Self-neglect risk assessment

An assessment using the Multi-Agency Self-neglect and Hoarding Risk Assessment Guidance Tool [Word Document] should be carried out by the most appropriate agency depending on the nature of the concerns. In most instances, this would be the referring agency. For example, where an individual is severely neglecting their health, the most appropriate lead agency may be a health partner such as District Nursing or Practice Surgery. Alternatively, Housing services or Environmental Health may be the most appropriate agencies to address hoarding and infestation while Adult Social Care would intervene where individuals grossly neglect their personal care and other daily living activities. Assessments can also be carried out jointly on an interagency basis. This must be informed by the views of individuals themselves, wherever possible and practicable as well as by the views of carers and/or relatives where appropriate to consider level of risk.

Specialist input may be required to clarify certain aspects of the adult’s functioning and risk. This includes considering the request for a Mental Health Act assessment where this appears to be appropriate. Another example would be a referral for psychological input. Where there are concerns about mental capacity, a mental capacity assessment must be considered at an early stage in relation to their ability to make informed decisions regarding the risks identified.

Building a positive relationship with individuals who self-neglect is critical to achieving change for them and ensuring their safety and protection. It is also key to maintaining the kind of contact that can enable interventions to be accepted with time

It may be necessary to work creatively and across job roles in some instances to maximise engagement. For example, if the adult has developed a trusting relationship with one professional but declines the intervention of other agencies, that one professional may be guided by colleagues to ask other questions or assess other risk aspects that are pertinent to their respective roles pending further attempts at engagement.

Consider all members of the household when assessing needs and risks as in some cases, more than one family member may need an assessment in their own right.

Addressing self-neglect requires time and patience; improvements often take time to come to fruition, sometimes weeks, months or even longer. Short-term preventative interventions are unlikely to succeed so professionals will need to allow flexibility in such cases.

It is NOT enough or appropriate to solely write a letter offering intervention or asking the adult to make contact. People who self-neglect or hoard are unlikely to respond to written correspondence. Use a method of communication, which is best suited to the individual taking into account any and all of their communication needs.