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Please note: this is an extract of the Self-neglect policies,  procedures and guidance document. Refer to this for the full guidance

Response to the declining of support and services 

Key points: 

  1. Practitioners should always work to engage with people, offer all the support they are able to without causing distress, and understand their limits to intervention if the person does not wish to engage.                                                                                                                                                 
  2. Where someone is assessed as not having capacity in relation to relevant decisions, actions should be taken in the persons best interests, in accordance with the Mental Capacity Act 2005.                                                                                                                                                                     
  3. Where mental capacity is presumed or has been assessed as being present, and the person is expressing that they do not wish to engage with services, any actions taken should be proportionate to the risk and with due consideration of Article 8 of the Human Rights Act.                                                                                                                                      
  4. Where a person is declining support assessed to be essential to their health or wellbeing, then further actions may still be appropriate to assess risk, offer support and support their engagement. However, in each case practitioners must weigh up whether their actions are proportionate to the risks, and no more intrusive than is necessary to achieve a legitimate aim. 

‘Talk to me, Hear my voice’ is the citizen-led practice principle adopted in Leeds. This is a phrase given to us by citizen groups, and is a short-hand term for working alongside someone to understand the person’s views, wishes, circumstances and desired outcomes. It is not always the case however, that people say, ‘Talk to me’. Sometimes they will say ‘I don’t want your help’, or simply ‘go away’ instead. This can be the biggest challenge for practitioners when working with adults who have self-neglecting behaviours as they may refuse to engage or accept support. 

The Leeds ‘Talk to me, Hear my voice’ principle is one of trying get alongside and work with people, and this includes seeking to understand why the person is reluctant or unwilling to seek or accept support. Practitioners should seek to engage with people who are self-neglect with due consideration of the best practice principles set out in Self-neglect policy, procedures and guidance. 

Before disengaging with a person declining support or services: 

  • Consider if the person has been provided with all the necessary information in a format they can understand 
  • Assess the risk as far as is possible given the person’s limited engagement 
  • Be open and honest; share concerns about these risks with the person self-neglecting  
  • Check as far as possible, if the person has understood the options and the consequences of their choices 
  • Listen to and show understanding of the person’s reasons for mistrust, disengagement, refusal and their choices and consider if there are ways to provide support in the way the person feels able to accept 
  • Where the person is willing, ensure there is the time to have conversations over a period of time to develop a trusting relationship 
  • Check out your concerns with other relevant agencies in accordance with the Safeguarding Adults Board: LSAB Information Sharing Policy 
  • Consider who (whether family, advocate, other professional) can support engagement with the person at risk. You may not be the best person. 
  • Formally assess a person’s mental capacity if there is evidence to indicate this is lacking in relation to these specific decisions. 
  • Formally record decisions, actions, attempts to engage and peoples responses. 

However, where there significant threat to the person’s health and wellbeing, practitioners and services should seek to provide continued support and take further actions in accordance with this policy. 

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