Self-Neglect
Amendment
In March 2025, the chapter Self-Neglect and Hoarding was replaced by two new chapters ‘Self-Neglect’ and ‘Hoarding’
The Safeguarding Adults Board has developed local guidance to support safeguarding where self-neglect and/or hoarding is a factor. It should be read alongside this section of the procedure.
Self-neglect can broadly be defined as one or more of the following:
| Lack of self-care | This includes neglect of personal hygiene, nutrition and hydration, or health, to an extent that may endanger safety or wellbeing. |
| Lack of environment care | This includes situations that may lead to domestic squalor or elevated levels of risk in the domestic environment (e.g., health or fire risks caused by hoarding). |
| Refusal of assistance to alleviate issues | This might include, for example, refusal of care services in either their home or a care environment or of health assessments or interventions, even if previously agreed, which could potentially improve self-care or the home environment. |
Self-neglect can be a result of a range of factors and understanding the fundamental causes is essential for addressing the concerns effectively. Some causes of Self-Neglect can include:
- Mental health issues such as depression, anxiety or diagnosed schizophrenia and psychosis;
- Cognitive impairments such as dementia, intellectual disabilities, or traumatic brain injury;
- Physical health issues such as chronic illness; mobility issues or substance misuse;
- Social isolation; or
- Trauma.
Self-neglect may be intentional or unintentional, brief or prolonged, and can occur as repeated or isolated incidents.
Given the complex and diverse nature of self-neglect, responses by a range of organisations are likely to be more effective than a single agency response with reference to housing providers.
It is important to recognise that assessments of self-neglect are grounded in, and influenced by, personal, social, and cultural values and people working with the adult should always reflect on how their own values might affect their judgement.
Finding the right balance between respecting the adult's autonomy and meeting the duty to protect their wellbeing can be challenging. It may involve building up a rapport with the adult to come to a better understanding about whether self-neglect are matters for adult safeguarding or any other kind of intervention.
As there are many causes of self-neglect, it is helpful to try and determine when the self-neglect began as this can help explain why it is happening.
Self-neglect should not be seen simply as a lifestyle choice or the way someone prefers to live. Professionals still have a duty of care to understand why those decisions are being made and explore how to support someone who is self-neglecting and unwilling to engage with help. This involves building a relationship with the person and requires multi-agency collaboration, rather than decisions being made by a single individual or service.
If a person self-neglects because they are unable to care for themselves due to, for example a physical disability, then the most appropriate course of action may be a full assessment of needs and a care and support plan.
Some people self-neglect because of trauma, loss, or bereavement. A person may have been neglected or abused, may be experiencing domestic abuse, or may have had significant loss in their life. This trauma or loss may have affected their self-esteem, self-worth, and ability to self-care. Support from mental health services or a full needs assessment may be helpful to consider all aspects of the person's wellbeing.
It is important to ensure that the adult is not being abused, coerced or harassed into making decisions resulting in self-neglect. There could be a range of reasons why someone can self-neglect, it is important not to make assumptions. Professional Curiosity is particularly helpful in these situations. See Professional Curiosity.
Crucial to all decision making is a robust risk assessment, preferably multi-agency that includes the views of the adult and their informal networks of support.
The risk assessment might cover:
- Capacity and consent;
- Indications of mental health issues;
- The level of risk to the persons physical health;
- The level of risk to their overall wellbeing;
- Effects on other people's health and wellbeing;
- Serious risk of fire;
- Serious environmental risk e.g. destruction or partial destruction of accommodation.
The Clutter Image Ratings (CIR) may also be a helpful decision-making tool. It is a rising pictorial scale of nine photographs showing clutter in three rooms – living room, bedroom and kitchen. See Clutter Image Ratings (CIR).
If the adult has a carer, it is important to consider their ability to meet the needs of the adult and rule out any neglect or acts of omission. It could be that the carer has unintentionally neglected the caring role because they are no longer able to cope.
Carers can also neglect themselves due to the stresses and demands of their caring responsibilities. It is important to consider whether a carers assessment may be required. Under the Care Act 2014 a carer is eligible for an assessment of their needs regardless of how many hours a week they provide care. See: Legal Requirements of a Carers Assessment.
The Environmental Health Service (EHS) has a range of powers to intervene where a property is in a condition that is prejudicial to health, or where the premise is materially affecting neighbouring premises.
In addition, where properties are verminous or pose a statutory nuisance, the EHS will take a leading role in case managing the necessary investigations and determining the most effective means of intervention.
Where the adult is residing in conditions that pose a threat only to their own welfare the powers available to the EHS may have limited or no effect.
Self-neglect becomes a safeguarding issue when an adult is at risk of significant harm or there is a risk of harm to their health, safety, or wellbeing due to their inability or unwillingness to care for themselves.
An update to the Care Act statutory guidance in March 2016 gave detail as to when self-neglect should be considered safeguarding:
"It should be noted that self-neglect may not prompt a section 42 enquiry. An assessment should be made on a case-by-case basis. A decision on whether a response is required under safeguarding will depend on the adult's ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support."
Signs that Self-Neglect may be a safeguarding concern are:
- When it is apparent that a person has poor personal hygiene, such as unkempt appearance, body odour and/or wearing unwashed clothing consistently;
- Where there is a decline in health because of non-engagement with essential treatment, for example declining medication, refusing pressure ulcer treatment;
- Their living environment is unclean, such as accumulation of rubbish, clutter, dirt or signs of pests or insects, which may also lead to fire risk or risk to others;
- Unsafe living conditions to include a lack of running water, heat and or electricity;
- Evidence of malnutrition or dehydration, lack of food in the home and weight loss.
The National Network of Safeguarding Adults Boards (NNSAB) website provides lots of useful information about safeguarding, including sharing best practice. The following is a list of common themes from Safeguarding Adult Reviews of deaths due to self-neglect:
- Refusal of help;
- Inadequate or delayed risk assessments;
- Lack of Multi-Agency Coordination;
- Failure to Escalate Concerns.
The purpose of SARs is outlined in the statutory guidance as to ‘promote effective learning and improvement action to prevent future deaths or serious harm occurring again’.
Some identified areas of improvement for services in relation to self-neglect are:
- Earlier, coordinated risk assessments;
- Enhanced multi-agency collaboration;
- Better use of mental health resources:
- Proactive escalation of concerns;
- Involvement of advocacy services.
For further information see: National Network for Chairs of Adult Safeguarding Boards.
Last Updated: March 13, 2025
v6
