Self Neglect and Hoarding: Learning from Research Suzannah Marsden - - PowerPoint PPT Presentation

Self Neglect and Hoarding: Learning from Research

Suzannah Marsden Research Advocate

What is Self Neglect?

• No universally agreed definition which has

created barriers in the development of consistent policies and procedures.

• Complex reasons for self neglect also mean

that the term has been difficult to define.

• Professionals views may be influenced by the

level of harm or risk associated with the behaviour.

What is Self Neglect?

HOW WOULD YOU DEFINE SELF NEGLECT? TALK TO YOUR PARTNER AND COME UP WITH A DEFINITION OF SELF NEGLECT

What is Self Neglect?

• In the publication ‘Self Neglect Policy and practice: research

messages for managers’ (SCIE) self neglect is broadly defined as;

• Lack of self care such as neglect of personal hygiene,

adequate nutrition, hydration, health thereby endangering safety and well being

• Lack of care of ones environment including hoarding and;
• Refusal of services to mitigate risk of harm

Care Act statutory guidance says that self neglect covers a wide range of behaviour, including neglect of one’s personal hygiene, health or surroundings and hoarding (DH 2016)

• Self neglect may be as a result from either

unwillingness or inability to self-care and sometimes may involve both

• Practitioners must explore both dimensions fully

INABILITY TO SELF CARE UNWILLINGNESS TO SELF CARE SELF NEGLECT

Why Self Neglect is such an issue of concern?

• Findings from Serious Case

Review and Safeguarding Adults Reviews.

• Concerns from Coroners Courts,

Ombudsmen and Partnership Agencies.

• Additional category of Self

Neglect in relation to Adult Safeguarding

• Impact of Inter agency working

and differing perspectives

• Tensions between values such as

rights to self determination and duty of care.

• Complex legislative frameworks
• Staff anxiety
• Managing significant risks
• Complexity around issues relating

to capacity

• Levels of knowledge, skills and

expertise

• Lack of a cohesive and consistent

understanding of Self Neglect.

• Trying to understand individuals

and their stories (which takes time and often involves assertive engagement with people).

What does the Research Say?

• Research in this area has included reviews of

policy and practices that have produced positive outcomes from the perspectives of key agencies and individuals (including service users) in relation to Self-Neglect (Braye et al 2014, SCIE Briefing, 2015).

• It identifies both successful service

involvement and the organisational structures needed to support this involvement

What does the Research Say?

Service Involvement-what helps?

• Where relationships can be nurtured over time.
• Understanding service users life histories.
• Robust Mental Capacity Assessments which

consider both decisional capacity (capacity to make decisions) and volitional capacity (capacity to carry out decisions).

• Understanding of complex legal options.
• Multi agency working
• Use of creative/flexible interventions

What does the research say?

Organisational issues-what helps?

• Shared and consistent understanding of what

defines Self –Neglect

• Formal rather than ‘ad hoc’ systems to ensure

coordination and communication between agencies.

• Allowing time for longer term engagement.
• Analysis of data regarding self neglect

referrals/outcomes.

• Training and practice development

Some questions for practitioners.

Organisational/team level

• How many service users with Self Neglecting behaviours does

your team work with? Are there training gaps?

• How established are your relationships with other key

agencies such as Environmental Health, Housing, Fire Services

• etc. Could these be better? How?
• Does your borough have a Hoarding panel?
• Is there a multi agency Self Neglect policy in your borough?
• How does your service process Safeguarding Referrals relating

to Self-Neglect?

• Is you team able to support the kind of long term engagement
• ften needed in such cases?

Some idea’s for Practitioners.

Individual practitioners

• Try and ‘find the person’. Understand the meaning of Self

Neglect for that person.

• Working at the persons own pace and recognising their

previous possibly negative experience of services.

• Where possible allowing the person to have some control
• ver the nature and pace of any intervention.
• Focus on risk minimisation
• Utilising a strengths based approach
• Awareness of legal powers, duties and the complex interfaces

between legislation.

Some idea’s for Practitioners

• Robust assessments of Mental Capacity. Willingness to involve
• ther professionals and to carry out these assessments via

several visits. Assessing decisional and volitional capacity.

• Creative interventions-harm reduction interventions (eg

utilising fire safety measures even if hoarding is still a problem).

• Decluttering/deep cleans are often not effective when used in

isolation.

• Sometimes coercive measures can be effective if combined

with support.

• Develop good communications ad working relations hips with
• ther agencies. Developing shared responsibilities and

coordinated interventions/support

Literacies for Self Neglect

Legal Literacy Knowledge and skilled application of legal options or requirements Ethical literacy Reflective and critical consideration and application of values Relational literacy Engaging with people’s biographies and lived experience. Demonstrating concerned curiosity Emotional literacy Managing stress and anxiety. Recognising the impact of personal orientations to practice Knowledge literacy Drawing on different sources of evidence Organisational literacy Understanding accountability and management of practice within a multi-agency context Challenging procedures, cultures and decision making where these make error more likely Decision making literacy Sharing information Managing the multi-agency partnership Explicitly weighing the evidence for different options

(Braye and Preston-Shoot 2016a)

Some idea’s for Practitioners…

• Use of Personal Budgets for

individualised care packages.

• Use of case conferences, multi

agency risk panels, reflective practice forums.

• Find out if your borough has multi

agency policies related to Self Neglect (Westminster and RBKC have developed such policies)

• Recognising that working with people

with Self Neglecting behaviours can be difficult, anxiety provoking and present with particular ethical complexities.

• References and

information

These learning materials were based on the publications; ‘Care Act 214 Guidance’ ‘ Self Neglect policy and practice: Key research messages’ Braye, Orr and Preston-Shoot 2015, published by the Social Care Institute of Excellence.

Additional References

‘Self Neglect Policy and practice: research messages for practitioners’ Braye, Orr and Preston- Shoot, SCIE, 2015 ‘Self Neglect and Adult safeguarding- findings from research’, DoH commissioned report, SCIE, 2011 ‘Self Neglect Policy and Practice: Building an Evidence Base for Adult Social Care’, SCIE, November 2014 ‘Tenants who Self Neglect-Safeguarding in Housing’-section on SCIE website with practice examples.