Abstract
Self-neglect is a health and social care condition involving individuals, usually older adults, who, in some way, take insufficient care of themselves to an extent detrimental to their health. This condition has a variety of forms including lack of personal hygiene, poor nutrition, poorly maintained homes, refusing access to health and social care practitioners and declining or failing to take prescribed medication, treatment and care. The condition called self-neglect is addressed, under the Care Act 2014, within Safeguarding Adults, usually through the application of a specific set of local self-neglect procedures which often prioritise Mental Capacity Assessments. In practice this condition presents a complexity of ethical dilemmas and challenges which, whilst not unique within health and social care, come together in specific ways for the condition called self-neglect and incorporate a form of institutional ageism.This report offers a critique of the health and social care literature on the condition called self-neglect. It considers the ethical and practical dilemmas faced by practitioners trying to implement self-neglect procedures and argues that the problematic nature of addressing this condition emerges from three inter-related and mutually supportive sources. First, a legal frame which positions the condition called self-neglect within Safeguarding Adults without sufficient consideration of the conceptual and practical differences between self-neglect and neglect by others. Second, a medical frame which assumes that self-neglect is a condition with causal explanations that can be addressed using a traditional health and social care approaches. Third a conceptual frame which places self-neglect as the opposite of self-care and involving agency which leads to an assumption that anyone diagnosed with the condition called self-neglect must necessarily lack the mental capacity to choose to self-care. Together these frames offer an ageist structural context which skews the balance between a practitioner’s duty of care and their requirement to implement person-centred care.
The second half of this report adds to these frames by including the perspectives of those individuals diagnosed with the condition called self-neglect. These individuals understand themselves to be coping and self-caring, with competent reasoning and self-governance capacities. But they lose their right to do these things when placed within the category self-neglect. By distinguishing between the rights conflict within the individual and an individual’s rights in tensions across practitioners’ decision making it is possible to understand how, within the legal frame for this condition, it is possible for contempt to emerge leading to poor outcomes for the individuals involved. A broader framing of self-neglect is constructed which does not deny that the state and conditions of the individuals involved is a cause for concern. Rather it suggests that their self-neglect needs to be viewed from a perspective where a distinction is made between:
• self-care activities which allow survival and functioning and come prior to health,
• care-for-the-self practices relating to identifying and working towards future goals which require health:
• care-of-the-self in response to self-care activity and care-for-the-self deficits during ill-health.
The processes by which self-care activities come to be carried out or not are the same for everyone. Unfortunately, for some the state and conditions of self-neglect emerge due to the impact of lack of self-care activity decisions made for good reasons over a lifetime which were beneficial in the past and have been incorporated into their current self-care narrative. Their personal self-care activity norms undergo allostatic changes so that they remain justified in considering themselves to be coping self-carers. They adapt to accommodate their deteriorating state and conditions in two main ways. First, over time their ‘self’ shrinks inwards to protect itself from the objects of disgust at or near the surface of the body. Second, the increasing isolation they experience means that they lose the challenge of social relations and become more self-reliant within their decision-making. These adaptations have important implications for how health and social care practitioners can successfully address self-neglect with the individuals involved.
| Date of Award | Mar 2025 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Michael Neu (Supervisor) |