Self-neglect

Self-neglect is an extreme lack of self-care incorporating a wide range of behaviour such as, neglecting to care for one's personal hygiene, health or surroundings, refusing assistance or services and includes behaviour such as hoarding.  Self-neglect may put one’s own health, safety or well-being at risk.

Whilst self-neglect may not be seen as incapacity it should be a reason to question capacity after all efforts made to seek a person’s consent.

Safeguarding duties apply to anyone who is self-neglecting and unable to protect themselves due to care and support needs 

There are various reasons why people self-neglect such as:

• deteriorating health and ability in older age.
• loss / bereavement, trauma (e.g. experiencing or witnessing previous abuse).
• physical or mental health conditions.
• substance addiction / misuse.  

Some people have insight into their behaviour, while others do not. It can often be very complex however not everyone who self-neglects needs to be safeguarded.

Any action taken should seek to minimise  risks while respecting the person’s choices, trying to engage with the person to offer as much support as possible without causing distress.

It is important that all efforts to engage with and support the person are clearly recorded.

Self-neglect can include:

• neglecting to care for personal hygiene, health or surroundings to the extent that it threatens personal health and safety. 
• inability to avoid self-harm.
• failure to seek help or access services to meet health and social care needs.
• inability or unwillingness to manage one’s personal affairs.
• behaviours such as hoarding. 

People who self-neglect can often decline help from others. However many who self-neglect, particularly older people, may lack ability and/or confidence to ask for help and may also not have others who can advocate or speak for them.  If a person is willing to accept help, they can be referred for a social care assessment

It is important to understand poor environmental and personal hygiene may not necessarily always be a result of self-neglect. It could be due to cognitive impairment, being physically unwell or impaired, poor eyesight, functional and financial constraints.

Consideration should be given to the risk posed to the person and those residing around them e.g. risk of falls/ risk of fire/ infestation due to hoarding

How do I respond? 

• mutual respect – not everyone’s lifestyle choice might be the same. Everyone has the right to be their self and to live a full life without prejudice, fear or barriers.    
• have a caring curiosity.
• be non-judgemental and empathetic - building trust is key, preferably with one person. 
• consider trauma the person may have experienced that could be contributing to self-neglect.
• work in partnership – providing a multi-agency response is essential - seek advice and support from statutory agencies.   
• consent is preferable but not always required to share information. 
• consider domestic abuse – someone being coerced and controlled may appear to be self-neglecting e.g. not attending appointments. 
• consider children – if a parent is neglecting themselves is there a risk of neglect to their children or is a child providing care for a parent (Young carer).

Things to consider:

There is no statutory provision in Northern Ireland specifically directed at identifying, investigating, and addressing cases of self-neglect other than potentially in cases where a person lacks decision-making capacity, or is suffering from a mental health disorder under the Mental Health Act 2001.  

Each case will require a professional Health and Social Care (HSC) assessment to determine the appropriate response and consider if any underlying factors require a protection response 

Self-neglect is not recognised as a category of abuse however falls under mainstream assessment of care and support needs