Is self-neglect a safeguarding concern? An ethical dilemma

Self-neglect and hoarding often go hand in hand—it is a complex situation and can have a negative impact on a person's health and wellbeing. Many individuals who neglect themselves have capacity, with strongly held beliefs and ideas that affect the way in which they behave and hoard items (NHS website, 2018). The condition often leaves health professionals in a dilemma, with the need to respect a person's autonomy, liberty and the right to make unwise decisions, along with the duty to protect the individual from harm.

Self-neglect is a public health issue, it impacts the health and wellbeing of the person and the wider community. It can affect relationships with family and neighbours, leaving people isolated and vulnerable to abuse. Individuals are frequently admitted to hospital with falls and infections due to cluttered and unsanitary living conditions. The admission period is often lengthy owing to the complexity of the discharge required. It is vital that, on discharge, the person is given adequate support to prevent repetitive self-neglect and hoarding behaviour. A support network needs to be established that includes health and social care professionals and other public services.