Interprofessional collaboration to support people experiencing self-neglect: a realist review of research studies and safeguarding adult reviews

Summary: Self-neglect, where adult individuals—for varying reasons—do not care for aspects of their health, wellbeing or home environment, involves significant risks and potential for harm. The importance of effective interprofessional and inter-agency collaboration in supporting people experiencing self-neglect is widely recognized, yet research and practice reviews attest to continuing challenges in collaborative working. This realist review integrates two sources of evidence, the international research literature and Safeguarding Adult Reviews (SARs) of practice cases in England, to theorize what mechanisms need to operate for effective inter-agency collaboration to support people experiencing self-neglect, and how context affects this. Searches in 2023–24 identified 41 studies and 273 SARs to inform the review, assessed on relevance and rigor. Findings: The review identified four mutually reinforcing elements that underpin collaborative working: (1) Common framework provided by policies, procedures and interfaces; (2) Mutual understanding of each other's roles and the task; (3) Shared vision of the person and situation “in the round”; (4) Management and monitoring ensuring commitment, learning and resources. Each is discussed in light of the distinctive challenges of self-neglect, and a composite example constructed from the review sources is used to illustrate. Applications: This review theorizes the elements needed for successful inter-agency and interprofessional collaboration in supporting people experiencing self-neglect. Its framework supports service leaders and researchers to consider how the mechanisms identified interact with the inter-agency context in which they unfold, and recognize the conditions needed for interventions to be effective.