More than three million adults in the UK may be living with a hoarding disorder, according to a recent BBC report. However, the figure is likely to have surged since the pandemic and the UK is now facing a “behind-closed-doors mental health emergency”, warns Heather Matuozzo, founder of leading social enterprise Clouds End CIC.
This crisis is not just about cleanliness and clutter; it’s about vulnerability, isolation and risk. Hoarding and self-neglect often coexist, creating complex safeguarding challenges for professionals across health, social care and public services.
Without robust training, clear protocols and cross-sector collaboration, the UK risks more preventable deaths and a growing population living in unsafe conditions.
In this article, we explore the current landscape of hoarding and self-neglect in the UK. It is one of the most challenging aspects of contemporary adult health and social care - the time to act is now.
What is self-neglect?
Self-neglect is an extreme lack of self-care. It is sometimes associated with hoarding and may be a result of other issues such as addictions.
There is no universally accepted formal or operational definition of self-neglect. However, a broad working definition comprising of three main forms of self-neglect has become widely accepted as:
- Lack of self-care. This includes neglect of one’s personal hygiene, nutrition and hydration, or health, to an extent that may endanger safety or well-being.
- Lack of care of one’s environment. This includes situations that may lead to domestic squalor or elevated levels of risk in the domestic environment (e.g. health or fire risks caused by hoarding).
- Refusal of services that might alleviate these issues. This might include, for example, refusal of care services in either their home or a care environment or of health assessments or interventions, even if previously agreed, which could potentially improve self-care or care of one’s environment.
Why is self-neglect a safeguarding concern?
Self-neglect and hoarding often stems from complex factors such as trauma, mental or physical health issues, loss or cognitive decline. Some of the more frequent underlying causes include physical or cognitive decline; advancing age; social isolation; neglect; mental illness and disorder; and grief and trauma.
What makes self-neglect particularly concerning is its demographic profile: almost half of those affected by self-neglect are over the age of 60. This intersection of mental health, ageing and vulnerability underscores the urgent need for professionals across health, social care and public service sectors to:
- Recognise signs of self-neglect and identify safeguarding concerns early.
- Balance risk and protection with individual autonomy and mental capacity.
The consequences of failing to act are stark. In July last year, it was revealed that six individuals aged between 58 and 79 died between March 2020 and August 2023 due to self-neglect. These tragedies prompted the Somerset Safeguarding Adults Board (SSAB) to call for improved safeguarding assessments and enhanced training around self-neglect.
Professor Michael Preston-Shoot, SSAB’s Chair, emphasised the importance of supporting practitioners until they are truly confident in conducting mental capacity assessments - a critical skill in preventing harm and protecting lives.
How can professionals maintain good practice in self-neglect work?
Self-neglect and hoarding represent one of the most complex areas of adult safeguarding practice. The challenge for professionals is how they maintain a sensitive balance between respecting individual autonomy and managing risk and protection.
There are several core themes that professionals who work with people facing self-neglect can implement into their practice:
- Relationship-focused. Build trust through consistency and empathy.
- Respect and autonomy. Support informed choice even where risk remains.
- Legal literacy. Understand statutory powers and limits.
- Early, purposeful multi-agency coordination. Housing, fire and rescue, environmental health, GP/mental health must work together and share information (lawfully) from the outset.
- Recording. Document all contacts, risk discussions and mental capacity decisions clearly.
- Trauma-informed. Follow a strengths and harm-reduction approach.
- Persistence and patience. Sustained engagement is often required to resolve complex self-neglect.
It is essential that professionals across health, social care, housing, and fire and rescue services receive comprehensive training on self-neglect and safeguarding. Not only must they be able to recognise when self-neglect constitutes a safeguarding issue requiring intervention, but also when a coordinated, multi-agency approach is critical to preventing harm.
How Bond Solon can help
Bond Solon is a premier provider of specialist training of health and social care professionals. We offer a range of safeguarding courses, including our Self Neglect and Hoarding course and our Self Neglect and Hoarding (Wales) course, aimed at ensuring health, social care other public services professionals can correctly identify, escalate, investigate and prevent cases where harm or abuse has occurred or is suspected.
What do our course delegates have to say?
Read on to find out what delegates on two of our recent Self Neglect and Hoarding courses have to say:
The trainer was really informative and welcoming. Good course. I do feel that the individuals that may benefit from this course were not present - i.e. other agencies such as fire service, waste etc.
A very useful course, and good to see how differing professions positively engage in the process. I found this aspect extremely relevant for this authority.