Social work practice with self-neglect and homelessness: Findings from vignette-based interviews

This article reports social workers' attitudes and approaches to working with people experiencing multiple exclusion homelessness (MEH) who self-neglect, and whether these people receive services, including safeguarding, differently from other populations. It draws on telephone interviews in 2020 with twenty-two social workers working with adults in a range of statutory local authority and National Health Service hospital roles in England. Interviews used two almost identical vignettes featuring self-neglect to prompt discussion and solicit experiences; one included homelessness and drug use to draw out any differences. Following transcription, interview data were analysed thematically. What emerged is a rich understanding of practice responses to self-neglect, but also uncertainties within contemporary social work: whether people who are homeless fall under the 'umbrella' of Adult Social Care and safeguarding; and whether self-neglect 'fits' under safeguarding. Additionally, participants described barriers to successful multi-agency support for people experiencing MEH, including stigma and exclusion from some statutory services. There was evidence that recent learning from Safeguarding Adults Reviews and local deaths has led to some examples of stronger multi-agency working in this context. The findings suggest more clarity is needed within the profession to ensure that people experiencing MEH benefit from strengthened social work input and safeguarding expertise. Do people who are experiencing homelessness and who have mental health problems, a traumatic personal history or use drugs or alcohol, receive the same statutory social care and safeguarding support as other people? Prompted by the deaths of people experiencing homelessness, which have highlighted the failure of local services, we interviewed twenty-two social workers working with adults in England to find out their attitudes and approaches to working with this group. Social workers raised issues that were unclear, such as whether social work sufficiently supports people who are homeless, and whether self-neglect-not keeping yourself safe and well-should ever be addressed as a part of safeguarding practice. Some described barriers to working with this population, such as when services don't work well together, when professionals stigmatise people using drink or drugs, and when services don't adapt to meet people's needs. Some described positive new developments bringing together local services to better support people who are homeless. Our findings suggest that we need greater agreement within the social work profession to ensure that people who are homeless receive the social care and safeguarding support that other people receive.

Automated summary

This article examines social workers' attitudes and approaches towards people experiencing multiple exclusion homelessness (MEH) and self-neglect. The study reveals uncertainties and barriers within contemporary social work, such as the classification of homeless individuals under Adult Social Care and safeguarding, and the inclusion of self-neglect as a part of safeguarding practice. While there have been some positive developments, more clarity is needed in the profession to ensure that people experiencing MEH receive the necessary social work support and safeguarding expertise.