Self-neglect

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Self-neglect is a behavioral condition in which an individual neglects to attend to their basic needs, such as personal hygiene, appropriate clothing, feeding, or tending appropriately to any medical conditions they have. [1] More generally, any lack of self-care in terms of personal health, hygiene and living conditions can be referred to as self-neglect. Extreme self-neglect can be known as Diogenes syndrome.

Contents

Classification

There are two types of self-neglect: intentional (active), and non-intentional (passive). Intentional self-neglect occurs when a person makes a conscious choice to engage in self-neglect. Non-intentional self-neglect occurs as a result of health-related conditions that contribute to the risk of developing self-neglect. Different societies and cultures can have different beliefs regarding acceptable living standards, making self-neglect a serious and complex problem requiring clinical, social, and ethical decisions in its management and treatment.[ citation needed ]

Presentation

Complication

Without sufficient personal hygiene, sores can develop and minor wounds may become infected. Existing health problems may be exacerbated, due to insufficient attention being paid to them by the individual. Neglect of personal hygiene may mean that the person suffers social difficulties and isolation.

Self-neglect can also lead to the individual having a general reduction in attempts to maintain a healthy lifestyle, with increased smoking, drug misuse or lack of exercise. [2]

Any mental causes of the self-neglect may also lead to the individual refusing offers of help from medical or adult social services.

Causes

Self-neglect can be as a result of brain injury, dementia or mental illness. [3] It can be a result of any mental or physical illness which has an effect on the person's physical abilities, energy levels, attention, organizational skills or motivation.

A decrease in motivation can also be a side effect of psychiatric medications, putting those who require them at a higher risk of self-neglect than might be caused by mental illness alone. [1] [2]

Risk factors

Risk factors are:[ citation needed ]

Age-related changes that result in functional decline, cognitive impairment, frailty, or psychiatric illness increase vulnerability for self-neglect.[ citation needed ] For this reason, it is thought that, while self-neglect can occur across the lifespan,[ citation needed ] it is more common in older people.[ citation needed ] Self-neglect is thought to be linked to underlying mental illnesses.

Living in squalor is sometimes accompanied by dementia, alcoholism, schizophrenia, or personality disorders.[ citation needed ] Conversely, research has shown that 30–50% people suffering from self-neglect have shown no psychiatric disorders that would explain their behavior.[ citation needed ] Alternate models to the medical model, such as sociological and psychological, offer broader perspectives that take into account the complexities and factors associated with self-neglect.[ citation needed ] These alternate models emphasize cultural and social values and personal circumstances, and posit that self-neglect develops over time and can be rooted in family relationships and cultural values.

Diagnosis

Definition

There is no clear operational definition of self-neglect - some research suggests it is not possible for a universal definition due to its complexity. Gibbons (2006) defined it as: "The inability (intentional or non-intentional) to maintain a socially and culturally accepted standard of self-care with the potential for serious consequences to the health and well-being of the self-neglecters and perhaps even to their community." [4] The behaviors and characteristics of living in self-neglect include unkempt personal appearance, hoarding items and pets, neglecting household maintenance, living in an unclean environment, poor personal hygiene, and eccentric behaviors. Research also points to behaviors such as unwillingness to take medication, and feelings of isolation. Some of these behaviors could be explained by functional and financial constraints, as well as personal or lifestyle choices.

Use in assessment of needs

Neglect of hygiene is considered as part of the Global Assessment of Functioning, where it indicates the lowest level of individual functioning. It is also part of the activities of daily living criteria used to assess an individual's care needs. In the UK, difficulty in attending to their own physical cleanliness or need for adequate food are part of the criteria indicating whether a person is eligible for Disability Living Allowance.

Treatments

Treatment may involve treating the cause of the individual's self-neglect, with treatments such as those for depression, dementia or any physical problems that are hampering their ability to care for themselves.

The individual may be monitored, so that any excessive deterioration in their health or levels of self-care can be observed and acted upon. [5]

Treatment can involve care workers providing home care, attending to cleansing, dressing or feeding the individual as necessary, without reducing their independence and autonomy any more than is essential. [6] In combination with other illnesses, self-neglect may be one of the indicators that a person would be a candidate for treatment in sheltered housing or residential care. This would also improve their condition by providing opportunities for social interaction.

