Conceptualising and responding to self‐neglect: the challenges for adult safeguarding
| Published date | 15 August 2011 |
| Date | 15 August 2011 |
| DOI | https://doi.org/10.1108/14668201111177905 |
| Pages | 182-193 |
| Author | Suzy Braye,David Orr,Michael Preston‐Shoot |
| Subject Matter | Health & social care,Sociology |
Conceptualising and responding to
self-neglect: the challenges for adult
safeguarding
Suzy Braye, David Orr and Michael Preston-Shoot
Abstract
Purpose – The research reported here aims to scope the concept of self-neglect as it is explored in the
literature and interpreted in practice by professionals involved in adult safeguarding.
Design/methodology/approach – The approach taken included a systematic search and thematic
analysis of English-language literature on self-neglect, workshops with UK-based adult safeguarding
leads and practitioners from social services, police and health services, and scrutiny of Safeguarding
Adults Boards’ documentation.
Findings – The concept of self-neglect is complex with contrasting definitions and aetiology,
accompanied by debates on the principles that guide intervention. Decision-making capacity is a key
pivot upon which professional responses to self-neglect turn. Intervention in self-neglect requirescareful
exploration in the context of principles of personalisation, choice, control, and empowerment that
underpin policy in adult social care and safeguarding.
Research limitations/implications – As a conceptual scoping review, this study seeks to establish
broad themes of use to practitioners working with self-neglect. It thus does not carry out a full quality
review of the literature identified and discussed, but serves as a base for this to be done in future.
Practical implications – Assessment in self-neglect should consider the influence of a number of
possible causative factors, and intervention must balance respect for autonomy on the one hand and a
perceived duty to preserve health and wellbeing on the other.
Originality/value – This article summarises and critically analyses the emerging key features of
evidence-informed practice in the challenging field of self-neglect.
Keywords Self neglect, Safeguarding, Adult protection, Capacity, Decision making, Adults
Paper type Literature review
Introduction
One of the most debated areas in adult safeguarding is the position of individuals who,
possibly having capacity for autonomous decision-making, choose to neglect their own
safety and well-being. The relationship between self-neglect and adult safeguarding is
contested in the UK context, partly because the current definition of abuse (DH, 2000)
includes only harmful actions or rights violations by someone other than the individual who is
at risk. Consequently, the extent of social care and health services’ engagement with
self-neglect in the UK is unknown. In the USA, unlike in the UK or Australia, self-neglect falls
within the remit of adult protection services (APS) and in many states is subject to mandatory
reporting. Self-neglect referrals comprise the largest proportion of cases dealt with by APS
(Dyer et al., 2007a). However, across the USA, statutory categorisations of self-neglect differ,
sometimes being independent of and sometimes included within definitions of neglect (Daly
and Jogerst, 2003). In Australia, moreover,self-neglect as a general category is rarely, if ever,
used. Rather, lack of self-care, hoarding and squalor are treated as separate phenomena
(McDermott et al., 2009). This mix of definitions from across jurisdictions only adds to the
complexity of self-neglect, in which an emphasis on decision-making autonomy by those who
have capacity co-exists alongside recognition of other potentially valid value positions,
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THE JOURNAL OF ADULT PROTECTION
j
VOL. 13 NO. 4 2011, pp. 182-193, QEmerald Group Publishing Limited, ISSN 1466-8203 DOI 10.1108/14668201111177905
Suzy Braye is a
Professor of Social Work
at the University of Sussex,
Brighton, UK. David Orr is a
Lecturer in Social Work in
the School of Education and
Social Work, University of
Sussex, Brighton, UK.
Michael Preston-Shoot is
Dean of the Faculty of
Health & Social Sciences,
University of Bedfordshire,
Luton, UK.
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