Tenants who self-neglect
Guidance for frontline housing staff and contractors
What can you do?
- Be able to identify individuals that self-neglect.
- Make sure the person has the mental capacity to make decisions about their safety.
- Understand that each individual case will need a personalised approach.
- Work with social care colleagues to agree the best approach to minimising risk to the person and others.
- Record interventions and decisions.
The SCIE report on self-neglect and adult safeguarding found that there is no conclusive evidence on what works best in supporting people who self-neglect.  Each case is individual but there are some approaches that may help to support people who neglect themselves or their environment:
- early intervention to prevent behaviour becoming entrenched
- a multi-agency approach
- use of effective screening tools that assist clinicians in identifying capabilities and risks
- sensitive and comprehensive assessment, including consideration of mental capacity
- relationship-based working – ‘sensitivity and gentle persistence’
- support with routine daily living tasks.
At 16 years old, Ann was made homeless due to a breakdown in her relationship with her mother. She had depression and anxiety, low self-esteem, low mood, poor sleeping pattern, poor health and low energy. Her battle with depression and anxiety stemmed from a history of sexual and physical abuse, as well as being victim to the effects of gang culture, which included bullying and harassment.
Ann lived in various hostels, and as a result of her poor state of mental wellbeing she began to self-neglect. She stayed in bed and stopped eating or washing regularly, her personal hygiene and health declined, and she was at risk of anorexia. She no longer took pride in her appearance or home environment.
Ann was supported by the Single Homeless Project. The effective support that was offered comprised a three-pronged action plan: self-esteem, daily living tasks and aspirations. The root of Ann’s depressed state was a severe lack of self-esteem. Exercises for depression and discussions helped to improve her self-esteem over time.
Due to her depressed state, Ann had very poor motivation and required support to return her to a normal routine. She had a support worker to monitor her and sometimes assist with living tasks, going with her to the laundry room, prompting her throughout the week with reminders and setting goals, and also reinforcing the importance of these tasks through discussions in ‘keywork’ sessions. Ann felt she needed something larger to work towards, so her support worker helped her to research jobs and courses related to her interests. A ‘moodboard’ with goals, advice and positive messages of encouragement helped Ann to move forward with her aspirations. Timeframes were set for all the tasks, and were broken down and monitored by the support worker, who regularly reviewed Ann’s progress and sometimes amended the goals to match with Ann’s needs and circumstances.
Ann found that working on her self-esteem was hard and was a matter of trial and error. Making use of counselling services helped. As a result of this support Ann improved and is now not self-neglecting.
Harry was an elderly man with mobility and mental health problems living in a general needs flat, where he died in a fire.
Harry was prone to self-neglect and hoarding. He had a supportive family but frequently refused help. A routine fire brigade safety check revealed Harry’s lifestyle as a fire risk. A referral to adult social services resulted in Harry being contacted by phone. Harry declined support and the fire brigade was informed that there was ‘nothing further social services could do’ because Harry ‘appeared to have capacity’. The fire brigade was advised to contact Harry’s landlord.
The fire brigade and housing provider worked closely together. Over a period of time, housing officers were able to build a relationship of trust with Harry, his family and neighbours, and encourage him to accept help and comply with requests for clearing his property without the need to take legal action. The housing provider committed to ongoing reviews and support.
Twelve months later, during a housing review, it was identified that Harry had begun hoarding again and his health was deteriorating. A neighbour then reported he was lighting fires inside his flat. While he was refusing help and treatment he was in contact with a number of different agencies.
The risks identified were not always translated into risk assessments to be shared to develop a multi-agency approach. The opportunity to utilise knowledge about Harry’s situation and the positive relationship developed with the housing provider was missed.