Self neglect

Self-neglect is something we are coming across more often than I have ever experienced before. It is something I feel like people are more aware of and more concerned about. We receive safeguarding reports about it but it can be very difficult to establish why someone is self neglecting or even get them to see that is what is happening.

Statistics show us that self neglect prevalence rates of 116-121 per every 100,000 of the population although it is likely that in reality it is much higher than that as it is under reported. This sounds like a low number when you look at it generally but it is definitely on the rise and there does not seem to be consistency across the board about the approach to be used or whether it should be reported as safeguarding or not. This has meant that there is an unfortunate amount of people who are being discussed in Safeguarding Adult Reviews (SARs) because referrals were not made to relevant authorities meaning that no support was provided and they experienced significant harm or even lost their lives due to the neglect. In a national analysis of Safeguarding reviews covering April 2019-March 2023 it showed that self-neglect was involved in 60% of cases and that self was cited as the perpetrator in 76% of cases. This is definitely on the rise and something we need to be trained or guided in when supporting those we work with. This would mean that the amount of SAR's taking place due to self-neglect would hopefully lower. I say hopefully because there will always be situations where someone has capacity and does not want to change anything. We will always do what we can to help people improve their situation and we will look at how to make them safer but we cannot always decide whether they choose to listen or not.

I think when it comes to working with someone who is self neglecting the first thing to remember is that everyone's expectation regarding cleanliness and tidiness is different. What I think is acceptable within a home may be extremely different to someone else. Unless somewhere is unsafe then there are many different ways to approach the situation and think about what else may be going on before making any major changes. The other aspect is neglecting yourself, meaning not washing, dressing or looking after yourself. Generally from my experience the majority of the time these two things go hand in hand.

A lot of the time when a situation like this is brought to the attention of Social Workers the initial feeling is to want to go in and save the person from the situation they are in or the property they live in. We hear the word inhabitable often but what does that actually mean in reality, is it truly unsafe or does how the person has chosen to live just not match up with the person who made the referral.

I was on some training recently focused on Safeguarding who had us work through some case studies and talk about how we would support the person. One talked about someone whose house was not cared for, they did not care for themselves and there were birds in the house due to a broken window. We talked about all the things we would do and how we would support the person which is fine in a training session but it would be interesting to see how that situation would go in the real world. We can say that we would get the window fixed, house cleaned, build a relationship and all the other wonderful things on paper but when actually working with people it is not always that easy. It may take an extremely long time before they are willing to speak to us or make any steps forward. We have referrals come over which talk about the need to build rapport with the person to get them to accept support but maybe that approach is not the right one to take. Maybe we need to be building the rapport to understand the situation and establish what the person wants instead of presuming or expecting that they will make all the changes cos its what is “best for them”, actually what do THEY think is best for them and why.

It can be easy to look at a situation such as these and think that people can't be bothered. That they do not want to care for themselves or their homes but have we stopped to think what others factors are potentially at play. Could it be that the person is neuro diverse and struggles with starting tasks, that everything feels overwhelming and seeking support feels like judgement. Could it be that they have recently been widowed and their spouse always did the household tasks. They don't know how but are also lost in their grief and struggling with motivation. Is it that they genuinely don't understand the risks of not looking after themselves and their home. Do they need someone to have an honest conversation with them about it. Are they having a mental health crisis and have no support system. There are so many different reasons why people end up in situations where they live in a cluttered, messy or dirty home as well as struggling to care for themselves.

In scenarios like this I would argue that the first step is not just to build the rapport but also to almost be a detective and uncover what is deeper. Try to gather information from those closest to the person (where possible), speak to the GP, read through the record and go into it with an open mind. It can be so easy when the notes state that the house is unkept, dirty, unclean or full of clutter to go into it with a preconceived idea of what to expect and with a list of suggestions but some people need a lot more before they are willing to even speak to a Social Worker. It also comes down to time, we are all busy and resources are stretched thin but sometimes time is the first thing someone needs from us. They may have nobody that sees them on a regular basis so they are lonely which is contributing to their mood and impacting how they care for themselves and their environment.

It reminds me of something I learnt going back to my first placement which is that what we think is most important to someone does not necessarily always match up with what is. Although there may be a specific medical condition or disability causing some of the issues they are experiencing actually that may be the last thing they want to think about. It may be that chatting about simple things like the weather is the right way to get things started instead of going in talking about the self-neglect first and foremost.

We need to do what we can whilst letting them lead the situation so that we can work together and get the best, most suitable outcome for them not what makes the best case study or looks best on paper. Some of the scenarios we worked on in the training were never even referred into social services or safeguarding because people aren't sure of the threshold or when to report and that person lost their life. We need to be learning from these tragic situations so it does not happen for someone else due to people being unsure what the right thing to do is.