Serious case review findings on the challenges of self-neglect: indicators for good practice

Abstract

Purpose – The purpose of this paper is to analyse in detail the findings from 40 serious case reviews (SCRs) involving adults who self-neglect, and to consider the commissioning and reporting of such inquiries in the context of accountability that also involves the Coroner and the Local Government Ombudsman. Design/methodology/approach – This study comprised a cross-case analysis of 32 SCRs, using a four-layer design of the adult and their living context, the team around the adult, the organisations around the team, and the Local Safeguarding Board around the organisations. Findings – Available reports tend towards description of events rather than appraisal of what influenced practice. They highlight the challenges in cases of self-neglect practice, including person-centred approaches, capacity assessment and securing engagement. Familiar themes emerge when the spotlight turns to professional and organisational networks, namely information-sharing, supervision, recording and compliance with procedures and legal rules. Some Local Safeguarding Adults Boards found the process of conducting and then using serious case reviews for service improvement challenging. Research limitations/implications – The cross-case approach to thematic analysis focuses on reports into situations where outcomes of professional and organisational intervention had been disappointing. Nonetheless, the themes derived from this analysis are similar to other research findings on what represents best practice when working with cases involving self-neglect. Practical implications – The paper identifies learning for the effective commissioning and conduct of SCRs, and for service improvement with respect to practice with adults who self-neglect. Originality/value – The paper offers further detailed analysis of a large sample of SCRs that builds the evidence-base for effective practice with adults who self-neglect and for efficient management of process of commissioning and conducting SCRs.