Safeguarding and Self Neglect

What is self neglect?

The term "self-neglect" is defined by the Care Act 2014.  This covers a wide range of behaviour including neglecting to care for one’s personal hygiene, health or surroundings and includes hoarding.  It should be noted that self-neglect may not prompt a section 42 safeguarding enquiry with an assessment made on a case by case basis. 

The decision on whether a response is required under safeguarding will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support.

Examples of self-neglect include:
  • Lack of self care, a refusal or inability to cater for basic needs, including personal hygiene, nutrition, hydration, health and appropriate clothing thereby endangering safety and well-being
  • Neglecting to seek assistance for medical issues
  • Lack of care of one’s environment, living in squalor or environments which cause risk and hoarding
  • Refusal of services, that could lessen the risk of harm

What are the signs of self neglect?

Possible indicators or signs of self neglect include the following;
  • Dehydration
  • Malnutrition
  • Untreated or improperly attended medical conditions and poor personal hygiene
  • Hazardous or unsafe living conditions (poor wiring, plumbing, heating etc)
  • Unsanitary or unclean living quarters (animal or insect infestation, no toilet, fecal or urine evidence)
  • Inappropriate or inadequate clothing
  • Lack of medical aids (walking aids, glasses etc)
  • Eccentric behaviours and lifestyle
Poor environments and personal hygiene may be a matter of personal or lifestyle choice.  However when a person has capacity it is important to work with them to understand their feelings and wishes.

If the person lacks capacity to make relevant decisions best interest decision making may be necessary whilst still taking account the person's wishes as far as these can be ascertained.

What are the causes of self neglect?

Reasons for self-neglect can be complex and may impact on a person’s health, wellbeing or living conditions but there can also be a negative impact on others. Without early intervention, existing health problems may worsen.  Neglect of personal hygiene may mean that the person suffers social difficulties and isolation, physical health problems or mental health breakdown.

There are risks from excess rubbish which can become infested and hoarding behaviour can be a fire risk, not only to the individual but family and neighbours.

Research has linked self-neglect to physical health problems, mental health issues, substance misuse, psychological and social factors, diminished social networks, personality traits, traumatic histories and life changing events all of which can have an impact on the person’s physical abilities, energy levels, attention, organisational skills, or motivation.

Treatment for self-neglect can include addressing the underlying cause of the condition, whether this is depression or a more severe learning disability. Home care is another good solution for self-neglect cases. Carers can attend to cleaning, dressing, or feeding the individual in a way that does not interfere with their independence or autonomy.

It is key to establish a trusting relationship with a person who is engaging in self-neglect because restricting their autonomy can be harmful.

Guidance for staff and professionals

Self-neglect has featured in a significant proportion of Safeguarding Adult Reviews (SARs) completed across the country following the death of an adult with care and support needs. These reviews illustrate the complexity of practice with adults who self-neglect.

To support professionals Cumbria Safeguarding Adults Board have issued a Self Neglect Procedure and Self Neglect Guidance

Resources and policy research about self-neglect for community practitioners, such as housing officers, social workers, police and health professionals can be found on the website Social Care Institute for Excellence - self neglect

What is Self-Neglect? How to recognise the signs Ann Craft Trust

If you are concerned about a case of self neglect you should seek advice through your line manager or Designated Safeguarding Lead

Concerned about an adult at risk?

If you are concerned about an adult at risk of self-neglect please contact your local adult social care office