Self-neglect cases: how should social workers intervene?

With the law so unclear, professional intervention in cases of self-neglect can be fraught with difficulties. Yet, as Vern Pitt reports, the pressure on social workers to ‘do something’ is great

See our interactive guide to how social workers should handle cases of self-neglect

Helping those who neglect themselves can prove an impossible task for social workers, whose actions risk the opprobrium of the very society that demands intervention. Yet the decision to enter the profession in the first place is often prompted by a desire to help.

Social workers Louise Keane and Vicky Bryant* say they feel pressure to “do something” in self-neglect cases, which are often referred from other agencies that have been unable to deal with the problems.

Bryant recalls being asked to conduct a mental health assessment for a man who was neglecting himself. “There was no clear evidence of a mental illness and it wasn’t appropriate to bring him into hospital or even assess him on that basis,” she says. “However, the neighbours of this man were pressuring the GP and the housing office to ‘do something’.”

Knowing what to do is tough. In February, Sheffield Adult Safeguarding Board published a serious case review into a woman who died after years of self-neglect and service refusal. However, review chair Margaret Flynn found there were no legal powers that could have prevented her death.

The law covering the area is highly ­fragmented. The National Assistance Act 1948, which appears to offer powers to remove a person from their home, may even come into conflict with the Human Rights Act 1998 because it contains no right of appeal. The Law Commission is reviewing adult social care law in order to simplify it, and its report in early May will shape government legislation next year.

Flynn hopes the National Assistance Act will be one area cleared up. “It’s not the problem of social workers that they have two sets of legislation that conflict,” she says.

The 2000 No Secrets statutory guidance on safeguarding adults also does not include self-neglect because there is no perpetrator of abuse, says Peter Morgan, chair of the Practitioners Alliance Against the Abuse of Vulnerable Adults. This means that some – though not all – local adult safeguarding procedures do not cover self-neglect.

Morgan would like the Law Commission to address the legal position on self-neglect in its report.

Given this context, it is unsurprising that social workers struggle to explain self-neglect cases to people outside the system. This is highlighted by last year’s inquest into the case of Mayan Coomeraswamy, a man with schizophrenia who was found dead in his squalid flat in Wandsworth, London.

Ruth Allen, director of social work at South West London and St George’s NHS Trust, had to explain the actions of her staff to the coroner. She says she was asked to return to the coroner repeatedly with ever simpler explanations. “When we were doing this piece of work to review this case the coroner’s questions did reveal how unclear the law is and how difficult it is to get a definitive decision process,” she says.

But changing the law is unlikely to solve entirely the tensions between expectations and powers. “We cannot impose a service on someone who refuses it. That will not change in the new legislation,” says Flynn.

*Not her real name

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