Faculty of Health, School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK.
Health Soc Care Community. 2022 Nov;30(6):e4395-e4404. doi: 10.1111/hsc.13839. Epub 2022 May 23.
The number of adults who self-neglect and thus fall under the aegis of local authority adult safeguarding procedures in England has increased substantially since the introduction of the Care Act 2014. The requirement for collaborative working between agencies dealing with these adults in a safeguarding context is explicit in government policy and legislation. Decisions made by the multiplicity of agencies that may work with people who self-neglect are largely guided by the Mental Capacity Act 2005 (MCA). The overall objective of this research was to develop a clearer understanding of how the range of agencies that might typically be involved in the life of a self-neglecting person work together. This article examines how agencies put the MCA into practice in their work with people who self-neglect, and how they understand their own and others' roles and responsibilities in so doing. This qualitative study took place in two local authorities in England from 2016 to 2017 and informed a wider action research study which was completed in 2019. Non-probability purposive sampling was used to recruit participants from the professional groups who might typically be involved with self-neglect cases. À total of 245 participants from across 17 different professional groups took part in semi-structured interviews, in a group, paired or individual format, decided by their customary working configuration. Data from the interview transcripts was analysed using thematic analysis. Three key themes in relation to how participants understood the MCA and multi-agency working emerged from the analysis of this data set. These were; a lack of understanding of the MCA by participants and other agencies; a reluctance to engage with MCA assessments; and a perception of manipulation of the MCA by other professionals. This study underlines the importance of the informed application of the MCA in working with people who self-neglect, and an urgent need to consider how this could be enhanced if the service user is not to experience intrusive interventions resulting from professional misinterpretation.
自 2014 年《护理法案》（Care Act）颁布以来，在英国，自我忽视的成年人数量大幅增加，因此需要地方当局成人保护程序的保护。政府政策和法规明确要求在保护背景下处理这些成年人的机构之间进行协作。在自我忽视的情况下与这些成年人合作的多个机构做出的决策主要受到 2005 年《精神能力法案》（MCA）的指导。这项研究的总体目标是更清楚地了解可能参与自我忽视者生活的各种机构如何共同协作。本文探讨了各机构如何在与自我忽视者的工作中实施 MCA，以及他们如何理解自己和他人在这方面的角色和责任。这项定性研究于 2016 年至 2017 年在英格兰的两个地方当局进行，并为 2019 年完成的更广泛的行动研究提供了信息。非概率目的性抽样用于从可能通常涉及自我忽视案件的专业群体中招募参与者。共有来自 17 个不同专业群体的 245 名参与者参加了半结构化访谈，访谈形式为小组、配对或个人，由他们的惯用工作配置决定。访谈记录中的数据使用主题分析进行分析。从对这组数据的分析中得出了与参与者对 MCA 和多机构工作的理解有关的三个关键主题。这些主题是：参与者和其他机构对 MCA 的理解不足；不愿进行 MCA 评估；以及其他专业人员对 MCA 的操纵的看法。这项研究强调了在与自我忽视者合作时，MCA 的知情应用的重要性，并且迫切需要考虑如果服务使用者没有因专业人员的错误解释而经历侵入性干预，如何增强这一点。
