Safeguarding practice guidance: self-neglect and hoarding

Self-neglect includes situations where a person is declining support with their care needs, hygiene, health or their environment, and this is having a significant impact on their overall well being. It can be a complex and challenging issue to address, because of the need to find the right balance between respecting a person's autonomy and fulfilling a duty to protect the adult's health and well-being.

Self-neglect implies there may be an inability or unwillingness or both to attend to ones' personal care and support needs and impact on well-being and safety. It may manifest in different ways, from lack of self-care to an extent that it threatens personal health and safety by way of, neglecting to care for one's: personal hygiene, and/or health, and/or surroundings, and/or hoarding. Hoarding is the excessive collection and retention of any material to the point that it impedes day to day functioning.

Self-neglect differs from other safeguarding concerns and forms of neglect as there is no perpetrator of abuse, however, abuse cannot be ruled out as a purpose for becoming self- neglectful.
 

People may self-neglect and/ or hoard for a variety of reasons, such as:

• unmet care and support needs
• an inability to maintain own self-care and household chores
• chronic use of substances and/or alcohol impacting on their functioning
• having parents who hoarded (a learnt behaviour)
• childhood neglect, trauma or an adverse experience
• the impact of abuse or neglect domestic violence and abuse
• life changing events such as loss of a job, social status or accommodation, bereavement
• the loss of a strongly held value system
• reduced independence due to an accident, trauma, major illness or the onset of frailty

An intervention or investigation into the reasons for self-neglect is necessary to determine if any form of abuse has taken place. This is not always easy, as it requires the concerned person to develop a rapport with the self-neglecting person and gain their trust in order to ask about their emotions and how they feel about themselves.

Safeguarding Adults Policy and Procedures

Section 2.6 in the Berkshire Safeguarding Adults Policy and Procedures is dedicated to self-neglect.

Safeguarding Adult Reviews

Below is a directory of published safeguarding adult reviews (SARs), by the SAB where learning from self-neglect has been identified. The SAB acknowledge that there are reoccurring themes from local and national learning from SARs that must be addressed. The SAB consider what the obstacles are in implementing recommendations and sustaining improvement and there will be a focus on good practice to promote learning, alongside an emphasis on good quality care principles and the role of effective support and supervision of the workforce to embed learning and inform future practice.

• Pauline [1MB]  - published 2023 by West of Berkshire Safeguarding Adults Board
• Louise [694KB]  - published 2022 by West of Berkshire Safeguarding Adults Board
• Ken [144KB]  - published 2021 by West of Berkshire Safeguarding Adults Board
• Henry [336KB]  - published 2020 by West of Berkshire Safeguarding Adults Board
• Carol [646KB]  - published 2020 by West of Berkshire Safeguarding Adults Board
• Paul [451KB]  - published 2019 by West of Berkshire Safeguarding Adults Board
• Aubrey [518KB]  - published 2018 by West of Berkshire Safeguarding Adults Board

There is a national SAR database, where you can search for SARs where learning in regard to self-neglect has been identified.

Frameworks and toolkits

Guidance and templates to help staff safeguard individuals who may be at risk from hoarding and self-neglect:

• the  Self-Neglect and Hoarding Safeguarding Pathway Toolkit [246KB]  has been created to support professionals across the West of Berkshire in their decision making when considering if a safeguarding concern should be raised in response to concerns in regard to vulnerable adults that are or are at risk of self-neglecting and/or hoarding - on completion of the toolkit a total risk score will be obtained and advice on what action should be taken in regard to the total score is provided - there are two example toolkits based on fictitious cases  Mr Brown [298KB]  and  Mrs Red [306KB] , please refer to for best practice examples of completed toolkits
• Supporting Individuals to Manage Risk and Multi Agency Framework (MARM)
• Clutter Image Ratings - used to determine the severity of hoarding in peoples homes - these have been produced as part of a study and are used widely across the world - It is understood that in the UK 2.5% to 6% homes are effected by hoarding

Learning materials

• in November 2023, Sue Ross, Assistant Director Safeguarding, Quality, Performance and Practice at Reading Borough Council, delivered a  presentation on Hoarding and learning from SARs [339KB]
• on the 18th October 2022, in response to the West of Berkshire Safeguarding Adults Partnership Boards Priority on Self-Neglect, the Boards Independent Chair Professor Keith Brown delivered a session on Self-Neglect and the Mental Capacity Act:

• Keith's story: produced by Birmingham Safeguarding Adults Board, a personal and touching film about hoarding
• in December 2020 the SAB produced a  5 minute briefing on self-neglect [257KB]
• in May 2021, West Midlands Regional Adults Safeguarding Leads delivered a webinar on Self-Neglect and the Mental Capacity Act
• the NHS have a useful guide on consent to treatment
• 'Self-Neglect: Understanding my Story - This is what works' talk by Deborah Barnett
• Lambeth Together produced a short animation which explains self-neglect and the role everyone plays
• on the 8th February 2023, Suzy Bray, Emerita of Social Work at University of Sussex and Independent Safeguarding Consultant, delivered a webinar on Identifying and Responding to Self Neglect - you can  download a copy Suzy's presentation here [643KB]
• during safeguarding adults week 2022 there was a day focused on self-neglect and the following learning tools was produced:
  • self neglect learning brief [180KB]
  • a recording of the webinar Self-Neglect presented by Suzy Braye - the webinar provides information and guidance regarding the psychology of self-neglect and how to work with this
  • a recording of the webinar on hoarding presented by Jo Cooke from Hoarding Disorders UK - the webinar provides guidance in order to work effectively with individuals who exhibit hoarding behaviours
  • a recording of the webinar on self-neglect and fire risk presented by Neil Whitemann from the Royal Berkshire Fire and Rescue Service - the webinar provides information and guidance of how to manage fire risk when working with individuals who may be at risk of fire at their homes due to hoarding behaviours