Mapping and review of self-neglect policies and procedures from safeguarding adults boards in England

Abstract

Purpose Local Safeguarding Adults Board (SAB) policies, procedures, guidance and related documents on self-neglect were gathered and analysed, to map what approaches are being taken across England. This paper aims to identify areas of divergence to highlight innovations or challenges faced by SABs. Design/methodology/approach Self-neglect documents were identified by searching SAB websites. Data were extracted into a framework enabling synthesis and comparison between documents. Findings This paper reports on how English SAB documentation defines self-neglect, treats executive capacity, lays out pathways for self-neglect cases, advises on refusal of service input and multi-agency coordination and draws on theories or tools. Greater coherence in understanding self-neglect has developed since it was brought within safeguarding in 2014; however, variation remains regarding scope, referral pathways and threshold criteria. Research limitations/implications This review was limited to published SAB documentation at one point in time and could not consider either the wider context of safeguarding guidance and training or implementation in practice. Practical implications This review provides an overview of how SABs are interpreting national guidance and guiding practitioners. The trends and areas of uncertainty identified offer a resource for informed research and policy-making. Originality/value To the best of the author’s knowledge, this is the first systematic survey of SAB self-neglect policies, procedures and guidance since self-neglect was included under safeguarding.

Human stories about self-neglect: told, untold, untellable and unheard narratives in safeguarding adult reviews

“…Despite a definition of self-neglect contained within statutory guidance [Department of Health and Social Care (DHSC), 2020], variability in how practitioners and managers respond to self-neglect has been attributed to uncertainty about how to define or conceptualise it (Harris et al , 2022; Owen et al , 2022). A review of SAB policies and procedures on self-neglect (Orr, 2023) found that the statutory definition did not provide clarity about what threshold behaviour should be considered self-neglect or indicate when services should become involved. The statutory definition was not used consistently, and there were divergent views on whether section 42 or referrals into multi-agency (risk management) meetings should be used as the pathway response.…”

“…Practitioners have also expressed uncertainty about how to balance a person’s right to private and family life with a duty to promote wellbeing and to prevent an escalation of care and support needs. In his research, Orr (2023) found that not all SABs have policies or procedures on self-neglect, whilst others vary in the attention given to the tension between self-determination, the right to private and family life and the duty to prevent foreseeable harm. Policies and procedures also vary in guidance given on assessing executive functioning and on how to respond to refusals of assessment or support by a person with mental capacity.…”