Opening the "too difficult box"
Download the above infographic (PNG)
End of project animation (YouTube; 4 mins 17 secs): Strengthening adult safeguarding responses to homelessness and self-neglect.
Final report
Harris, J., Martineau, S., Cornes, M., Manthorpe, J., Tinelli, M., Ornelas, B. & Burridge. S. (2025) Opening the “too difficult box”: Strengthening adult safeguarding responses to homelessness and self-neglect, York: NIHR School for Social Care Research.
Economic analysis report
Tinelli M, Harris J, Cornes M, Martineau S, Ornelas B, Burridge S, Manthorpe, J (2024) Strengthening adult safeguarding responses to homelessness and self-neglect: economic analysis report, London: London School of Economics and Political Science.
More publications from this study can be found under the Outputs and Activity tabs further down the page.
Strengthening adult safeguarding responses to homelessness and self-neglect
This 2019 - 2023 study, co-led by Michelle Cornes of HSCWRU and Michela Tinelli (LSE), with Jess Harris taking over from Michelle Cornes in autumn 2022, is funded by the NIHR School for Social Care Research. Also on the team: Stephen Martineau and Jill Manthorpe of HSCWRU; Bruno Ornelas (Concrete); Stan Burridge (Expert Focus), PPIE/Peer Researcher; James Fuller, PPIE/Peer Researcher.
This study explores how self-neglect is experienced by people who are homeless, and how this can be addressed through strengthening local adult safeguarding responses. Little is known about what constitutes ‘positive practice’ and the services and support that are needed to address this problem, particularly where it intersects with substance misuse and other extreme forms of deep social exclusion. Concerns have been raised by government about the adequacy of safeguarding, why there have been so few Safeguarding Adults Reviews into the deaths of people who are homeless, and whether learning from these Reviews is being implemented.
Methods
This study is employing participatory and action orientated methods to work collaboratively with Safeguarding Adults Boards across three English local authority areas to identify positive practices and areas for improvement. In 2020 we carried out a review of the research, legal and policy literature, and telephone interviews with social workers about their views and experiences of working with people who self-neglect, with a focus on whether people experiencing Multiple Exclusion Homelessness experience Adult Social Care services, including safeguarding, differently. In 2021 primary data collection in the three local authorities has included 60 online interviews with practitioners and starting the face to face interviews with people who are homeless; economic modelling using SARs is underway and we have been generating impact using Communities of Practice (CoPs) in each site. All the study findings will inform the development of national practice guidance on self-neglect and homelessness plus other outputs for specific audiences.
See
- Showcase of social care research in NIHR Policy Research Units (22 March 2023)
Related work in adult safeguarding
Report
Martineau, S. J., Cornes, M., Manthorpe, J., Ornelas, B., & Fuller, J. (2019). Safeguarding, homelessness and rough sleeping: An analysis of Safeguarding Adults Reviews. London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London.
Related projects at the Unit (2022-2023)
- Evidencing the social work role within responses to multiple exclusion homelessness
- Examining mental capacity approaches to multiple exclusion homelessness
- Just another form of exclusion? Carrying out research with people experiencing multiple exclusion homelessness
See also
The Unit's conducted a parallel project examining social care responses to self-neglect and hoarding among older people. As well as fieldwork, this study published two evidence reviews, one on self-neglect (2021) and one on hoarding (2022).
The photo below shows team member Stan Burridge at a project outreach event in London (see under Activity).
Project Team
Expert Focus
Visiting Professorial Fellow
Research Fellow
Research Fellow
Rough Sleeping Adviser, Ministry for Housing, Communities and Local Government
London School of Economics
Publications
End of project animation (YouTube; 4 mins 17 secs): Strengthening adult safeguarding responses to homelessness and self-neglect.
Harris, J., Martineau, S., Cornes, M., Manthorpe, J., Tinelli, M., Ornelas, B. & Burridge. S. (2025) Opening the “too difficult box”: Strengthening adult safeguarding responses to homelessness and self-neglect, York: NIHR School for Social Care Research.
