How do you navigate between the need to protect adults who may be at risk of harm, and respecting the right of each individual to live their life as they chose?
People may be at risk of self-neglect for various reasons, including reduced decision-making capacity, mental health difficulties, or an inability to manage their daily lives because of frailty due to aging.
Self-neglect can be either unintentional arising from an underlying health condition or personal circumstances or, intentional arising from a deliberate choice.
Perhaps by its very nature, self-neglect does not emerge strongly in data on adult safeguarding, accounting for just 3-4% of all concerns received by the HSE National Safeguarding Office annually.
Those reports do, however, show that self-neglect often co-exists with other types of abuse perpetrated by a third party.
This finding coincides with research from the US where elder self-neglect was associated with an increased subsequent risk of elder abuse, caregiver neglect and financial exploitation.
Case histories provided to Safeguarding Ireland have also indicated that self-neglect may occur within a household as part of a pattern of coercive control by a dominant household member.
However, indicators of possible self-neglect can first become evident in other, non-health or social care settings through for example; self-disconnection of a pre-payment meter, extreme self-rationing of energy supply or other essential goods or services necessary to avoid physical harm or pain.
Research by Citizens Advice UK found that ‘vulnerable people self-disconnect more often, more recently, and for longer’.
Since life history is strongly associated with self-neglect, it needs to be understood both in the context of the life experiences of the individual as well as the current context.
Self-neglect in later life has been linked to traumatic personal life experiences including suffering loss, childhood abuse, migration and traumatic life events in early years. Self-neglect has also been associated with high stress levels, economic vulnerability and mental health problems.
Research shows that self-neglect in adults at risk is often not just a personal preference or ‘behavioural idiosyncrasy’, but a spectrum of behaviours associated with increased morbidity and impairments in daily living.
Safeguarding professionals, public health nurses, housing officers, An Garda Síochána and other health and social care professionals, providers of essential goods and services, family, friends and community members can all play an important role in helping adults at risk remain safe in the community.
There is no statutory provision in Ireland specifically directed at identifying, investigating, and addressing cases of self-neglect other than potentially in cases where a person lacks decision-making capacity, or is suffering from a mental health disorder under the Mental Health Act 2001.
Safeguarding Ireland’s review of Irish and international literature on self-neglect and adult safeguarding has concluded that:
- There is a clear need to ensure that professionals concerned with safeguarding are provided with the skills, policies and legislative framework for dealing with cases of self-neglect
- Any interventions must give due recognition to a person’s right to autonomy, including the right to refuse supports, provided the individual has decision-making capacity
- Professionals need to be able to operate in a context where appropriate provisions exist and where there is clarity regarding access, sharing of information, cooperation between agencies and reporting mechanisms
- There is a need for a broader and more integrated approach to self-neglect in an overall safeguarding context at national level including the Gardaí, health and safety personnel, health and social care personnel as well as local communities.
If you are worried that someone you know is at risk of harm due to self-neglect, Safeguarding Ireland’s message is to – ‘Call out Abuse’ and report it. Use this link to find out where to report.
Safeguarding Ireland is calling for the establishment of a new independent Adult Safeguarding Authority to reduce adult abuse.
For more on self-neglect and adult safeguarding, including case studies, see Safeguarding Ireland’s Report – Identifying Risks Sharing Responsibilities.