The starting point for all interventions is to encourage the person to do things for themselves. Where this fails in the first instance, this approach should be revisited and all efforts and responses of the person to this approach should be fully recorded.
Research suggests that improvements to health, wellbeing and home conditions can be achieved by spending time building relationships and gaining trust. When people are persuaded to accept help, short-term interventions are unlikely to be successful - practitioners should be enabled to take a long-term approach.
Communicate to the adult regarding the timings of appointments and when these will take place to avoid drift and maintain momentum during which some action can be taken that will achieve a desired outcome. We should make it easier for people to strengthen their networks or engage in existing or new hobbies and receive the opportunity to meet people and share interests. Make use where possible of any existing safe environment or someone the adult trusts when introducing the idea of support and/or services. Consider options for short-term respite if required, for example.
Positive engagement:
- identify the underlying causes that help to address the issue;
- it is not helpful for practitioners to make judgements about cleanliness;
- try and empathise even if it is behaviours you do not understand;
- agree small steps;
- the person may fear losing control, it is important to allay such fears;
- it can be helpful to make agreements to achieve progress;
- regular, encouraging engagement and gentle persistence may help with progress and risk management; and
- robust risk assessment may be the best outcome achievable if it is not possible to change the adult’s behaviour.
Providing small practical help at the outset may help build trust.
Practical tasks may include:
- utilising local partners such as RSPCA, the fire service, environmental health, and housing;
- helping with property management and repairs;
- some individuals may be helped by counselling or other therapies, including obsessive compulsive disorder or addictions; and
- facilitating or co-ordinating doctors’ appointments or providing practical support to attend appointments.
Where a person cannot face the scale of the task but is willing to make progress, offer to provide decluttering or ‘deep cleaning’ services. When significant risks are identified, and serious harm is implied gaining quotes for work needed to restore essential safety and hygiene to unsafe and unhygienic properties may be required.
If the person is refusing to have a non-residential financial assessment or pay for support, discussion should take place with relevant managers across social work and housing to consider the justification for suspending or wavering charges, even on a temporary basis, to allow critical support to be provided. This can sometimes be a way of engaging the individual and/or reducing a significant or immediate risk.
Each case will need to be assessed on an individual bases. It should also be remembered that children can be affected by adults who self-neglect. Where there are concerns for a child in the context of an adult who displays self-neglect, the Children’s Reception Team should be contacted. [Tel: 0800 731 5520]
If the situation surrounding the adult at risk meets a significant level of risk, the worker should discuss with their line manager who should advise whether a multi-agency case conference should be instigated. Please consult the clutter image rating.
Ratings reaching scale 4 or above should be raising concerns and starting an intervention.