Self-neglect and hoarding

A shoe discarded in sand

There are many reasons why people may neglect themselves. Self-neglect covers a wide range of behaviour such as neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.

When an adult who may have needs for care and support appears to be at risk of self-neglect, and may be refusing care and support or whose self-neglecting behaviours pose a risk to others, it can be difficult for practitioners or concerned carers, friends/family members, to understand how statutory duties and legal powers could be applied to improve the adult’s situation. The Care Act s42 Safeguarding triage should be considered and applied where necessary.

What is self-neglect?

The Care Act 2014 identifies self-neglect as a safeguarding responsibility and defines self-neglect as covering a wide range of behaviours such as:

Neglecting to care for one's personal hygiene
Neglecting to care for one's health
Neglecting to care for one's surroundings
Hoarding

This could also include the refusal of services, treatment, assessments or intervention, which could potentially improve self-care or care of one’s environment. There are other less overt forms of self–neglect such as: eating disorders; substance use; and alcohol abuse.

Some cases of self-neglect may solely be due to disability or inability and therefore may not require further enquiries to be made, if an assessment and care and support plan would meet those needs.

4LSAB self-neglect policy and resources

When an adult who may have needs for care and support appears to be at risk of self-neglect, and may be refusing care and support or whose self-neglecting behaviours pose a risk to others, it can be difficult for practitioners or concerned carers, friends/family members, to understand how statutory duties and legal powers could be applied to improve the Adult’s situation. The following policy and resources have been developed to provide guidance for practitioners on how to work with individuals who are identified as suffering from self-neglect:

Self-neglect one-minute guides

Self_Neglect Front Page Southampton has seen an increase in the number and in complexity of safeguarding concerns that involve self-neglect. In response to this the Southampton Safeguarding Partnership have developed a suite of six ‘Self-neglect One Minute Guides’ that focus on key areas.

The Lambeth SAB has produced a video on how to respond to self-neglect.

Self-neglect SARs

The Hampshire Safeguarding Adults Board published earlier this year an independent thematic Safeguarding Adults Review (SAR) into the circumstances surrounding six individual cases of self-neglect which resulted in the deaths of those involved. The learning from this review can be found here: Self-Neglect Thematic Review (March 2022)

A presentation on Good Practice in Self-Neglect (using SAR learning and research evidence to inform practice) by Suzy Braye, Emerita Professor of Social Work, can be viewed here: Self-Neglect Presentation (January 2022)

Hoarding

What is hoarding?

Hoarding is the excessive collection & retention of any material to the point that it impedes day to day functioning. This can include:

Inanimate objects (commonly clothes, newspapers, books, DVDs, letters & food/packaging)
Animals
Data

What symptoms and behaviours to look out for?

Inability to throw things away
Severe anxiety when attempting to discard items
Indecision about where to put things or what to keep
Distress, such as feeling overwhelmed or embarrassed about their possessions
Suspicion of other people touching items
Obsessive thoughts and actions: fear of running out of an item or of needing it for the future
Functional impairments such as the loss of living space, becoming isolated from family and friends, financial difficulties, health hazards in the home

4LSAB multi-agency hoarding guidance

The 4LSAB Multi-Agency Hoarding Guidance sets out a framework for collaborative multi-agency working across Hampshire using a ‘person centred solution’ based model to support those demonstrating hoarding behaviours.

The purpose of this guidance is to support providers, practitioners, and other professionals to identify when to raise concerns regarding poor self care or lack of care for living conditions, identify agencies who can provide support and set out what they may expect by way of a response and encourage and support defensible decision making in accordance with our duty of care. This guidance should be read in conjunction with the Hampshire 4LSAB Multi-Agency Safeguarding Policy.