Self neglect

Self-neglect covers a wide range of behaviours relating to neglecting to care for one's personal hygiene, health or surroundings.

Examples of self-neglect include:

• A lack of self-care which could be a refusal or inability to cater for basic needs. This could include neglect of personal hygiene, nutrition and hydration, appropriate clothing, or neglecting to seek assistance for medical or health issues, to an extent that may endanger safety or wellbeing.
• A lack of environment care including situations that may lead to domestic squalor, accumulation of rubbish in outside spaces, dirt accumulating in the home or elevated levels of risk in the domestic environment (for example health or fire risks caused by hoarding).
• Hoarding - this can be a feature of self-neglect and involves the collecting of food, items or sometimes animals.
• Refusal of assistance to alleviate issues. This might include, for example, refusal of care services in either their home or a care environment or of health assessments or interventions, even if previously agreed, which could potentially improve self-care or the home environment.

What causes self-neglect

Self-neglect can result from any mental or physical illness that has an effect on the person's physical abilities, energy levels, attention, organisational skills, or motivation. This could include a behavioural condition, a mental health issue, a brain injury, dementia or other mental disorder, obsessive compulsive disorder or hoarding disorder, a physical illness, reduced motivation as a side effect of medication or addiction. Self-neglect can be triggered by trauma and significant life events or it can be personal choice. 

• obsessive compulsive disorder or hoarding disorder
• physical illness which has an effect on abilities, energy levels, attention span, organisational skills or motivation
• reduced motivation as a side effect of medication
• addictions
• traumatic life change

Periods of self-neglect can also be intentional, unintentional, brief, prolonged, repeated or single incidents.

There are two types of self-neglect:

Intentional, or active self-neglect

When a person makes a conscious choice to engage in self-neglect. For example, they may actively refuse to visit a doctor when they're feeling unwell.

Non-intentional, or passive self-neglect

When health-related conditions contribute to a risk of developing self-neglect. For example, a person with a learning disability may have lapses in concentration that may make them forget to attend to their personal hygiene.

When self-neglect is an issue

We often assume that self-neglect is a choice that people make, as they will decline help and support, often feeling that they do not need it. It is important when working with an adult who self-neglects to reflect on how our own values and consider how these may affect our judgement when understanding the reasons why someone may self-neglect.

There are limitations to what others can do if the adult has mental capacity to make their own decisions about how they live. Sometimes, even when all agencies have done everything in their power to support an individual, they may die or suffer significant harm as a result of their own action or inaction. It is therefore vital that all efforts to engage with and support an individual are clearly recorded.

The inclusion of self-neglect in the Care Act statutory guidance with regard to safeguarding focused attention on the issue and led local authorities to develop new approaches to working with people. In some cases, where the adult has care and support needs, safeguarding responses may be appropriate. However, the inclusion of self-neglect in statutory guidance does not mean that everyone who self-neglects needs to be safeguarded.

Safeguarding duties will apply where the adult has care and support needs (many people who self-neglect do not), and they are at risk of self-neglect and they are unable to protect themselves because of their care and support needs. In most cases, the intervention should seek to minimise the risk while respecting the individual's choices. It is rare that a total transformation will take place and positive change should be seen as a long-term, incremental process.

In Gateshead, safeguarding should be considered as an option where a person who is self-neglecting is refusing support that has been offered to them, and remains at high risk of harm to themselves or of presenting harm to others.

Further information

The North East Safeguarding Adult Review Champions have produced 7-minute guides on different aspects of self-neglect:

• Self-Neglect: An overview (PDF, 494 KB)(opens new window)
• Self-Neglect and Engagement (PDF, 550 KB)(opens new window)
• Self-Neglect: Alcohol and Substance Misuse (PDF, 473 KB)(opens new window)
• Self-Neglect and Hoarding (PDF, 455 KB)(opens new window)
• Self-Neglect and Homelessness (PDF, 658 KB)(opens new window)
• Self-Neglect and Self Care (PDF, 505 KB)(opens new window)
• Self-Neglect and Trauma (PDF, 502 KB)(opens new window)

View the "What to do about Self Neglect" animation on YouTube

These guides can also be found in the Practice Resources and Guidance (Local) section of TRi-X (opens new window) .