Self-neglect and Hoarding
Self-neglect covers a wide range of behaviour which in general means someone is not caring for their own personal hygiene, health, safety or surroundings. It can also include hoarding behaviour, although not always. Hoarding can involve specific things, very general items, or animals – even data can be hoarded!
The reasons for self-neglect are often complicated, although sometimes there may be a simpler reason for a change in circumstance. Someone who develops dementia, for example, may forget how to do certain household tasks, or someone with a new disability may not be able to maintain their personal hygiene in the same way as they had before.
Self-neglect will not often be taken forward as a s42 (safeguarding adults) enquiry - however supporting someone who self-neglects or hoards will usually need agencies to work together closely, in line with safeguarding adult processes. Professionals meetings should be used to help that joint working, especially where a number of risks have been identified.
Chronic self-neglect and/or hoarding is likely to have developed over many years, and it may be considered a safeguarding concern at the point:
- where the person with care and support needs can no longer control their behaviour, so they cannot protect themselves;
- where there is a defined high risk of harm to the individual;
- or the physical / environmental risk to others is significant.
“Safeguarding duties will apply where the adult has care and support needs (many people who self-neglect do not), and they are at risk of self-neglect and they are unable to protect themselves because of their care and support needs. In most cases, the intervention should seek to minimise the risk while respecting the individual’s choices. It is rare that a total transformation will take place and positive change should be seen as a long-term, incremental process.” Self-neglect: At a glance | SCIE
Organisations involved must look at any concerns raised to them under their existing duties and responsibilities under the law, and work together with the person to understand the underlying cause of the self-neglect or hoarding issues.
It often needs longer term involvement to build relationships, identify and work on any past trauma; and the workers involved need to come together to support the person to understand and manage any specific risks where possible.
Workers need to understand that people have the right to choose their lifestyle, balanced with their mental health or their capacity to understand the consequences of their actions.
It can often be a care or risk management issue rather than a safeguarding concern and may require a social care assessment - although it should be recognised that it will not always be appropriate to refer to the local authority straightaway. There may be initial support that other agencies can provide, especially where it appears unlikely that the person has care and support needs.
Lambeth Safeguarding Adults Board created this 3 minute video about self-neglect:
NSAB have developed and published Norfolk’s Self-Neglect and Hoarding Strategy, which has more detailed guidance on how to work with and support individuals in this category - Safeguarding Adults Reviews frequently highlight self-neglect signs and symptoms as a factor in or indicators of subsequent serious events that have resulted in life threatening consequences, or even death. When seen in isolation, self-neglect and/or hoarding behaviours may not give rise to safeguarding intervention. However, when viewed alongside other potential risks, a very different picture often emerges.
To address and coordinate this important area of work across partner agencies, NSAB produced and published this strategy, which aims to be part of the growing work around early intervention and preventative agendas.
It directs collaborative multi-agency discussions of self-neglect and/or hoarding cases to the Early Help Hubs (EHH). To encourage a more preventative approach to cases of self-neglect and/or hoarding, the trigger point for taking a case to the EHHs is level 2 (image 4 upwards) on the Clutter Image Rating Scale (CIRT). The strategy sets out clearly that a collaborative and multi-disciplinary approach to those at risk is the most effective way to achieve creative and proportionate interventions that respect the individual’s right to self-determination. The strategy includes the Self-neglect and Hoarding Assessment Triangle which might be helpful to practitioners.
In 2020, ADASS (Association of Directors of Adult Social Services) and the East of England SGAN (safeguarding adults network) published a learning support document. Recognising that working with adults at risk of self-neglect and/or hoarding is complex, they wanted to produce a document that supports frontline practitioners and reinforces good practice.
While this document is aimed primarily at adult social services social work practitioners and managers employed in statutory roles, its content is relevant to all professionals who may work with adults who self-neglect and/ or hoard.
Case studies are used as examples of how to work effectively with people who self-neglect and/or hoard and key points of good practice are included. These have been taken from research studies and particularly from the work of Michael Preston-Shoot, Suzy Braye and David Orr.
Strategy and Practitioner Guide
All partners are encouraged to download the strategy and cascade within their organisations.
Published alongside the strategy is a Practitioner Guide. This guide is intended as a toolkit to support practitioners from a range of agencies with management of cases where an adult is deemed to be at risk due to self-neglecting and/or hoarding behaviours.
The Practitioner Guide includes:
- The Clutter Image Rating Scale (CIRT)
- Assessment Tool Guidelines
- Guidance for practitioners
- Guidance questions which could be used during an assessment
- Hoarding self-assessment tool