Tinelli M, Harris J, Cornes M, Martineau S, Ornelas B, Burridge S, Manthorpe, J (2024) Strengthening adult safeguarding responses to homelessness and self-neglect: economic analysis report, London: London School of Economics and Political Science. https://eprints.lse.ac.uk/127510/
Jess Harris, Stephen Martineau, Jill Manthorpe, Stan Burridge, Bruno Ornelas, Michela Tinelli, Michelle Cornes, Social work practice with self-neglect and homelessness: Findings from vignette-based interviews, The British Journal of Social Work, Volume 53, Issue 4, June 2023, Pages 2256–2276, https://doi.org/10.1093/bjsw/bcac180
Harris, J. (Ed.) (2022) Safeguarding Responses to Homelessness and Self-Neglect Communities of Practice Report: Key messages emerging from conversations in research study sites, London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London.
Manthorpe, J., Harris, J., Burridge, S., Fuller, J., Martineau, S., Ornelas, B., Tinelli, M. and Cornes M. (2021) 'Social Work Practice with Adults under the Rising Second Wave of Covid-19 in England: Frontline Experiences and the Use of Professional Judgement', The British Journal of Social Work.
Martineau, S. (2020) 'Three early papers on self-neglect', The Journal of Adult Protection. (Blog post introducing this article - December 2020)
The publication feed is not currently available.
Conferences
Jess Harris spoke at the Showcase of social care research in NIHR Policy Research Units (2), hosted by the NIHR Policy Research Unit in Adult Social Care on 22 March 2023. Recording, summary and slides.
Harris, J. and Burridge, S. (2023) Lived experience perspectives on homelessness, self-neglect and safeguarding. Homelessness Series, King's College London. 25 April.
Harris, J., Burridge, S. and Ornelas, B. (2023) Safeguarding responses to homelessness & self-neglect. Emerging messages from a national study. Homelessness Series, King's College London. 31 January.
Harris, J. and Tinelli, M. (2023) Safeguarding, self-neglect and homelessness. City and Hackney, London. 23 January.
Tinelli, M. and Harris, J. (2022) Economic impact of closing the gaps in responses to homelessness and self-neglect. Homelessness Series, King's College London. 12 December.
Harris, J. (2022) Social Work & Homelessness. Emerging messages from a national study of homelessness, self-neglect & safeguarding. Homelessness Series, King's College London. 26 October.
‘Whose responsibility are they?’ What is the role of social work in safeguarding people experiencing multiple exclusion homelessness who self-neglect? Presentation by Jess Harris at the JSWEC Conference, 24 June 2022.
'What do Safeguarding Adult Reviews (SARs) tell us about deaths among people who are homeless? Focus on Self-Neglect' Presentation by Michelle Cornes and Jo Coombes (Peer Researcher/Expert by Experience) to the Primary Care Safeguarding Forum: Annual Conference 2021, 12 March 2021 (online)
Outreach event in London: working with experts by experience
On 17 August 2021 HSCWRU Advisory Group member Stan Burridge and researcher Jess Harris spent the afternoon helping out at a HSCWRU co-branded community event in London. The event was supported by a small National Lottery grant secured by HSCWRU to carry out awareness-raising related to homelessness, led by Stan, ex-homeless Expert by Experience. HSCWRU has been working with MRS Independent Living, who hosted the event, and the event was an excellent opportunity for Stan and Jess to talk to the local homeless population that MRS Independent Living supports.
News
Unit work discussed at local authority safeguarding learning event
Jess Harris presented findings from the safeguarding, homelessness and self-neglect study
Unit work discussed at local authority learning event
Jess Harris presented emerging findings from the MCA study
Unit research features in Huck
The magazine cites Unit work on homelessness
Adult Safeguarding: Past, Present and Future
Jess Harris and Jill Manthorpe presented Unit work at a University of Bath conference
Unit self-neglect studies present findings at Trinity College Dublin
Nicole Steils and Jess Harris were invited speakers at international adult safeguarding conference
Project Team
Expert Focus
Visiting Professorial Fellow
Research Fellow
Research Fellow
Rough Sleeping Adviser, Ministry for Housing, Communities and Local Government
London School of Economics
Publications
End of project animation (YouTube; 4 mins 17 secs): Strengthening adult safeguarding responses to homelessness and self-neglect.
Harris, J., Martineau, S., Cornes, M., Manthorpe, J., Tinelli, M., Ornelas, B. & Burridge. S. (2025) Opening the “too difficult box”: Strengthening adult safeguarding responses to homelessness and self-neglect, York: NIHR School for Social Care Research.
