Self Neglect and Hoarding: Learning from Research Suzannah Marsden Research Advocate
What is Self Neglect? • No universally agreed definition which has created barriers in the development of consistent policies and procedures. • Complex reasons for self neglect also mean that the term has been difficult to define. • Professionals views may be influenced by the level of harm or risk associated with the behaviour.
What is Self Neglect? HOW WOULD YOU DEFINE SELF NEGLECT? TALK TO YOUR PARTNER AND COME UP WITH A DEFINITION OF SELF NEGLECT
What is Self Neglect? • In the publication ‘Self Neglect Policy and practice: research messages for managers’ (SCIE) self neglect is broadly defined as; • Lack of self care such as neglect of personal hygiene, adequate nutrition, hydration, health thereby endangering safety and well being • Lack of care of ones environment including hoarding and; • Refusal of services to mitigate risk of harm Care Act statutory guidance says that self neglect covers a wide range of behaviour, including neglect of one’s personal hygiene, health or surroundings and hoarding (DH 2016)
• Self neglect may be as a result from either unwillingness or inability to self-care and sometimes may involve both UNWILLINGNESS TO INABILITY TO SELF SELF SELF CARE CARE NEGLECT • Practitioners must explore both dimensions fully
Why Self Neglect is such an issue of concern? • • Findings from Serious Case Complex legislative frameworks Review and Safeguarding Adults • Staff anxiety Reviews. • Managing significant risks • Concerns from Coroners Courts, • Complexity around issues relating Ombudsmen and Partnership to capacity Agencies. • Levels of knowledge, skills and • Additional category of Self expertise Neglect in relation to Adult • Lack of a cohesive and consistent Safeguarding understanding of Self Neglect. • Impact of Inter agency working • Trying to understand individuals and differing perspectives and their stories (which takes • Tensions between values such as time and often involves assertive rights to self determination and engagement with people). duty of care.
What does the Research Say? • Research in this area has included reviews of policy and practices that have produced positive outcomes from the perspectives of key agencies and individuals (including service users) in relation to Self-Neglect (Braye et al 2014, SCIE Briefing, 2015). • It identifies both successful service involvement and the organisational structures needed to support this involvement
What does the Research Say? Service Involvement-what helps? • Where relationships can be nurtured over time. • Understanding service users life histories. • Robust Mental Capacity Assessments which consider both decisional capacity (capacity to make decisions) and volitional capacity (capacity to carry out decisions ). • Understanding of complex legal options. • Multi agency working • Use of creative/flexible interventions
What does the research say? Organisational issues-what helps? • Shared and consistent understanding of what defines Self – Neglect • Formal rather than ‘ad hoc’ systems to ensure coordination and communication between agencies. • Allowing time for longer term engagement. • Analysis of data regarding self neglect referrals/outcomes. • Training and practice development
Some questions for practitioners. Organisational/team level • How many service users with Self Neglecting behaviours does your team work with? Are there training gaps? • How established are your relationships with other key agencies such as Environmental Health, Housing, Fire Services etc. Could these be better? How? • Does your borough have a Hoarding panel? • Is there a multi agency Self Neglect policy in your borough? • How does your service process Safeguarding Referrals relating to Self-Neglect? • Is you team able to support the kind of long term engagement often needed in such cases?
Some idea’s for Practitioners. Individual practitioners • Try and ‘find the person’. Understand the meaning of Self Neglect for that person. • Working at the persons own pace and recognising their previous possibly negative experience of services. • Where possible allowing the person to have some control over the nature and pace of any intervention. • Focus on risk minimisation • Utilising a strengths based approach • Awareness of legal powers, duties and the complex interfaces between legislation.
Some idea’s for Practitioners • Robust assessments of Mental Capacity. Willingness to involve other professionals and to carry out these assessments via several visits. Assessing decisional and volitional capacity. • Creative interventions-harm reduction interventions (eg utilising fire safety measures even if hoarding is still a problem). • Decluttering/deep cleans are often not effective when used in isolation. • Sometimes coercive measures can be effective if combined with support. • Develop good communications ad working relations hips with other agencies. Developing shared responsibilities and coordinated interventions/support
Literacies for Self Neglect Legal Literacy Knowledge and skilled application of legal options or requirements Ethical literacy Reflective and critical consideration and application of values Relational Engaging with people’s biographies and lived experience. literacy Demonstrating concerned curiosity Emotional Managing stress and anxiety. literacy Recognising the impact of personal orientations to practice Knowledge Drawing on different sources of evidence literacy Organisational Understanding accountability and management of practice within literacy a multi-agency context Challenging procedures, cultures and decision making where these make error more likely Decision making Sharing information literacy Managing the multi-agency partnership Explicitly weighing the evidence for different options (Braye and Preston-Shoot 2016a)
Some idea’s for Practitioners… • • References and Use of Personal Budgets for individualised care packages. information • Use of case conferences, multi agency risk panels, reflective practice forums. These learning materials were based on • Find out if your borough has multi the publications; agency policies related to Self Neglect (Westminster and RBKC have ‘Care Act 214 Guidance’ developed such policies) ‘ Self Neglect policy and practice: Key • Recognising that working with people research messages’ Braye, Orr and with Self Neglecting behaviours can Preston-Shoot 2015, published by the be difficult, anxiety provoking and Social Care Institute of Excellence. present with particular ethical complexities.
Additional References ‘Self Neglect Policy and practice: ‘Tenants who Self Neglect -Safeguarding research messages for practitioners ’ in Housing ’ -section on SCIE website with practice examples. Braye, Orr and Preston- Shoot, SCIE, 2015 ‘Self Neglect and Adult safeguarding - findings from research’, DoH commissioned report, SCIE, 2011 ‘Self Neglect Policy and Practice: Building an Evidence Base for Adult Social Care’, SCIE, November 2014
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