Self Neglect: An Overview – 7 Minute Briefing

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This briefing is part of a series on self-neglect. Each briefing should be read alongside your Safeguarding Adults Board multi-agency policy, procedures, and practice guidance

Self-Neglect: Definition

Self-neglect covers a wide range of behaviour relating to care for one’s personal hygiene, health or surroundings, and includes behaviour such as hoarding. Three recognised forms of self-neglect include:

  • Lack of self-care – this may include neglecting personal hygiene, nutrition and hydration or health (e.g. non-attendance at medical appointments/not taking medication as needed)
  • Lack of care of one’s environment – this may result in unpleasant or dirty home conditions, and increased risk of fire due to hoarding
  • Refusal of services that could alleviate the above

What to look for:

Self-Neglect can happen anywhere (including health & care settings), However, adults who self-neglect are more likely to live alone, be an older person, experience mental ill-health, have alcohol or drug problems and have a history of poor personal hygiene or living conditions. Signs include:

  • Not enough food, or food is rotten
  • The home is filthy, odorous, hazardous or unsafe
  • Major repairs/maintenance to the home is required
  • Presence of human or animal faeces in the home
  • Accumulation of possessions
  • A large number of pets and/or abuse or neglect of pets
  • The adult may:
    • Have dirty hair, nails and skin
    • Smell of urine and/or faeces
    • Have skin rashes or pressure ulcers
    • Have a poor diet and/or hydration
    • Show increased confusion or disorientation    
    • Have deteriorating physical or mental health e.g. diabetes, dementia
    • Be socially isolated

Mental Capacity

The Mental Capacity Act is a law that defines mental capacity for a specific decision as the ability to understand, retain, use or weigh up and communicate the information relevant to the decision. Executive functioning is the ability to think, act, and solve problems, using the information learned and remembered. Capacity and executive functioning in respect of decision making is important for practice but on some occasions, capacity is used to justify not intervening in cases of probable self-neglect, therefore leaving people at considerable risk. Promoting autonomy and supporting protection should not be mutually exclusive but balanced to best serve people experiencing self-neglect. Consideration should also be given to Making Safeguarding Personal and building a trusting relationship with the person in order to help them achieve their desired outcomes.

One of the first considerations should be whether the person has mental capacity to understand the risks associated with the actions/lack of actions.  Any action proposed must be with the person’s consent, where they have mental capacity, unless there is a risk to others (such as a fire risk due to hoarding, or public health concerns).  In extreme cases of self-neglect and/or hoarding behaviour, the very nature of the environment should lead professionals to question whether the person has capacity to consent to the proposed action or intervention and trigger a mental capacity assessment.  Consider if the person has the functional capacity to make a particular decision and executive functioning which is their ability to carry out the decision.  Please see links below for further information on Mental Capacity and executive functioning. 

The Care Act Statutory Guidance recognises it can be difficult to distinguish between whether a person is making a capacitated choice to live in a particular way (which may be described as an unwise choice or decision) or whether:

  • The person lacks mental capacity to make the decision; or
  • There is concern regarding the adult’s ability to protect themselves by controlling their own behaviour

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Professional Curiosity

Professional curiosity is about exploring and understanding what is happening with an individual and/or within a family. It is about:

  • Enquiring deeper and using proactive questioning and appropriate challenge
  • Understanding one’s own responsibility and knowing when to act, rather than making assumptions or taking things at ‘face value’
  • Thinking ‘outside the box’, beyond a practitioner’s usual professional role, considering all of the individual’s/family’s circumstances holistically and using a trauma-informed approach.
  • Being curious, engaging with individuals and families through visits, conversations, asking relevant questions – gathering historical and current information

Language

Language (both that which is written/typed and spoken words) used by professionals about individuals who self-neglect should be respectful of the person, not judgemental, and should also follow Making Safeguarding Personal principles. 

Using positive, respectful language can build trust and lead to better outcomes for the individual, as they are more likely to engage with any suggested changes, services or interventions. 

Engagement

Individuals who self-neglect often decline support and may not identify that they need support. Due to the nature of self-neglect, be mindful that engagement may take time and fluctuate.

Advocacy is taking action to support people to say what they want, secure their rights, pursue their interests and obtain services they need. Advocacy providers and Advocates work in partnership with the people they support and take their side, promoting social inclusion, equality and social justice.

Strengthening the role of Advocacy in Making Safeguarding Personal

Consideration must be given to the use of more creative ways to engage adults and their families which promote effective relationship building, engagement and not disengagement. Where a person has been subject to safeguarding interventions, all partners should consider how they involve the person and their family from the very outset of those enquiries and how statutory and non-statutory advocacy can support this including consideration of Carers Assessments for those who are part of the person’s family and wider support network.

Multi-Agency Roles and Responsibilities

Successful intervention is more likely when different services work together to identify solutions and look at a person’s needs as a whole. Consider a Multi-disciplinary team meeting approach and identify a key worker through which care and support is coordinated by a named team member. While things like cleaning interventions may provide a short-term solution to self-neglect and/or hoarding, longer-term solutions should be sought as part of an integrated multi-agency plan. The aim is to prevent serious injury or death of the individuals by ensuring that:

  • The person is empowered as far as possible to make their own decisions and to make changes to their circumstances that lead to positive outcomes
  • There is a shared, multi-agency understanding and recognition of issues
  • There is effective and practical multi-agency working, which challenges practice and ensures that concerns/risks receive appropriate prioritisation
  • All interventions to work with an individual who has self-neglecting and/or hoarding behaviours are based on the principles of making safeguarding personal
  • All agencies and organisations uphold their duties of care

Raising A Safeguarding Concern

Responding to self-neglect depends upon the level of risk or harm posed to the person and/or others, and whether the person is able to protect themselves and determine their own action. Workers should refer to their local safeguarding adults’ guidance to determine whether a safeguarding concern should be raised. The person who has the concern should raise the Concern.

Questions to Consider

  • Do you know what self-neglect is?
  • Do you know what the key signs of self-neglect are?
  • Are you aware of your responsibilities under the Care Act 2014 in relation to self-neglect, and the available safeguarding actions that can be taken as a result of this?
  • Do you know that self-neglect is a qualifying factor for an assessment of care and support needs under the Care Act 2014?
  • Do you know what your local Safeguarding Adults Board’s Multi-Agency Self-Neglect Policy, Procedure, Guidance and Briefings are, and how to make best use of these?

What you and your staff can do to gain a greater understating of Self-Neglect

  • All agencies should remind staff of their obligations to comply with their local Safeguarding Adults Board’s Multi-Agency Safeguarding Adults Procedures.
  • Ensure that where adults need assistance to address the risks associated with self-neglect,
    professionals work together to support people to make decisions about their wellbeing, providing
    this help in a timely and consistent way.
  • Ensure that the aims of Making Safeguarding Personal are embedded in all interventions.
  • Make yourself aware of local self-neglect guidance and resources, as well as the Regional
    Safeguarding Adults Network resources on self-neglect

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Produced by the North East SAR Champions

V2 June 2025