Safeguarding review after death of seven Manx residents from 'self-neglect'

Changes to safeguarding policies in light of report

Seven Manx residents have died in cases of 'self-neglect'  in the past four years.

A Serious Case Management Review (SCMR) written by independent author Sylvia Manson, has now been published, examining the circumstances around the end of the their lives and what agencies on the Isle of Man could have done better, and how they can learn from it.

The seven people have been given pseudonyms for the purpose of the report: Robin, Andrea, Emma, Thomas, James, Margaret and Harriet. Their ages range from their thirties to their eighties.

Each person's death, the report says, was under 'very sad circumstances' where areas such as personal hygiene, dietary and health needs all fell below what would be considered acceptable standards.

Self-neglect may also relate, it says, to a 'lack of care to one's environment' - such as unhygienic living conditions and clutter arising from hoarding.

There was also, at times, a refusal to accept aid or advice from the services on offer on the Isle of Man.

The review looks at the last two years of their lives - these are some of their stories which contain details some readers may find distressing.

Robin - The primary case

Robin, a man in his eighties, died in December 2021 of hypothermia in the house he was born in.

He is the primary case in this review and the person whose death sparked the Serious Case Management Review - he was on the radar of social services for more than two decades.

The Isle of Man Safeguarding Board will undertake a SCMR only when there is concern over how the board and other agencies/ bodies work together to safeguard an individual who has later died or suffered serious harm, and where abuse or neglect is known or suspected.

Robin's family home, it's said, used to be kept in a 'pristine' condition, but at the time of his death had fallen into disrepair and had become 'unsanitary' and 'unsafe'.

'The floorboards, walls and chimney were crumbling, there was no heat or hot water, and the only source of electricity was a single socket.'

He had sores on his legs from sleeping on a mattress where the padding had been chewed away by mice and other rodents.

Robin became known to Adult Social Care after being referred by his GP in 2001 - when it was noted he was living in squalor and resisted help and support.

He had no family on the Isle of Man but a cousin living in the UK kept in touch and tried to offer and find support. 

Despite appearing to be financially capable Robin was said to be reluctant to pay for services or even put the heating on in his home.

'He worried about money. He would salvage out-of-date food from supermarket bins.'

In the two decades that followed the review details how services tried, but ultimately failed, to help him.

Looking back on Robin's death the review finds missed opportunities, limited mental health support and evidence that practitioners became 'desensitised and blunted' to his day-to-day experience. 

It suggests more could have been done to negotiate 'small steps' towards change. 

Thomas 

The man known as Thomas was only in his thirties when he passed away in June 2020 after an overdose of Venlafaxine whilst under the influence of alcohol.

He's the youngest of the seven individuals.

It's not clear, the report states, that he intended to die but at the time of his death he'd been neglecting self-care and was living in 'very poor and unhygienic conditions'.

He was living alone after separating from his wife and had a long history of anxiety and depression.

Like Robin, Thomas was in contact with support services. He was well known to mental health services and the Drug and Alcohol Team.

It was noted that the services were responsive to him and, prior to his death, the report finds there were no concerns that indicated a need for a safeguarding response.

Margaret - Lost from sight

Margaret, a European migrant to the Isle of Man, died in her eighties in March 2021 of hypothermia after a fall in her unheated house. 

Unlike Robin or Thomas she was unknown to any services on the Island, nor was she registered with a GP.

'[Margaret] fell through the net of support that might have been available'- Coroner.

Separated from her husband, and living alone, the report details how Margaret's life changed dramatically following a fall several years ago.

Margaret's neighbour, a 'compassionate and respectful' man, supported and kept an eye on her. His view, however, was that Margaret would have resisted help from the services.

The review suggests her lack of contact with Adult Social Care Services shows an apparent 'lack of awareness' within the Isle of Man of the support available.

Image: Members of the Isle of Man Safeguarding Board (left to right) - Stuart Quayle, Interim CEO Department of Health and Social Care, Chief Constable Gary Roberts, Lesley Walker, Independent Chair, Safeguarding Board, Teresa Cope, Manx Care CEO, and Director of Social Care, Sally Shaw.

'There is a need for an IOM self-neglect strategy'

The recommendations in the review amount to what is described as 'a substantial agenda'.

Manx Care says it's focused on strengthening safeguarding adults across Health and Social Care.

In response to this review the health body has announced plans to establish a Multi-Agency Safeguarding Hub (MASH) in collaboration with the Isle of Man Constabulary.

MASH organisations are common in the UK and it's hoped a Manx hub will help connect the links, between the different support networks available on the Isle of Man, to ensure no one 'slips through the cracks'.

Manx Care is also developing Wellbeing Partnership Hubs across the Island for agencies to 'coordinate care'.

In many of the cases the review found practitioners were often reluctant to put in recommendations or referrals to other agencies, something the Safeguarding Board told Manx Radio it's keen to amend - insisting no member of staff should ever have hesitations about making a judgement call if they're concerned for someone's welfare.

'Professional curiosity' is something the board says it's keen to encourage and emphasise within healthcare. 

'If you've got a concern about a loved one or a neighbour and you feel someone might be self-neglecting please make contact with the agencies.'  - Lesley Walker

Lesley Walker is the independent chair of the Safeguarding Board - she spoke to Manx Radio's Lewis Foster:

The Department of Infrastructure's housing department intends to develop the current housing support offering, as a potential 'intervention' point to identify those struggling with self-neglect - but this will need political support.

The Department of Health and Social Care is also working to bring in new legislation on mental capacity - to assist practitioners in determining whether individuals have the capacity to make their own decisions.

'We're very keen that the Act is fit for purpose, effective and the professionals that are impacted by it are properly trained.' - Stuart Quayle

Stuart Quayle, the interim chief executive of the department, spoke to Manx Radio:

You can find the full report and response from the Safeguarding Board here.