Tinelli M, Harris J, Cornes M, Martineau S, Ornelas B, Burridge S, Manthorpe, J (2024) Strengthening adult safeguarding responses to homelessness and self-neglect: economic analysis report, London: London School of Economics and Political Science. https://eprints.lse.ac.uk/127510/
Jess Harris, Stephen Martineau, Jill Manthorpe, Stan Burridge, Bruno Ornelas, Michela Tinelli, Michelle Cornes, Social work practice with self-neglect and homelessness: Findings from vignette-based interviews, The British Journal of Social Work, Volume 53, Issue 4, June 2023, Pages 2256–2276, https://doi.org/10.1093/bjsw/bcac180
Harris, J. (Ed.) (2022) Safeguarding Responses to Homelessness and Self-Neglect Communities of Practice Report: Key messages emerging from conversations in research study sites, London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London.
Manthorpe, J., Harris, J., Burridge, S., Fuller, J., Martineau, S., Ornelas, B., Tinelli, M. and Cornes M. (2021) 'Social Work Practice with Adults under the Rising Second Wave of Covid-19 in England: Frontline Experiences and the Use of Professional Judgement', The British Journal of Social Work.
Martineau, S. (2020) 'Three early papers on self-neglect', The Journal of Adult Protection. (Blog post introducing this article - December 2020)
The publication feed is not currently available.
Conferences
Jess Harris spoke at the Showcase of social care research in NIHR Policy Research Units (2), hosted by the NIHR Policy Research Unit in Adult Social Care on 22 March 2023. Recording, summary and slides.
Harris, J. and Burridge, S. (2023) Lived experience perspectives on homelessness, self-neglect and safeguarding. Homelessness Series, King's College London. 25 April.
Harris, J., Burridge, S. and Ornelas, B. (2023) Safeguarding responses to homelessness & self-neglect. Emerging messages from a national study. Homelessness Series, King's College London. 31 January.
Harris, J. and Tinelli, M. (2023) Safeguarding, self-neglect and homelessness. City and Hackney, London. 23 January.
Tinelli, M. and Harris, J. (2022) Economic impact of closing the gaps in responses to homelessness and self-neglect. Homelessness Series, King's College London. 12 December.
Harris, J. (2022) Social Work & Homelessness. Emerging messages from a national study of homelessness, self-neglect & safeguarding. Homelessness Series, King's College London. 26 October.
‘Whose responsibility are they?’ What is the role of social work in safeguarding people experiencing multiple exclusion homelessness who self-neglect? Presentation by Jess Harris at the JSWEC Conference, 24 June 2022.
'What do Safeguarding Adult Reviews (SARs) tell us about deaths among people who are homeless? Focus on Self-Neglect' Presentation by Michelle Cornes and Jo Coombes (Peer Researcher/Expert by Experience) to the Primary Care Safeguarding Forum: Annual Conference 2021, 12 March 2021 (online)
Outreach event in London: working with experts by experience
On 17 August 2021 HSCWRU Advisory Group member Stan Burridge and researcher Jess Harris spent the afternoon helping out at a HSCWRU co-branded community event in London. The event was supported by a small National Lottery grant secured by HSCWRU to carry out awareness-raising related to homelessness, led by Stan, ex-homeless Expert by Experience. HSCWRU has been working with MRS Independent Living, who hosted the event, and the event was an excellent opportunity for Stan and Jess to talk to the local homeless population that MRS Independent Living supports.
News
Unit work discussed at local authority safeguarding learning event
Jess Harris presented findings from the safeguarding, homelessness and self-neglect study
Unit work discussed at local authority learning event
Jess Harris presented emerging findings from the MCA study
Unit research features in Huck
The magazine cites Unit work on homelessness
Adult Safeguarding: Past, Present and Future
Jess Harris and Jill Manthorpe presented Unit work at a University of Bath conference
Unit self-neglect studies present findings at Trinity College Dublin
Nicole Steils and Jess Harris were invited speakers at international adult safeguarding conference
Our Partners
NIHR School for Social Care Research
Principal Investigators
Visiting Professorial Fellow
Research Fellow