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Opening the "too difficult box"

Disheveled person sleeping rough on a park bench

Note: both the final report and the economic report from this study are forthcoming.

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.


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.


Related work in adult safeguarding


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)

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).

Stan Burridge standing next to a poster

Our Partners


NIHR School for Social Care Research

Project status: Ongoing