If the person is deemed not to have the mental capacity to make decisions about their own care, they may be sectioned [7] or compelled to accept help. If they are in possession of their mental faculties, they have a right to refuse treatment.

See also

Related Research Articles

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

Health has a variety of definitions, which have been used for different purposes over time. Health can be promoted by encouraging healthful activities, such as regular physical exercise and adequate sleep, and by reducing or avoiding unhealthful activities or situations, such as smoking or excessive stress. Some factors affecting health are due to individual choices, such as whether to engage in a high-risk behavior, while others are due to structural causes, such as whether the society is arranged in a way that makes it easier or harder for people to get necessary healthcare services. Still, other factors are beyond both individual and group choices, such as genetic disorders.

Elder abuse is "a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person." This definition has been adopted by the World Health Organization (WHO) from a definition put forward by Hourglass in the UK. Laws protecting the elderly from abuse are similar to and related to laws protecting dependent adults from abuse.

A factitious disorder is a mental disorder in which a person, without a malingering motive, acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms, purely to attain a patient's role. People with a factitious disorder may produce symptoms by contaminating urine samples, taking hallucinogens, injecting fecal material to produce abscesses, and similar behaviour. The word factitious derives from the Latin word factītius, meaning "human-made".

<span class="mw-page-title-main">Mental health</span> Level of human psychological well-being

Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. According to World Health Organization (WHO), it is a "state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community". It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others. From the perspectives of positive psychology or holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve psychological resilience. Cultural differences, personal philosophy, subjective assessments, and competing professional theories all affect how one defines "mental health". Some early signs related to mental health difficulties are sleep irritation, lack of energy, lack of appetite, thinking of harming oneself or others, self-isolating, and frequently zoning out.

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<span class="mw-page-title-main">Self-care</span> Taking care of ones own health

Self-care has been defined as the process of establishing behaviors to ensure holistic well-being of oneself, to promote health, and actively manage illness when it occurs. Individuals engage in some form of self-care daily with food choices, exercise, sleep, and hygiene. Self-care is not only a solo activity, as the community—a group that supports the person performing self-care—overall plays a role in access to, implementation of, and success of self-care activities.

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A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individuals were the forefront brigade to develop the community programs, which today may be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment, individual and family psychoeducation, adult day care, foster care, family services and mental health counseling.

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<span class="mw-page-title-main">Caregiver</span> Person helping another with activities of daily living

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<span class="mw-page-title-main">Homelessness and mental health</span>

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Mental health inequality refers to the differences in the quality, access, and health care different communities and populations receive for mental health services. Globally, the World Health Organization estimates that 350 million people are affected with depressive disorders. Mental health can be defined as an individual's well-being and/or the absence of clinically defined mental illness. Inequalities that can occur in mental healthcare may include mental health status, access to and quality of care, and mental health outcomes, which may differ across populations of different race, ethnicity, sexual orientation, sex, gender, socioeconomic statuses, education level, and geographic location. Social determinants of health, more specifically the social determinants of mental health, that can influence an individual's susceptibility to developing mental disorders and illnesses include, but are not limited to, economic status, education level, demographics, geographic location and genetics.

References

  1. 1 2 Pathways Courses – Out of the Shadows
  2. 1 2 "BBC News - HEALTH - Health check demand for mentally ill". news.bbc.co.uk. 2002-02-22. Retrieved 19 May 2017.
  3. "FindArticles.com - CBSi". findarticles.com. Retrieved 19 May 2017.
  4. Gibbons, S., Lauder, W. (2006) Self-neglect: a proposed new NANDA diagnosis, International Journal of Nursing Terminologies and Classifications, Jan-Mar, 17, 1
  5. 4. Risks Arising from Self-Neglect or a Person's Own Behaviour or Lifestyle Archived 2007-08-20 at the Wayback Machine
  6. "Archived copy" (PDF). Archived from the original (PDF) on 2009-03-17. Retrieved 2007-11-19.{{cite web}}: CS1 maint: archived copy as title (link)
  7. "Doctorate in Clinical Psychology". psychology.iop.kcl.ac.uk. Archived from the original on 21 October 2007. Retrieved 19 May 2017.