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Approach to self-neglect in Darlington and Key Principles

The DSP believes the challenges self-neglect presents are best addressed through following three key principles:

Key Principle 1: Robust partnership working from the earliest practical stage

Early coordinated interventions from a range of partners, working together with the adult to assess needs and find solutions should be tried first, where this is possible.

  • The partner agency that first identifies a concern about self-neglect should take the initial responsibility to bring together appropriate partners to discuss these concerns and identify the lead agency from that point.
  • In some cases, a point may be reached where reporting concerns about self-neglect for an Adult Safeguarding Enquiry led by Adult Social Care may be necessary.
  • Where self-neglect is a concern, a risk assessment should be routinely completed before an agency closes a case due to the adult not co-operating, engaging or keeping appointments. The Care and Support Statutory Guidance (Care Act 2014) states that it is crucial to work alongside the person, understanding how their past experiences influence current behaviour. This is often referred to as trauma informed practice.
  • Where there is multi-agency concern about an adult's self-neglect, no agency should close down its involvement without there first being a multi-agency discussion.
  • If a dispute arises between practitioners of agencies about a professional judgement that cannot be resolved at their level, this should be escalated appropriately within each agency to seek a resolution.

Key Principle 2: Interventions should draw upon knowledge of the kinds of approaches that tend to work best

Research has shown that some approaches tend to work better than others: 

Key Principle 3: Agencies should place the adult at the centre of plans to support them

An adult affected by self-neglect has a right to choice and control over their life to the greatest extent possible, and the principles of person-centred care and support should apply in any intervention with them. ("No decisions about me without me'')

  • All workers have a duty of care to consider whether an adult at risk has the mental capacity to understand the risks caused by the decisions they make; and the impact these have upon their safety and wellbeing, or the safety and wellbeing of others.
  • When an adult lacks the mental capacity to make a decision, the principles of the Mental Capacity Act must be applied.
  • The consent of the adult to share information with others should always be sought. If not obtained and there is a belief that the adult may be at risk of neglect, then a decision must be made to share information and with whom must be made.
  • However, whilst it is preferable to work with the consent of the adult, a balance must be struck between negotiated and imposed interventions.
  • Sometimes an agency's legal duties will require it to impose an approach upon an adult in order to protect others (see - Consent and Choice).
  • The Six Principles of safeguarding adults (Empowerment, Prevention, Protection, Proportionality, Partnership and Accountability) must be applied with adults who self-neglect, as with safeguarding concerns.