Self-neglect cases frequently end up on social workers’ desks because other agencies do not know what to do with them, while the public and press expect action.
In February, Sheffield Adult Safeguarding Board published a serious case review into a woman who died following years of self-neglect and service refusal. Margaret Flynn, author of the review, concluded there was nothing more social workers could have done, adding: “The occasionally distorting mirror of the media appears uninterested in understanding why physically vulnerable but competent adults who self-neglect are not ‘rescued.'”
The Sheffield case is not unique in terms of media focus. In March 2010 the inquest into the death of a man who had neglected himself in Wandsworth was reported by The Guardian, which said care staff had not intervened in the erroneous belief that they would be violating his human rights.
Ruth Allen, director of social work at South West London and St George’s Mental Health NHS trust, was overseeing the case. “There is some sense of pressure and I think some of that pressure is justified,” she says. “We have to demonstrate our duty of care to those that are vulnerable has been fulfilled.”
The nature of self-neglect makes it interesting to the public, argues Flynn. “It’s horribly interesting,” she says. Self-neglect usually involves people living in conditions of extreme squalor, often neglecting personal hygiene for years. Situations where people live among years of rubbish, sometimes infested with vermin, are not uncommon.
But social workers’ powers to intervene are limited, particularly if the person does not lack mental capacity or have a mental disorder, ruling out intervention under the Mental Capacity Act 2005 or Mental Health Act 1983.
Raising public awareness of these limitations will be necessary, says Michael Preston-Shoot, professor of social work at the University of Bedfordshire, who has compiled guidance on self-neglect cases for the Department of Health, due for publication shortly. “What emerged from our research for the DH is that one of the roles of safeguarding adult boards is to raise community awareness.” He says that should extend to what the current rules are and the limitations of the powers of the state.
Social work bodies will have to be more vocal too, says Preston-Shoot. “In nursing and medicine you have national organisations communicating about what good nursing practice looks like and what good standards of medical care look like. Social workers have never really had an organisation that has been able to do that or an organisation that has had the standing that means the media go to it.” He hopes the proposed college of social work will fill this role.
Don’t look to politicians to fill this void, says Peter Morgan, chair of Practitioner Alliance Against Abuse of Vulnerable Adults (PAAVA). He doesn’t believe standing up for the ethics of tackling self-neglect is a vote winner although the cases may fascinate voters.
Being open with the public is key, argues Penny Furness-Smith, co-chair of the Association of Directors of Adult Social Services’ safeguarding adults network. “People are never going to feel comfortable that [service users] make decisions that leave them dying but if there is a process which has been gone through that is defensible then it’s OK,” she says.
Self-neglect cases: How should social workers intervene?
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