4. Risks Arising from Self-Neglect or a Person's Own Behaviour or Lifestyle
4.1 A vulnerable adult will be considered under this procedure where they are unable to provide adequate care for themselves and one or more of the following situations apply:
- They are unable to obtain necessary care to meet their needs.
- They are unable to make reasonable or informed decisions because of their state of mental health or because they have a learning disability or an acquired brain injury. (See Appendix I of this document for details regarding mental capacity and the Department of Health guidelines on consent to medical treatment.) They are unable to protect themselves adequately against potential exploitation or abuse.
- They have refused essential services without which their health and safety needs cannot be met.
4.2 Often, the cases which give rise to the most concern are those where a vulnerable adult refuses help and services and is seen to be at grave risk as a result. If an agency is satisfied that the vulnerable adult has the capacity to make an informed decision, then that person has the right to refuse services.
4.3 In these circumstances, agencies must discuss their concerns at a Case Conference convened under this procedure where information can be shared with the vulnerable adult. Exclusion of the vulnerable adult from this process is to be the exception, and then only with good reason.
4.4 Where the vulnerable adult continues to refuse all assistance, this decision, together with any reasons, should be fully recorded and maintained on the person's Social Services file, with a full record of the efforts and actions taken by the agencies to assist the vulnerable adult.
4.5 Appropriate communication should be forwarded to the vulnerable adult concerned setting out what services were offered and why and the fact of the person's refusal to accept them. This needs to make clear that the person can contact the relevant agency at any time in the future for services. In cases of high risk, consideration should be given to arrangements for monitoring the case to ensure that circumstances do not deteriorate to an unacceptable degree.