Learning lessons about self-neglect? An analysis of serious case reviews
| DOI | https://doi.org/10.1108/JAP-05-2014-0014 |
| Pages | 3-18 |
| Date | 09 February 2015 |
| Published date | 09 February 2015 |
| Author | Suzy Braye,David Orr,Michael Preston-Shoot |
| Subject Matter | Health & social care,Vulnerable groups,Adult protection |
Learning lessons about self-neglect?
An analysis of serious case reviews
Suzy Braye, David Orr and Michael Preston-Shoot
Suzy Braye is a Professor of
Social Work and Dr David Orr is
a Lecturer in Social Work, both
are based at School of
Education and Social Work,
University of Sussex,
Brighton, UK.
Professor Michael
Preston-Shoot is the Executive
Dean, based at Faculty of
Health & Social Sciences,
University of Bedfordshire,
Luton, UK.
Abstract
Purpose – The purpose of this paper is to report the findings from research into 40 serious case reviews
(SCRs) involving adults who self-neglect.
Design/methodology/approach – The study comprised analysis of 40 SCRs where self-neglect featured.
The reviews were found through detailed searching of Local Safeguarding Adult Board (LSAB) web sites
and through contacts with Board managers and independent chairs. A four layer analysis is presented
of the characteristics of each case and SCR, of the recommendations and of the emerging themes.
Learning for service improvement is presented thematically, focusing on the adult and their immediate
context, the team around the adult, the organisations around the team and the Local Safeguarding
Board around the organisations.
Findings – There is no one typical presentation of self-neglect; cases vary in terms of age, household
composition, lack of self-care, lack of care of one’s environment and/or refusal to engage. Recommendations
foreground LSABs, adult social care and unspecified agencies, and focus on staff support, procedures and the
components of best practice and effective SCRs. Reports emphasise the importance of a person-centred
approach, within the context of ongoing assessment of mental capacity and risk, with agencies sharing
information and working closely together, supported by management and supervision, and practising within
detailed procedural guidance.
Research limitations/implications – There is no national database of SCRs commissioned by LSABs
and currently there is no requirement to publish the outcomes of such inquiries. It may be that there are
further SCRs, or other forms of inquiry, that have been commissioned by Boards but not publicised. This
limits the learning that has been available for service improvement.
Practical implications – The paper identifies practice, management and organisational issues that should
be considered when working with adults who self-neglect. These cases are often complex and stressful for
those involved. The thematic analysis adds to the evidence-base of how best to approach engagement
with adults who self-neglect and to engage the multi-agency network in assessing and managing risk and
mental capacity.
Originality/value – The paper offers the first formal evaluation of SCRs that focus on adults who
self-neglect. The analysis of the findings and the recommendations from the investigations into the 40 cases
adds to the evidence-base for effective practice with adults who self-neglect.
Keywords Service improvement, Care Act 2014, Policy and practice development,
Safeguarding adults reviews, Self-neglect, Serious case reviews
Paper type Research paper
Introduction
In England and Wales Local Safeguarding Adults Boards (LSABs) have not been required to
conduct or publish serious case reviews (SCRs). Many have adopted guidelines published by
the Association of Directors of Social Services (ADSS, 2005) but these are only advisory.
Consequently, some uncertainty has existed on what circumstances should trigger such
reviews and practice is variable in the absence of central government guidance on thresholds,
inter-agency co-operation, resourcing, media management, timescales and publication
(Manthorpe and Martineau, 2012). No database exists of commissioned and published SCRs,
DOI 10.1108/JAP-05-2014-0014 VOL. 17 NO. 1 2015, pp. 3-18, CEmerald Group Publishing Limited, ISSN 1466-8203
j
THE JOURNAL OF ADULT PROTECTION
j
PAGE 3
which makes collation and analysis to facilitate learning and practice development difficult
(Braye et al., 2011; Manthorpe and Martineau, 2011). Those SCRs that are published, however,
if only in executive summary form, can cast considerable light on safeguarding practice.
The Care Act 2014, which reforms adult social care and adult safeguarding law in England
and Wales, places a duty on LSABs (henceforth constituted on a statutory basis) to carry out and
publish safeguarding adult reviews where serious abuse or neglect has contributed to the death
or serious harm of an individual, and where there is reasonable cause for concern about how
professionals and agencies have worked together. LSABs will also have a power to undertake
reviews in other circumstances, the purpose throughout being to learn lessons and improve
future practice. This responds to the need to learn from challenging cases and to channel that
learning from individual incidents into the wider service context and professional network in
order to improve standards and governance (Brown, 2009).
One of the key challenges in adult safeguarding is ensuring the wellbeing of adults where
risk arises from self-neglect rather than from a third party, particularly where theydo not wish to
engage with the state’s protective agenda. Research has identified that health and social care
professionals often find self-neglect cases of this kind to be enormously challenging and fraught
with ethical and legal dilemmas, particularly when adults are judged to have mental capacity to
refuse support (Braye et al., 2011, 2013). Practitioners report feeling exposed when coping
with disappointments and anxiety, and uncertain how to balance a duty of care with a person’s
right to private life. Organisational systems may not clearly locate strategic responsibility for
complex cases that require flexible, multi-professional interventions, or facilitate effective
practice, which resides in the ability to build relationships over time, to balance concerned
curiosity with respect and persistence, to routinely assess mental capacity and to evaluate
possible legal options (Braye et al., 2014). Maximising sources of learning is therefore essential.
Self-neglect is complex and diverse. In England there is no standard definition and, currently,
cases of adults who self-neglect fall outside the statutory guidance on adult safeguarding,
which requires third party involvement in abuse and neglect (DH, 2000). Despite this, where
adults who self-neglect have died or suffered significant harm LSABs have sometimes
commissioned SCRs, but those that have been published have not been collated or
analysed hitherto.
This paper presents the first analysis of available SCRs involving cases of adults who
self-neglect. It provides an index of materials that has utility for adult social care and broader
safeguarding networks, including practitioners, managers and trainers. Lessons for single
and multi-agency practice are identified, and implications for legislation and public policy also
emerge. Self-neglect for definitional purposes in this paper, drawing on the literature and
practice (Braye et al., 2011, 2013), centres on:
’lack of self-care – neglect of personal hygiene, nutrition, hydration, and health; and/or
’lack of care of one’s environment – squalor and hoarding; and/or
’refusal of services that would mitigate risk of harm to safety and well-being.
SCRs in the adult safeguarding literature
The purpose of SCRs is not to apportion blame or establish culpability but to learn and
implement lessons from a case about how agencies and professionals worked together. The
purpose is also to disseminate examples of good individual practice and effective inter-agency
working. Typically a chronology of events will be compiled and terms of reference set. The
agencies involved will produce individual management reports, written by someone not involved
in the substantive case, which will then be drawn upon by a commissioned overview report
writer who produces the SCR and Executive Summary. At their best SCRs are quality
improvement tools, to be drawn upon for learning and service improvement, but they can be
compromised by variable standards of analysis and by lack of inter-agency engagement.
To date there has been limited discussion in adult safeguarding literature on SCRs with respect
to: what methodologies of inquiry might be useful; whether they should be published in part or in
PAGE 4
j
THE JOURNAL OF ADULT PROTECTION
j
VOL. 17 NO. 1 2015
To continue reading
Request your trial