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A quick introduction

What it is...

Self-neglect can involve a wide range of behaviour such as a lack of self-care and / or a lack of care of one’s environment resulting in a significant risk to the person's health and wellbeing. 

A key element of self-neglect is the refusal of support or services that would otherwise reduce or remove the risk of harm to them. 

What is the cause?

There is no one reason, neglect can arise due to a range of mental, physical, social and environmental factors. It may be a longstanding pattern or a recent change and be linked to loss, past trauma and/or low self-esteem with responses shaped by rationalisation, shame or denial. However, contributing elements may include:

  • a person’s brain injury, dementia or other mental disorder
  • obsessive compulsive disorder or hoarding disorder
  • physical illness which has an effect on abilities, energy levels, attention span,
  • organisational skills or motivation
  • reduced motivation as a side effect of medication
  • addictions
  • traumatic life change.

Why is this so challenging?

Although someone might be considered to be in need of support, they may disagree or find it difficult or be unable to accept that support.  This challenges us to:

  • To find the balance between 'trying to help' and 'not interfering' in that person's right to privacy; 
  • To consider how we can offer support in a way the person feels able to accept. this might involve building relationships and trust over time and focusing on issues that are of greatest concern to them; and
  • Support people to make informed decisions and to consider if there is evidence to suggest a person may lack mental capacity to make decisions about their care and support

How these pages can help you in your role

We know how challenging it is for practitioners and services to support people who self-neglect and for these reasons the Board has established the Self-neglect policy, procedures and guidance as well as a set of toolkit resources that can support you in your role.  Please make use of the guidance and resources on the following pages.

Also included is the  Leeds Self-neglect Strategy sets out the Board's ambition to promote the continued development of support and practice in this area. 

5 Quick learning points:

Learning from national research and our experiences in Leeds, tells us that the following elements can make all the difference to the outcomes experienced by people who self-neglect.

  1. Work with and alongside people - be the person they can trust, support them in ways they feel able to accept
  2. Don't work in isolation with your partners - multi-agency working is important
  3. Come together to assess risk - develop a shared understanding of the issues and concerns
  4. Come together to develop joined up actions plans - coordinated plans are important
  5. Consider issues of mental capacity - support people to make informed decisions and consider if there is evidence to suggest the person may lack capacity around their care and support.

Additional Issues

If someone who self-neglects or hoards, refuses support or services that would protect their safety and wellbeing, this should never be dismissed this as a ‘lifestyle choice’. 

People’s circumstances, life histories or their reasons for not seeking or accepting help, may not always be clear, but it will often be the case that people didn’t really choose to live in this way.

Self-neglect: Is it really a choice, when:

  • You don’t see how things could be different? 
  • You don’t think you’re worth anything different? 
  • You didn’t choose to live this way, but adapted gradually to circumstances 
  • Your mental ill-health makes self-motivation difficult? 
  • Impairment of your executive brain function makes your decisions difficult to implement?

Consider these real-life quotes:

“I get tired because daily routines are exhausting me, to do the simple things like get washed, put on clean clothes, wash my hair”.                                                                                                                                      
“I don’t have time to make a note of everything in the paper that has an interest to me and so I’m very fearful of throwing something away”.                                                               
“I’m drinking, I’m not washing; I wouldn’t say I’m losing the will to live, that’s a bit strong, but I don’t care, I just don’t care”.                                                                                                                                                     
“I got it into my head that I’m unimportant, so it doesn’t matter what I look like or what I smell like”

The Leeds Safeguarding Adults Board has undertaken Safeguarding Adults Reviews in relation to some people who unfortunately died in circumstances of self-neglect, to identify how organisations can work better together to provide support. 

The Leeds ALWAYS Care message has come from these reviews We have adopted the term as part of our Leeds Self-neglect Strategy and alongside our Self-neglect Policies, Procedures, and guidance, as a reminder to always see the person and always care about making a difference.

​"ALWAYS Care" - ALWAYS respond to self-neglect, small steps make a big difference:

  • Awareness, 
  • Look for the person, 
  • What is really happening? 
  • Assess the risk, 
  • Your time to act,                            
  • Solutions focussed

For further information - See our Always Care Resource

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