The Department of Health is currently consulting on the draft regulations and Guidance to accompany the implementation of Part I of the Care Act 2014 (the deadline for responses is 15 August 2014). The draft Guidance on Adult Safeguarding follows its spiritual predecessor, No Secrets, in not including self-neglect amongst the definition of abuse and neglect. For my part, I regret this absence and would urge it to be revisited. Its absence is now particularly important because the duty of enquiry brought in by s.42 of the Care Act will be triggered where an adult has needs for care and support, “is experiencing, or is at risk of, abuse or neglect,” and as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it. Abuse has no statutory definition (s.42(3) not serving as a statutory definition but as clarification that the term includes financial abuse). Social workers and other professionals will invariably therefore have regard to the Safeguarding Guidance for purposes of determining whether the adult in question is subject to (or at risk of) abuse or neglect. It seems to me inevitable that if self-neglect is not referred to in the Guidance, there is a real risk that it will be perceived as somehow being a lower priority than situations involving third parties. If you agree, might I invite you to respond in this vein to the consultation by 15 August?
Some of the real difficulties in this area are discussed in detail, and from a profoundly wise and humane perspective (drawing on a rich historical, sociological and philosophical range of insights), in Vile Bodies: Understanding the Neglect of Personal Hygiene in a Sterile Society, a free resource published by Peter Bates (full disclosure, I have had some very modest input into the section relating to the law). I would commend it very highly for all those concerned with seeking to ‘do the right thing’ in respect of those who are classed as self-neglecting.