Self-neglect policy and practice: research messages for practitioners

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, 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 an 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 within workflow patterns 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 enforced intervention becomes necessary.