Martin was a 51 year old man who at the time of his death had been living in squalid conditions and was physically frail. The Lambeth Safeguarding Adults Board commissioned an independent Safeguarding Adults Review (SAR) to explore the learning from the circumstances of Martin’s death.

This SAR raised important issues around the link with mental capacity and self-neglect. This included key learning around the need for mental capacity assessments to explore more than what a person says they can do; “a mental capacity assessment must also explore whether the person can put these verbal claims into some sort of meaningful action, and if they cannot whether they are able to use and weigh this information to make decisions about other options” (7.1 Learning Point 1). Furthermore, there is a need for better understanding of the interaction between self-neglecting behaviour and risk to the person’s vital interest, and the need for a deeper level of professional curiosity. (7.3 Learning Point 6).

The review also highlighted issues with multi-agency communication and escalation processes. This included learning around referral mechanisms and the processes in place to respond to imminent risk (7.2 Learning Point 5).

The Lambeth Safeguarding Adults Board has agreed all recommendations from this review, and this will now be built in to a targeted action plan. This will include the development of multi-agency self-neglect policies and procedures, and communication pathways which allow for frontline practitioners to initiate urgency multi-agency conversations with all agencies involved.

The full report by independent reviewer Kate Spreadbury can be found on the LSAB website.

Mr E died in a house fire in March 2017. Mr E had had periodic contact with mental health services from 1990 up until his death, with support generally focused on the issues of anxiety and depression. Lambeth’s Substance Misuse Team had also offered information and support to help Mr E access services which could help with his drinking.

A Safeguarding Adults Review was undertaken and this found that a considerable amount of work had been done by the agencies involved with Mr E and that repeated attempts were made to engage him and to encourage him to accept support. Lambeth Fire Brigade’s report indicated that the fire started most likely via an unextinguished cigarette. It is most likely that Mr E’s ability to react may have been limited by intake of alcohol and other substances. As such, there was no link established between Mr E’s death and lack of action by those involved with him.

Nonetheless, the review process identified a number of important recommendations that have been developed in to an action plan that will be monitored by the Lambeth Safeguarding Adults Board.

The recommendations included improving communication pathways by having an escalation procedure and the development of a multi-agency self-neglect policy which would set out how agencies can raise persons of concern, and facilitate a multiagency approach, where the threshold for a safeguarding enquiry is not met.

The Executive Summary for SAR E can be found on our website.

Following the success of last year's masterclass series, the Board had now produced a new booklet which captures the essential knowledge and legislative frameworks that can guide professionals working with adults at risk.

The content includes key areas for multi-agency learning including:

• Coercion and Control for capable adults
• Self-Neglect & Hoarding
• Making Safeguarding Personal
• Safeguarding Adults Reviews  
• Modern Slavery  

The booklet provides links to further resources and research on best practice.

This masterclass booklet can be found on the LSAB website alongside a wide range of different resources to support frontline practitioners, from awareness raising material to guidance and policy.

This project was supported by the Lambeth Together project, a new initiative which  sees organisations working alongside the communities they serve. The Board hopes to continue collaborating with Lambeth Together as we embark on new projects.

On the 1st July, the Community Reference Group (CRG) a hosted an event for voluntary and community sector workers which explored the vital role that these groups and individuals play when responding to the complex issue of self-neglect in a person-centred way.

Self-neglect includes situations where a person is declining support with their care needs, hygiene, health or their environment, and this is having a significant impact on their overall wellbeing. Possible indicators of self-neglect include:

• Very poor personal hygiene
• Unkempt appearance
• Lack of essential food, clothing or shelter
• Malnutrition and/or dehydration
• Living in squalid or unsanitary conditions
• Neglecting household maintenance
• Hoarding
• Collecting a large number of animals in inappropriate conditions
• Non-compliance with health or care services
• Inability or unwillingness to take medication or treat illness or injury

Self-neglect is a key priority for the Lambeth Safeguarding Adults Board. It is a key theme in many Safeguarding Adults Reviews across the country, and recent SARs in Lambeth have also highlighted important learning in this area.

As well as providing space to learn about self-neglect, the event also encouraged attendees to think about what more they could do within their organisation to help protect adults at risk from abuse and neglect. To help guide participants, the CRG developed a pledge document that lists simple ways to raise awareness of adult safeguarding and play a preventative role – this handy tool is available to download from our resource page.