East Sussex Safeguarding Adults Board Safeguarding Conference 25 June 2013

1. East Sussex Safeguarding Adults Board Safeguarding Conference 25 June 2013

2. Keith Hinkley Director of Adult Social Care East Sussex County Council

3. Welcome • Safeguarding is everyone’s responsibility and business • Future of safeguarding/Care Bill • Role of individuals, professionals and communities • Focus on prevention and reduction of harm, abuse and neglect

4. Aims: • increase knowledge of safeguarding: current thinking and responses • insight into the impact of abuse to improve outcomes for individuals • beyond immediate safeguarding to preventive activity • promote dignity and safety in care • good practice in self-neglect • networking

5. Self-Neglect:Messages from Research Suzy Braye, David Orr and Michael Preston-Shoot University of Sussex and University of Bedfordshire Presented by Suzy Braye and David Orr East Sussex Safeguarding Conference 25 June 2013

6. Self-neglect: sources of research evidence Interviews, survey, analysis of local policies Systematic review, SAB documents, focus groups Literature, focus groups, interviews

7. Our focus for today - to present research findings on:

8. 1. Complex interplay of challenges

9. What do we mean by self-neglect? • No widespread standard definition • A broad working definition, based on the literature • Lack of self care: personal hygiene, nutrition and hydration, or health • Lack of care of one’s environment: domestic squalor, hoarding • Refusal of services that might alleviate associated risks

10. Recognition of definitional complexity • A very broad range of manifestations • Arising from inability or unwillingness to care for oneself, or both

11. The challenges of finding a framework for intervention • Self-neglect falls outside current definitions relating to vulnerable adults in England (unlike in the US) • Abuse and neglect are named explicitly in the national policy guidance on eligibility, whereas self-neglect is not • It is rarely mentioned in SAB documentation (though SCRs are sometimes conducted when severe harm ensues) • There is no fixed pattern of consensus on where responsibility lies • Adult social care? Safeguarding? Housing? • Danger that it becomes “nobody’s business” • There is no formalised interagency mechanism for information-sharing and decision-making

12. Challenges from self-neglect per se • Complexity of causation, manifestation and intervention • Difficulties of engagement • Tensions between autonomy and duty of care • Assessment of mental capacity • Short-term vs long-term interventions • Uncertainty about legal frameworks • Frustration and anxiety • Lack of training

13. Challenges from organisational & service environments • Eligibility barriers making it difficult to work preventively • Service culture that prioritises independence as a goal and operates care pathways that are not achievable in cases of self-neglect • Workflow patterns based on time-limited care management not longer-term involvement that enable relationship-building • Agency cultures and work practices that made interagency and interprofessional negotiations difficult • Finding an organisational home for self-neglect - perceived as everybody’s, nobody’s or somebody else’s business • Different thresholds of concern

14. Mental capacity affects perception of risk and intervention focus Mental capacity Self-care Self-neglect Mental incapacity

15. Self-neglect challenges professional value positions • A duty of care, to secure dignity, even where mental capacity is present, is valued and in some cases prioritised over autonomy • Communities are also seen has having rights that counter-balance those of individuals