23 May 2022

This update intends to provide insight into recent learning from Safeguarding Adults Reviews (SARs) and key considerations when responding to self-neglect concerns.

Safeguarding Adults Boards (SABs) have a duty to conduct a Safeguarding Adult Review (SAR) when:

•An adult dies as a result of abuse or neglect, or experiences serious abuse or neglect, and

•There is concern about how agencies worked together to safeguard the individual

The purpose:

•To identify lessons to be learnt from the case and apply those lessons to future cases

•To improve how agencies work, singly and together to Safeguard Adults.

Learning from the voices of lived experience:

Recent analysis of 340 + reviews identified that self-neglect was the most frequent type of abuse/neglect reviewed under the SAR process.

What causes self-neglect?

Physical health issues:

  • Impaired physical functioning, Pain, Nutritional deficiency

Mental Health issues

  • Depression; negative symptoms, Frontal lobe dysfunction, Impaired Cognitive functioning

Substance misuse

  • Alcohol, Other illicit drugs

Psycho-social factors

  • Diminished social networks; limited economic resources, Poor access to social or health services, Trauma: life history/life changing events; personality traits; high perceived self-efficacy.

Key considerations in responding to self-neglect:

•Seeing the whole person in their situation

•A trauma-informed, whole system response to the person in context

•Being careful when thinking about removing a coping strategy

•In the context of people’s experiences, the notion of lifestyle choice is erroneous but too often an assumption or stereotype

•Tackling symptoms is less effective than addressing causes.

•Attempting to change someone’s behaviour without understanding its survival function will prove unsuccessful. The presenting problem is a way of coping, however dysfunctional it may appear. Put another way, individuals experiencing multiple exclusion homelessness are in a “life threatening double bind, driven addictively to avoid suffering through ways that only deepen their suffering.”

The approach and what does this might mean in practice

Building rapport - Taking time to get to know the person; refusing to be shocked; avoiding kneejerk responses; finding interests, history, stories

Finding the right tone - Being honest while also being non-judgemental, separating the person from the behaviour

Finding the right person - Working with or through someone who is well placed to get engagement

Going at the individual’s pace - Moving slowly and not forcing things; continued involvement over time

Finding something that motivates the individual - Linking to interests or drivers for the self-neglect (eg. waste/environment)

Agreeing a plan - Making clear what is going to happen; the next visit might be the initial plan

Starting with practicalities - Providing small practical help at the outset may help build trust

Bartering - Linking practical help to another element of agreement -bargaining

Focusing on what can be agreed Finding something to be the basis of initial agreement, that can be built on later

Keeping company Being available and spending time to build up trust

Factors to keep in mind during those early stages of intervention:

  • What is the person’s own view of the self-neglect?
  • Is the self-neglect important to the person in some way?
  • Does it play a role as a coping mechanism?
  • Does the person have mental capacity in relation to specific decisions about self-care and/or acceptance of care and support?
  • Is the self-neglect intentional or not?
  • Is the self-neglect a recent change or a long-standing pattern?
  • Are there links between the self-neglect and health or disability?
  • Is alcohol consumption or substance misuse related to the self-neglect?
  • How might the person’s life history, family or social relationships be interconnected with the self-neglect?
  • What strengths does the person have – what is he or she managing well and how might this be built on? What motivation for change does the person have?

Being honest about potential consequences

If you have any concerns regarding mental capacity then please contact the mental capacity team 0151 472 4537

All relevant referral forms, guides and safeguarding team contact information can be found on YourSpace.

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