Self Neglect and Hoarding
Self-Neglect and Hoarding Pilot, Support Group and Multiagency Advisory Panel
(See related Self-Neglect and hoarding Policy and guidance toolkit in Policy and Procedures)
SNHRP Referral Form (May 2024 version)
Self-neglect is defined in the Care Act 2014 as a lack of self-care to the extent that it threatens personal health and safety. It can include neglecting to care for one’s personal hygiene, physical or mental health or their physical environment.
Hoarding is outlined in the act as a specific example of self-neglect and is defined by a compulsion to acquire new possessions and/or a reluctance to discard possessions one already owns. The resulting clutter can amass to truly dangerous levels, leading to significantly increased risks associated with fire, trips and falls and disease associated with unsanitary conditions including vermin and insect infestation. Hoarding Disorder is now recognised as a distinct psychiatric condition by the NHS.
The Self-Neglect & Hoarding Pilot was launched by Royal Greenwich because of a significant increase in the numbers of such cases being encountered by the local community in recent years and research showing that self-neglect is a prominent theme in 45% of all Safeguarding Adult Reviews conducted nationwide, as outlined in the National SARs Analysis (Preston-Shoot, 2021).
The aims of the pilot are:
- To improve the local offer made to people with hoarding behaviours and to those engaging in other forms of self-neglect.
- To promote evidence-informed approaches being adopted by professionals when working with this cohort of service-users.
- To provide opportunities for more “joined up” multidisciplinary working between the public and voluntary sectors and the NHS.
- To strive for better outcomes for people who engage in self-neglect.
There are currently 4 streams to this work which are detailed below.
Peer Support Groups
One of the key initiatives of the Self-Neglect & Hoarding Pilot has been the launch of a dedicated hoarding support group for residents of Royal Greenwich.
Two support groups have been established; one weekly and one monthly.
The weekly support group adopts an adapted cognitive behavioural therapy (CBT) programme that has been designed specifically for people who struggle with clutter and hoarding behaviours. An important element of the Buried in Treasures Workshop is to help people who hoard understand that this is a mental health issue which including psychological factors, possible genetic factors, learned behaviour from others, issues relating to executive dysfunction and unresolved trauma. Alongside providing empirically-based strategies designed to help people address a reluctance to discard items and a compulsion to acquire new possessions, another important element of the Buried in Treasures Workshop is to help address deep-seated feelings of shame, stigmatisation and isolation that are often experienced by people who hoard. The Buried in Treasures Workshop is current co-facilitated by a social worker from Health & Adult Services, an Assistant Psychologist from Oxleas NHS Mental Health Foundation Trust and by a person with lived experience of hoarding behaviour.
In addition, we are now also setting up a monthly peer support group which is not based on the Buried in Treasures format. This is also professionally facilitated and is aimed at people who have either completed the Buried in Treasures Workshop but who feel they continue to require from a degree of support in relation to their hoarding behaviour or for residents who cannot commit to the frequency and times of the Buried in Treasures Workshop. The monthly group is facilitated by a social worker from Health & Adult Services
If you are interested in attending either the weekly or monthly peer support groups or would like more information please Ian McPherson for an informal discussion about this on 07935 700076 or email hoarding-support@royalgreenwich.gov.uk
The Self-Neglect & Hoarding Risk Panel
Another key initiative launched as part of the pilot has been the Self-Neglect and Hoarding Risk Panel. This adopts a multi-agency approach to self-neglect and hoarding behaviours and enables any professional dealing with such a case to bring it to this multi-agency advisory panel with the aim of collaborative strategising of solutions and new approaches to consider adopting. Self-neglect and hoarding cases can be amongst some of the most challenging faced by professionals, exacerbated further by the fact that evidence clearly shows the very significant risks involved in such cases and the disproportionate prevalence of self-neglect as a prominent theme in Safeguarding Adult Reviews
This operational panel sits every six weeks and is attended by a representative from core group stakeholders including Oxleas Mental Health, RBG Adult Safeguarding, RBG Complex Care Team, RBG Environmental Health, RBG Housing, Live Well Greenwich and the London Fire Brigade.
Referrals are open to any professional in the public and voluntary sectors.
If you wish to refer a case to panel, please contact hoarding-support@royalgreenwich.gov.uk or call 020 8921 2446 to discuss the case.
SNHRP Referral Form (May 2024 version)
The Self-Neglect & Hoarding Strategic Group
The third element of the pilot has involved the creation of a strategic group that sits above the Self-Neglect and Hoarding Risk Panel. This consists of senior managers (Assistant Director level and above) from Housing, Environmental Health, Health & Adult Services as well as from Oxleas Mental Health. The Borough Commander of the London Fire Brigade, the RBG Head of Adult Safeguarding and an Inspector from the Metropolitan Police Service also sit on this panel, which meets quarterly and is chaired by the Director of Health and Adult Services.
The remit of the Strategic Group is to review the progress of the Self-Neglect & Hoarding Pilot and to be informed by the data and trends that are being generated as the pilot progresses. Additionally, the Strategic Group is well-placed to foster and promote a more integrated, joined up approach to this challenging area of practice. This includes not only trying to promote a better “whole council” approach to self-neglect and hoarding, but also extending this to include our partners in Mental Health and the Emergency Services.
The Safer Homes Initiative
The final element of the Self-Neglect & Hoarding Project will be the creation of a small, highly specialist team which will work exclusively with people who hoard. This approach is modelled on innovative and pioneering approaches adopted by several other UK local authorities which aims to incorporate evidence-informed approaches as well as practical, physical and emotional support to those who live in cluttered environments.
A core aim of the Safer Homes Initiative will be an emphasis on adopting a harm reduction approach to help people who hoard to be safer living in their homes. The approach will incorporate weekly home visits by a trained professional to the person’s home to address and reduce the various risks associated with living in a cluttered environment and to help the person reclaim . Importantly, the Safer Homes Initiative will adopt a strengths-based and person-centred approach which involves the professional and the resident addressing these safety issues together in a trusting relationship and will also involve the resident learning strategies that facilitate them in becoming able to become more adept at sorting, categorising and making decisions about their possessions, identifying maladaptive beliefs they may have about their belongings and becoming better able to tolerate the uncomfortable feelings associated with discarding and/or non-acquiring behaviours.
The Safer Homes Initiative aims to adopted an integrated, collaborative “whole council” approach. For more information about this exciting new team, please contact Ian McPherson on 07935 700076 or email hoarding-support@royalgreenwich.gov.uk