
Advice should be sought from safeguarding or governance leads if in doubt.