Self-neglect policy and practice: Learning from the frontline and people with lived experience

The research on which this briefing is based (Braye et al, 2014) set out to identify what could be learnt from policies and practices that have produced positive outcomes in self-neglect work, from the perspectives of key groups of people – practitioners and managers in adult social care and in safeguarding, and people who use services.

Service involvement was found to be more successful where it:

• was based on a relationship of trust built over time, at the individual’s own pace
• worked to ‘find’ the whole person and to understand their life history rather than just the particular need that might fit into an organisation’s specific role
• took account of the individual’s mental capacity to make self-care decisions
• was informed by an in-depth understanding of legal options
• was honest and open about risks and options
• made use of creative and flexible interventions
• drew on effective multi-agency working.

In turn, the organisational arrangements that best supported such work included:

• a clear location for strategic responsibility for self-neglect, often the Local Safeguarding Adults Board (LSAB)
• shared understandings of how self-neglect might be defined
• joined-up systems to ensure coordination between agencies
• time allocations that allow for longer-term supportive involvement
• data collection on self-neglect referrals and outcomes
• training and practice development around the ethical challenges, legal options and skills involved in working with adults who self-neglect.

At the heart of self-neglect practice is a complex balance of knowing, being and doing:

• knowing, in the sense of understanding the person, their history and the significance of their self-neglect, along with all the knowledge resources that underpin professional practice
• being, in the sense of showing personal and professional qualities of respect, empathy, honesty, reliability, care, being present, staying alongside and keeping company
• doing, in the sense of balancing hands-on and hands-off approaches, seeking the tiny opportunity for agreement, doing things that will make a small difference while negotiating for the bigger things, and deciding with others when the risks are so great that some intervention must take place.