SPECIAL EDITION: 4 Self-neglect | September 2021
Welcome to this September edition of Pass It On News.
WSSAB is committed to raising awareness of self-neglect given its repetition in featuring in our Safeguarding Adult Reviews, and the significant work being progressed in our Multi-Agency Risk Management subgroup on this issue.
We are delighted to have a contributing article from Camilla O'Brennan, Multi-Agency Officer for WSCC, who has formulated, produced and established the Safe & Habitable Homes Forum which addresses self-neglect related to the home environment within the county.
Self-neglect is extreme lack of self-care that can threaten the persons health and safety. It can sometimes be associated with other issues such as; hoarding, addiction and/or poor mental health.
As a professional, it can be difficult to engage with those who self-neglect, as they often decline support from agencies. Whilst there are limitations as to what professionals can do if the person has been assessed as having mental capacity to make their own decisions about how they live, there do continue to be options. This includes continued attempts to engage and monitor risk, ensuring multi-agency risk meetings are held, and referral to Multi-Agency Risk Management (MARM) subgroup once all attempts to reduce risk have been made, but risk remains high.
WSSAB oversee the operational infrastructure, and interdisciplinary involvement of professionals working with those who self-neglect.
Please see:
To support practitioners, we have recently published a Self-Neglect Podcast which accompanies our self-neglect Learning Briefing
You should also be aware of the Sussex Multi-Agency Procedures to Support Adults who Self-Neglect which details:
- Self-Neglect and the interplay with;
- Signs and causes
- Collaborative multi-agency working
The Safe & Habitable Homes Forum is a Community Initiative Partnership to address self-neglect in people’s homes. The Forum shares good practice to sustain people with self-neglect concerns in suitable and safer homes for the benefit of their health and wellbeing in order for them to remain in the community, and to avoid residential care, hospital admission and loss of life. The Forum focuses particularly on hoarding or filthy and verminous conditions, and recognises that cases may be further complicated by eviction, cuckooing, substance misuse, domestic abuse, and re-housed when previously homeless.
The Forum, consisting of a multi-agency panel of partners, provides practice advice, guidance, and innovative solutions to practitioners. This is based on a strength-based and person-centred approach. Where appropriate, bespoke packages for people that could not be achieved with a ‘usual care’ approach may be explored. Hoarding is complex and can be related to many other concerns that impact managing a safe and suitable home.
The Forum promotes a step-by-step toolkit to support partners practice to be consistent. The Toolkit is available form Safe & Habitable Homes Admin housing4health@westsussex.gov.uk and will soon be available on the Connect to Support website under Types of Abuse (Self-Neglect). A Case Management Enquiry can be presented at the Forum for any person living in West Sussex who is over 18 years old and there is a professional concern of self-neglect related to suitable, safe and habitable housing.
Given the emotive nature of self-neglect and the associated risks, it is natural that professionals want to raise their concerns via safeguarding. However, in all but rare cases, safeguarding isn’t the most appropriate way of providing support, and may well delay someone receiving the right support. This may be because the person does not meet the thresholds for a safeguarding enquiry, that is as they do not have care and support needs, and they understand the risk they are posing to themselves and can manage this situation.
It is recognised that self-neglect related to housing concerns is a complex situation and that a variety of agencies will come into contact with the same person. Hoarding is now also, recognised as a mental health diagnosis (DSM V). Not all those who hoard will meet criteria for support from statutory services such as Mental Health.
Research and experience shows that the best outcome for those who self-neglect, is for all agencies to work with the person at their pace, using different methods of encouragement, whilst remaining non-judgemental and exploring different options for support.
The Forum Step-by-Step Toolkit references the following resources:
Please direct any Safe & Habitable Homes Forum case management enquires to housing4health@westsussex.gov.uk
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Our Adult J Learning Review
West Sussex SAB's published Learning Review for Adult J. Adult J was a person with a history of psychological illness and a diagnosis of Motor Neurone Disease. Adult J died as a result of substantial burns they sustained when lighting a cigarette from the stove within their home. The review found that the rationale for not intervening using Mental Capacity Act assessments and self-neglect processes were not always documented.
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Brighton & Hove SAB have published a SAR regarding James who was a 42-year-old male who had an acquired brain injury but who continued to live independently despite concerns around cuckooing and his mental capacity to care for himself appropriately and manage his finances. In the final six months of James’ life, it was noted by professionals that he appeared ‘dishevelled’ and ‘unkempt’. Part of the conclusion of this SAR was that assessments of James’ needs did not take sufficient account of his acquired brain injury and the impact this had on his (in)ability to care for himself. |
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Sandwell Sab have published a SAR on Anne, who was a 56-year-old female with long-term anxiety caused by an abusive marriage and traumatic life experiences including; her daughters diagnosis of cancer and the death of her father. Anne also had medical issues which impacted her mobility and her ability to care for herself. Her family raised concerns about self-neglect. There were no direct assessments of, or home visits to Anne, and therefore the poor conditions of her home were not discovered. The primary recommendation from this review was that self-neglect guidance was not known or complied with. |
East Sussex Safeguarding Adults Board Organisational Learning from Research & Safeguarding Adult Reviews in Self-Neglect.
In 2018 the University of Sussex commenced research, in conjunction with the East Sussex Safeguarding Adults Board, to explore how existing findings from SARs involving self-neglect can be embedded into practice. The research found that understanding and awareness of self-neglect appeared to have increased, since its initial introduction into the Care & Support Statutory Guidance. The research also revealed areas for attention including; mismatched expectations in inter-agency working, how best to communicate and reinforce key messages and ensuring that learning from reviews reached those who might benefit from it. You can read the Learning Briefing here.
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