The research on which this briefing is based 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 stakeholders – practitioners and managers in adult social care and in safeguarding, and people who use services.
Self-neglect practice was found to be more successful where practitioners:
- took time to build rapport and a relationship of trust, through persistence, patience and continuity of involvement
- tried to ‘find’ the whole person and to understand the meaning of their self-neglect in the context of their life history, rather than just the particular need that might fit into an organisation’s specific role
- worked at the individual’s pace, but were able to spot moments of motivation that could facilitate change, even if the steps towards it were small
- ensured that they understood the nature of the individual’s mental capacity in respect of self-care decisions
- were honest, open and transparent about risks and options
- had in-depth understanding of legal mandates providing options for intervention
- made use of creative and flexible interventions, including family members and community resources where appropriate
- engaged in effective multi-agency working to ensure inter-disciplinary and specialist perspectives, and coordination of work towards shared goals.
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 between agencies of how self-neglect might be defined and understood
- data collection on self-neglect referrals, interventions and outcomes
- clear referral routes
- systems in place to ensure coordination and shared risk management between agencies
- time allocations that allow for longer-term supportive, relationship-based involvement
- training and practice development around the ethical challenges, legal options and skills involved in working with adults who self-neglect
- supervision systems that both challenge and support practitioners.
At the heart of self-neglect practice is a complex interaction between 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-off and hands-on approaches, seeking the tiny element of latitude for agreement, doing things that will make a small difference while negotiating for the bigger things, and deciding with others when intervention becomes a requirement.