Self-Neglect & Hoarding

Self-Neglect

What is Self-Neglect?

Self-neglect is the inability (intentional or non-intentional) to maintain a socially and culturally acceptable standard of self-care with the potential for serious consequences to the health and well-being of the individual and perhaps also to the wider community.  An individual may be considered as self-neglecting and therefore maybe at risk of harm where they are:

• Either unable, or unwilling to provide adequate care for themselves;
• Unable or unwilling to obtain necessary care to meet their needs; and/or
• Declining essential support without which their health and safety needs cannot be met.

How do you recognise Self-Neglect?

You may know that you are already working with people who self-neglect. Even if you haven’t yet directly worked with people who self-neglect you may be aware from case reviews or even media articles covering related issues e.g. people who have died in concerning conditions, or as a result of untreated infections.

The list below, contains some of the indicators of self-neglect:

• Obsessive hoarding;

  • Poor diet and nutrition, for example where there is little food in the fridge or it is out of date;
  • Living in a very unclean environment, for example with rodent infestation;
  • Refusing necessary help from health and/social care services in relation to personal hygiene and care;
  • Having poor personal hygiene, poor healing etc.

Working with self-neglect can be a complex, potentially challenging and distressing area for professionals, and those affected by it, including friends and family.  It can be particularly difficult if the individual has mental capacity and is refusing support.

What do I do if I am concerned about someone?

If you become aware that a person is self-neglecting and appropriate steps are not taken to respond, there is a real risk of the situation worsening and may eventually result in permanent damage to a person’s mental or physical health or even death.  If there are immediate serious risks to life and limb, you should consider if it is necessary to call emergency services e.g. London Ambulance Service and any other immediate actions required to minimise the risk to the individual or others.  If you work in health or social care or any other agency or professional group with an obligation under safeguarding, you have a responsibility to report any issues of self-neglect that you may encounter.  The purpose of reporting is to ensure that there is a co-ordinated response to serious risks identified for a person who is self-neglecting.

How do I report suspected Self-Neglect?

If you are concerned about someone who may be at risk of harm from self-neglect you should complete a safeguarding referral to the local authority via completing the on-line form:

The Board has a Self-Neglect and Hoarding Protocol, the 2nd Edition of which was published in April 2021.

This is currently under review.

Hoarding

Hoarding Disorder (HD) is a recognised mental health condition which affects around 5% of the population. It is where someone acquires an excessive number of items and stores them in a chaotic manner, usually resulting in unmanageable amounts of clutter.   Hoarding behaviours often begin in childhood, and can be associated with experiences of trauma and grief.  People who Hoard (PwH) form strong attachments to possessions and accumulate items, that may actually be of little or no monetary value.

HD is challenging to treat because PwH may not see it as a problem, or have little awareness of how it’s affecting their life or the lives of others. They may also feel embarrassed at the state of their property and feel stigmatized, vulnerable and isolated.  They are likely to find it difficult to engage with professionals who are trying to support them due to previous trauma leading to trust issues, which is very understandable.

Hoarding can be part of a wider self-neglect issue.  It’s really important to encourage a person who is hoarding to seek help, as their difficulties discarding objects can not only cause loneliness and mental health problems but also pose a health and safety risk.

Why might someone hoard?

Mental Health problems associated with hoarding:

Links to each of these mental health disorders are linked to the official NHS website

Behaviours include:

  • Excessive acquisition
  • Saving behaviours and inability to discard
  • Difficulty organising
  • Complexity in decision making
  • Attachment to items
  • Perfectionism (including over attention to detail)
  • Avoidance (anxiety)
  • Trust issues
  • Lack of insight doesn’t see the problem
  • Absence of distress (until asked to discard)
  • Justification e.g. the place is too small, no time to organise

Hoarding UK offer lots of information and advice on hoarding as well as offering support groups all around the UK.

Further Information, Guidance and Reading for Professionals

Below is a multi-agency 7 Minute Briefing on the topic of self-neglect:

UK Hoarding Partnership is a group of professionals from local authorities, housing associations, emergency services, NHS, charities etc., who share good practice and insight in working with PwH.

HQN National Briefing