The Isle of Man Safeguarding Board has said the island needs to ‘work better together’ following the death of seven adults because of self-neglect.

The board has published a Serious Case Management Review (SCMR) that includes recommendations to tackle self-neglect.

An SCMR identifies learning and applies this to improve safeguarding systems and practice to prevent harm.

This latest review, carried out by an experienced independent reviewer, identifies learning for all agencies and sectors and makes recommendations about how to better safeguard adults that are self-neglecting.

The deaths, which were part of the review, occurred between 2018 and 2022 and causes ranged from hypothermia to sepsis.

Only one of the seven cases met the criteria for a SCMR due to the level of multi-agency involvement with that individual, but it was agreed to undertake a thematic review of six similar cases.

This would provide more information to the agencies who wanted to reflect on how they could work more effectively together and with other sectors, to support individuals who are self-neglecting.

Self-neglect refers to a range of behaviours including a person not addressing their personal hygiene, dietary or health needs.

It may also be seen in a lack of care for their environment – living in unhygienic or unsafe home conditions, with clutter arising from hoarding resulting in serious health and safety risks, including fire risks.

It can lead to a refusal of assessments, support or interventions from services which may be able to address or provide support with some of the issues.

The SCMR collected reports from all agencies involved at any point with the individuals, and the information collated built a picture of the network around the individuals. The agencies involved included Manx Care, voluntary services, environmental health and the police – though some individuals were not engaged with any services.

A number of the individuals were in the plain sight of their communities and neighbours, but were isolated and often not referred for support or intervention.

The report also highlighted the struggle faced by professionals to engage with the individuals, the need for staff to consistently apply self-neglect guidance, improve their awareness of the legal framework and use formal capacity assessments and risk assessment tools.

It concluded that in order to improve how self-neglect is dealt with, the review recognised that services, communities and the voluntary sector need to work better together by sharing information, discussing concerns and engaging with the individuals family and wider network.


These networks of support need to be brought together and GPs need to be fully engaged.

The report has resulted in two specific recommendations. The first is that the Isle of Man Safeguarding Board should lead a strategy and implementation plan for self-neglect. This will look at introducing a ‘team around the adult’ approach, with specific training, policy and guidance on working with self-neglect.

And Manx Care mental health services should develop a policy to guide practice where service users do not attend appointments, including guidance on follow-up measures and communications with other agencies or family members as appropriate.

Independent chair of the Safeguarding Board, Lesley Walker, said: ‘It’s important that we continue to commission these reviews looking at difficult and complicated issues, so that we can develop and improve practice to better safeguard the vulnerable in our society.

‘It is my job to provide scrutiny and challenge of agencies in the Isle of Man and hold them to account for delivery of any necessary improvements to practice.

‘Work has already commenced as outlined in the board response to this review, to address the learning and the Safeguarding Board agencies have commissioned a specific piece of work to engage all sectors in improving the response to self-neglect.

‘The board agencies are committed to improving how self-neglect is recognised and dealt with, and that professionals feel confident about the best way they can intervene and support vulnerable adults in these circumstances.’

The full report and the response from the Safeguarding Board are available via the website