Self Neglect and Engagement – 7 Minute Briefing

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Overview

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.

The Issue

The Care Act 2014 incorporated self-neglect as an abuse category, recognising that self-neglect is a safeguarding concern for those adults in receipt of, or in need of care and support, when their health and well-being is being seriously compromised. There are many reasons why an individual may self-neglect, including previous trauma, enduring and deteriorating physical and/or mental health conditions e.g. dementia, and addictions. Individuals who self-neglect often decline support and may not identify that they need support.  There may be a limit to what professionals and family, friends and neighbours can do, if the adult is deemed to have mental capacity regarding how they live.

Reasons why Engagement may take more time

  • The person may be embarrassed to have visitors and withdraw from family, friends, their community and professionals, becoming socially isolated.
  • Anxiety, shame, fear and feeling overwhelmed can be contributory factors to refusing to engage and sustaining engagement with others, including professionals.
  • Refusal of support – this may be for many different reasons, but if there are concerns, it is important not to walk away.
  • The person may have an excessive attachment to possessions, or be a rescuer of animals, due to issues with emotional attachment which can relate to previous trauma.
  • The person may have lived in a particular way for many years, with deteriorating health exacerbating the risks to themselves and others.
  • Anti-social behaviour.
  • Mental health issues.
  • The person may have communication needs, making engagement more difficult for them.

Engagement

  • Confirm with the person their preferred form of communication.
  • Understand it may take time to develop rapport and trust: talking about the person’s interests and what is important to them at their pace, is the first step.
  • Promote consistency where possible – time limited work and short-term interventions are proven not to work.
  • Be person-led: the person’s wishes should always be considered, in line with risk thresholds and assessment of any immediate risk to the person or others.
  • Be respectful.
  • Understanding a person’s journey can help them and you. Identify how they can be best supported.
  • Use the Mental Capacity Act to empower and support with decision making.

Engagement and Risk

  • Communicate about risk openly and honestly with all involved, including the person.
  • The autonomy of an adult with capacity should be respected, including their right to make what others might consider to be an unwise decision. However, this does not mean the outcome should be no further action. Sustaining engagement is fundamental approach being taken.
  • Ensure there is a multi-agency approach and meeting(s) so that risk is a shared responsibility. This may be under safeguarding procedures, depending on the level of risk.
  • If the person is not seen or professionals lose contact – consider at the planning stage, what is the escalation plan/risks?
  • Is there a contingency plan in place: if needs change/ risks increase, co-ordinated with the person and the agencies working with them?
  • Be mindful of the ‘perfect storm’; a person’s reluctance to engage alongside an organisation being stretched for resources, can lead to unmanaged risk.

Team around the Person

  • Where possible, identify a professional(s) who will take the lead; a key worker(s) who knows or can support the person best or consider advocacy.
  • Identify who is providing informal support (such as informal carers) and whether they can continue to provide this: sometimes assumptions are made about what support is being provided, when it is not, or circumstances have changed. Consider Carer Assessments. The positive support from a carer can also mask the signs of self-neglect.
  • It is important that professionals offer flexible and creative solutions. This will promote engagement. Consider reasons why someone may not attend  appointments – for example limited access to transport/money.  
  • Can reasonable adjustments be made to enhance someone’s engagement/ involvement, communication and understanding?
  • Be empathic and non-judgemental.
  • Be tenacious in your engagement. It may take a long time to develop trust.

Links to further Information

Produced by the North East SAR Champions

v2 June 2025