‘Care Act has missed opportunity to tackle self-neglect’

The Care Act 2014 may have missed a “golden opportunity” to address the issue of self-neglect, the Joint Social Work Education Conference heard yesterday.

Maria Brent, a research fellow at Royal Holloway University, said the Act aimed to put adult safeguarding on a stronger statutory footing but questioned whether it had really examined the issues around self-neglect.

While the Act places places councils under a duty to make enquiries where it appears a person with care needs is at risk of abuse or neglect and unable to protect themselves as a result of their needs, neither the legislation nor draft statutory guidance on its implementation mentions self-neglect.

“Self-neglect does not seem to be defined, it does not necessarily have an organisational home and there seems to be a lack of consistent national responses and procedures especially on how to support social workers in managing self-neglect,” said Brent.

Brent and her colleague, social work lecturer Stefan Brown, gave a session on understanding self-neglect in safeguarding adults at risk, which explored key issues from a literature review. The presentation highlighted the concerns of both service users and social workers working in this area.

Personal and professional perspectives

Drawing on evidence from two studies on older people who self-neglect, Brown said that not being listened to and a lack of respect for life choices were major concerns raised by service users.

He said: “Service users would often say [on self-neglect that] this is my life choice and it is not being understood and respected. This is obviously problematic from a safeguarding point of view, but that doesn’t mean there shouldn’t be some respect and understanding of that life choice as well.”

Brown went on to highlight the organisational and professional challenges faced by social workers. He said the research suggested that self-neglect lacked a clear definition and stressed the need for a clear framework for practice, which would help all professionals understand how to help people who self-neglect.

“If there is not clear policy guidance then social workers are going to be lost, in an organisational sense, in how they can address self-neglect,” he said.

Where should self-neglect sit?

The session concluded with a lively debate on ‘where self-neglect should sit’, with audience member and professor of social policy, Alisoun Milne, arguing that placing self-neglect in the “safeguarding lens” could constrain service users. She said: “We need to look at self-neglect in terms of need.”

Pearse McCusker, programme lead for the BA (Hons) Social Work degree at Glasgow Caledonian University, added an interesting perspective from Scotland, whose adult safeguarding legislation explicitly covers self-neglect.

“There are obviously debates on how far adult protection should go in terms of intervening in adults’ lives but if there are people that are neglecting themselves then surely local authorities and public bodies have the responsibility to investigate those circumstances and to offer support,” he said. “If the legal mandate to do that isn’t there then will it happen?”