Best practice doesn't just happen on its own. We need to create the conditions for it to thrive. Working with people who self-neglect presents unique challenges for practitioners and services. To meet these challenges each organisation needs to reflect on how prepared they are to support someone living in these circumstances: 

Being an Always Care organisation involves: 

• providing front-line practitioners with the knowledge and understanding to work with those who self-neglect. 
• supporting staff teams to develop the skills needed to work with people with complex needs, and 
• providing the advice and support practitioners need to carry out challenging roles. 

Our Ask, is simply to review the pillars of the Leeds Self-neglect Strategy below: 

• People: Always work with and alongside people who self-neglect 
• Prevention: Always work to prevent the risk of serious self-neglect 
• Partnership: Always bring partners together to support those at risk 
• Practice: Always develop and support best practice in Leeds 

And consider what more your organisation can do to support your teams achieve the best possible outcomes for those who self-neglect. 

To assist, we are providing you with a range of resources here that you can use or adapt for your organisation. 

How to be an Always Care organisation:

A. Promote the Leeds Always Care practice principles within your organisation 

• Awareness
• Look for the person behind the behaviour 
• What is really happening 
• Assess risk and the person's needs - Be open and honest about risks and options 
• Your time to act 
• Solution focused 

B. Find ways to enable your teams to work with and alongside someone who self-neglects 

Helping people who self-neglect often requires building trust and relationships. This can take time and with busy case loads and other workplace pressures this can be a challenge for services. Please consider how you can protect time for practitioners to build relationships with those most at risk from self-neglect. 

Promote strength based, person centred approaches. That is, recognise people's strengths and what they can do, rather than focusing solely on what is difficult for them. Start by recognising their issues and priorities. 

C. Adopt flexible approaches 

Recognise why someone might find it difficult to accept support. Be willing to work in alternative ways to make accessing support easier for the person at risk. Not everyone will attend an appointment for example. 

How to be an Always Care organisation:

A. Raise awareness of self-neglect 

Help your staff and volunteers to spot the signs and understand what self-neglect involves and why it can happen. Challenge those who dismiss it as a lifestyle choice. This Quick Introduction to Self-neglect may be helpful for you or your teams. 

B. Set out your expectations of staff when someone declines essential support 

Provide your teams with guidance as to what to do and consider, when someone in need declines support that is so essential to their health and wellbeing. This LSAB Responding to Service Refusals guidance will assist. You could adapt this for your organisation. 

C. Promote Fire Safety awareness 

People have died in Leeds in fire related incidents involving self-neglect. The risk is higher within highly cluttered environments or where fire risks are not being managed safely within the home, for example safe cooking or smoking practices. 

Ensure your staff and volunteers have the skills, knowledge and confidence to identify and respond to home fire risks. Ensure your assessment processes enable practitioners to identify and respond to concerns. Be aware of the Safe and Well Visits offered by West Yorkshire Fire & Rescue Service, and access these as and when needed. 

How to be an Always Care organisation:

A. Work together in partnership for those who self-neglect 

Ensure your organisation works in a multi-agency way when it is involved with someone who self-neglects. Work positively to engage with other partners; respond positively to requests to meet and discuss concerns. Follow the LSAB Self-neglect policy, procedures and guidance 

Make use of multi-agency meetings, assess risk together, and develop shared action plans. See available meeting agenda's and assessment templates: LSAB Multi-agency risk assessment and meetings. Do all you can to attend and contribute when a meeting is called. 

Always seek to resolve professional disagreements in the best interests of the person at risk: LSAB resolving professional concerns guidance 

B. Ensure services and contractors commissioned by your organisation understand their role and responsibilities in relation to adults who self-neglect 

If you commission services you have additional responsibilities. Whatever the service you commission, you have a role in in ensuring those services know how to recognise and respond to issues of self-neglect. Be clear about your expectations, pass on the information they will need to fulfil their role, check this happens. 

How to be an Always Care organisation:

A. Embed the LSAB Self-neglect Policies, procedures and guidance 

Ensure all Self-neglect policies and procedures are adopted and embedded into practice, inclusive of: LSAB Self-neglect policy, procedures and guidance - this sets out best practice principles and agreed approaches within Leeds, and our Self-neglect Toolkit resources 

B. Actively promote understanding of mental capacity safeguards (including understanding of Executive Capacity) 

Ensure your staff and volunteers understand that there can be difference between what people say they can do in a mental capacity assessment and what they may actually be able to do in practice. This is why it is important that assessments are supported by real life observations. It is important that your training around Mental Capacity includes this. The Mental Capacity and Self-neglect references listed on LSAB website may assist. 

C. Build skills and knowledge 

Consider the following:

• Professional curiosity guidance - this seeks to support practitioners to see the person behind the behaviour, and for organisations to support and enable professionally curious practice. Our approach in Leeds: "Look further, think wider, see more"                                                                                                                   
• Think Family, Work Family approaches - recognise that people usually live within family network. Is there a child in the house that is impacted? Is there a family carer who is entitled to support in their own right? Are there family members who can help bring about change?                                                                                                 
• Sometimes alcohol dependency can be an underlying or contributing factor in self-neglect. Check out the available training for your staff teams: Training for Professionals - Forward Leeds                                                                                                                                                                                                                  
• Sometimes self-neglect can be associated with traumatic life experiences. An understanding of such approaches will help in building connections and understanding needs of the person at risk. For more information see: Working definition of trauma-informed practice - GOV.UK                                                                                                                                                                      
• Knowing and understanding legal frameworks is important in finding the best ways to support an individual at risk. This LSAB guide can help: Legal Literacy 

D. Provide supervision and reflective practice opportunities 

Working with people who self-neglect can be challenging, ensure your practitioners have the practical and emotional support needed, as well as opportunities to reflect on and develop their practice. 

Help practitioners to question their assumptions and reformulate their approaches. This Reflective Practice Checklist may assist. 

E. Assure yourself of good practice 

Don't assume; know that your organisation is working in the best ways to support people who self-neglect. Talk to your front-line practitioners, ask questions, find out what really happens and what the challenges are. Take wider steps to support practitioners with difficult roles and assure yourself of practice within your organisation. 

How to be an Always Care organisation:

A) Nominate a self-neglect practice lead 

Improving outcomes for people who self-neglect is challenging but achievable. Even small changes can make a big difference to the risk being experienced and people's quality of life. Having the right foundations in place will support front-line practice, and this starts by us all striving to be Always Care Organisations. We recommend nominating someone within your organisation as the self-neglect practice lead, someone who is passionate and who has the energy, to review this guide and consider how to take forward the recommendations within the context of your organisation. 

Thank you for taking forward these issues and challenges