Adult safeguarding: Self neglect

Capacity is a highly significant factor in both understanding and intervening in situations of self-neglect

There are a wide range of perspectives that inform professionals’ understanding of self-neglect. There is, however, no conclusive evidence on causation, or on the effectiveness of particular interventions. There are tensions between respect for autonomy and a perceived duty to preserve health and wellbeing. The former principle may extend as far as recognising that an individual who chooses to die through self-neglect should not be prevented from doing so; the latter may engage the view that action should be taken, even if resisted, to preserve an individual’s safety and dignity. Human rights arguments are engaged in support of either perspective.

The autonomy of an adult with capacity is likely to be respected, and efforts directed to building and maintaining supportive relationships through which services can in time be negotiated. Capacity assessments, however, may not take full account of the complex nature of capacity; the distinction in the literature between decisional and executive capacity is not found in practice, and its importance for determining responses to self-neglect may need to be considered further.