How can I support someone who self-neglects

Self-neglect has been quite a complex issue that families and communities have had to grapple with over many years. It was largely considered, rather incorrectly, as a ‘lifestyle choice’ which made intervention by authorities and even community-based organisations quite challenging. It, therefore, took a long time before it came to be recognised as a form of abuse under the Care Act, 2014.

Within church or faith-based communities, the challenge remains in identifying when a person’s self-care becomes a safeguarding concern and discovering the best ways to address it, whilst recognising the freedom of choice of the individual.

This information endeavours to help church leaders and members involved with supporting adults at risk, to develop a better understanding of the issue and identifying ways in which individuals concerned can be supported appropriately and safely.

What is self-neglect?

It is the inability (intentional or non-intentional) to maintain a socially and culturally accepted standard of self-care with the potential for serious consequences to the health and well-being of the people who self -neglect and perhaps even to their community. (Gibbons, 2006).

An individual may be considered as self-neglecting and therefore may be at risk of harm where they are:

  • Either unable or unwilling to provide adequate care for themselves;
  • Unable or unwilling to obtain necessary care to meet their needs; and/or
  • Declining essential support without which their health and safety needs cannot be met.

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, health or surroundings and includes behaviour such as hoarding. The safeguarding duties apply to an adult who:

  • Has needs for care and support (whether or not the local authority is meeting any of those needs) and
  • Is experiencing, or at risk of, abuse or neglect; and
  • As a result of those care and support, needs are unable to protect themselves from either the risk of or the experience of abuse or neglect.

Safeguarding a person who hoards or self neglects requires an enquiry into the reasons behind a person’s hoarding and self-neglect. The Local Authority has a duty to make enquiries, provide advice, guidance and signpost.

Self-neglect...Why?

There are various reasons why people self-neglect. Some people have insight into their behaviour, while others do not; some may be experiencing an underlying condition, such as dementia, mental health concerns or learning disability. Managing the balance between protecting adults from self-neglect on the one hand and promoting their right to self-determination on the other is a challenge.

Balancing choice, control, independence and well-being calls for sensitive and carefully considered support for the individual. Dismissing self-neglect as a “lifestyle” choice is not an acceptable solution in a caring society.

Apart from this, there is the question of whether the adult has the mental capacity to make an informed choice about how they are living and the amount of risk to which they are exposing themselves. Assessing mental capacity and trying to understand what lies behind self-neglect is often complex. It is usually best achieved by referring the individual to Social Services.

How do you recognise Self-neglect?

Even if you haven’t yet directly come into contact with people who self-neglect you may have seen TV or news items covering related issues. For example, there have been news items and documentaries about people who have died in concerning conditions, as well as programmes on the related issue of hoarding.

Some of the indicators of self-neglect are:

  • Living in a very unclean environment for example rodent infestation or living with a toilet completely blocked with faeces;
  • Neglecting household maintenance, and therefore creating hazards or fire risks, for example, rotten floorboards creating trip hazards or lack of boiler or electrical maintenance;
  • Having eccentric behaviour/ lifestyles, such as obsessive hoarding;
  • Poor diet and nutrition. For example, there is little or no fresh food in the fridge, or food is mouldy and very out of date;
  • Refusing necessary help from health and/or Social Care staff in relation to personal hygiene and care;
  • Having poor personal hygiene, poor healing/sores, long toenails;

Working with self-neglect can be a complex, potentially challenging and distressing area for and those affected by it. It is particularly difficult when a person has mental capacity and is refusing services.

What do I do if I am concerned about someone?

If you become aware that a person is self-neglecting and appropriate steps are not taken to respond, there is a real risk of the situation worsening and may eventually result in permanent damage to a person’s mental or physical health or even death. If there are immediate serious risks to life and limb, you should consider if it is necessary to call emergency services (e.g. ambulance) and any other immediate actions required to minimise the risk to the individual or others. If the individual has family or close friends let them know as soon as possible.

How do I report suspected self-neglect?

As self-neglect is a recognised safeguarding issue you should report your concerns to Adult Social Services in your area. They will have a duty line for safeguarding concerns during office hours and an out of hours emergency duty officer. If you are concerned about someone who may be at risk of harm from self-neglect you should gather as much information as possible, including, if known, clear immediate risks.

Information should include if known:

  • Person's name
  • Contact details
  • What are the risks and concerns
  • State of property, including the risk of fire
  • The appearance of a person (including clothing, weight, personal hygiene)
  • Health concerns (physical and/ or mental)
  • Any concerns about the persons mental capacity
  • Any animals

Any history that is known about the person including:

  • Social networks
  • Carers
  • Family
  • Details of previous/attempts to work with the person
  • Refusals of help
  • If the person is aware you are contacting a service

Do not worry if you can’t obtain this information. It is better to report the concern with the information you have and allow the statutory authorities to pick up the report and investigate it further.

What can the Church do?

Early stages of dementia that is not diagnosed can lead to self-neglect. If you notice this in a person for whom you give pastoral care, suggest they visit their G.P. Offer to support them to go to the appointment.

Illness, malnutrition and medication mismanagement are also factors that lead to self-neglect. The church could develop a pastoral system that identifies when individuals who used to attend regularly are missing. A visit may help the church to understand what is happening and give them an opportunity to refer the person to the G.P. or Social Services.

Depression and isolation is a serious issue in older adults and often leads to self-neglect. Can your church organise social groups for older people? A lunch club, board games, hymns of praise, music etc. This provides opportunities for interaction and prevents isolation.

Consider becoming a Dementia Friendly Church. There are some useful resources available from other organisations about becoming Dementia Friendly. Methodist Homes (MHA) and Church of England have developed advice and programmes and Premier provide useful steps on becoming dementia friendly Train people to become befrienders who visit people who they are concerned about. Offer to buy some basic food and help with some cleaning.

Useful contacts

Here are some useful websites and resources when dealing with the area of self-neglect:

Age UK

Friends of the Elderly

MHA

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