Approaches to service refusal

Due to the commonly compulsive nature of self-neglect and hoarding, professionals should not have an unquestioning acceptance of an individual’s assurances that they do not need support or that they will implement plans to reduce risk, such as clearing the house. New strategies should be considered in the face of mounting evidence that the adult is not following through with those plans.

Where the level of risk remains high, professionals should remain proactively involved despite the difficulties and challenges of engagement. Professionals can focus on small improvements and changes that the person accepts while continuing to negotiate on larger, more contested issues. The focus should remain on building a relationship of trust through which consensual solutions can be offered.

As mentioned elsewhere in this operational guidance, it is good practice for professionals to recognise the root causes, triggers and reasons why the individual self-neglects or hoards. Only then can intervention be tailored appropriately.

Legal advice should be sought where required, to ensure the correct application of applicable legislation, see table of possible legal interventions. Legal processes should not stop the response to immediate risk and to making ongoing timely decisions.

Any concerns relating to the individual’s mental health should be recognised and communicated to the GP and where relevant the Tees and Esk Wear Valley NHS Foundation Trust and the appropriate action taken. For further information see Challenges of Self-neglect and what works best.