See also Local Contacts for contact information for the Safeguarding Teams and the Emergency Duty Team.
November 2018: This chapter has been revised as a result of local review.
- 1. Introduction
- 2. Patterns of Abuse
- 3. Location of Abuse
- 4. Who might Abuse?
- 5 The Legal framework for Safeguarding Concerns
- 6. Types of Abuse and Neglect
- 7. Other Types of Abuse
- a violation of an individual’s human and civil rights by any other person;
- or persons which may result in significant harm.
Abuse may be:
- a single act or repeated acts;
- an act of neglect or a failure to act;
- multiple acts (for example, an adult may be neglected and financially abused).
Abuse is about the misuse of the power and control that one person has over another. Where there is dependency, there is a possibility of abuse or neglect unless adequate safeguards are put in place.
Intent is not necessarily an issue at the point of deciding whether an act or a failure to act is abuse; it is the impact of the act on the person and the harm or risk of harm to that individual.
Acts of abuse may constitute a criminal offence.
Safeguarding adults refers to an adult who is experiencing or at risk of abuse or neglect, hereon referred to as an adult.
2. Patterns of Abuse
Incidents of abuse may be one off or multiple, and affect one person or more.
Professionals and others should look beyond single incidents or individuals, to identify patterns of harm, just as the Care Quality Commission, as the regulator of service quality, does when it looks at the quality of care in health and care services. Repeated instances of poor care may be an indication of more serious problems and of what is now described as organisational abuse. In order to see these patterns it is important that information is recorded and appropriately shared (see also Information Sharing and Record Keeping).
Patterns of abuse vary and include:
- serial abuse in which the perpetrator seeks out and ‘grooms’ individuals. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse;
- long term abuse in the context of an ongoing family relationship such as domestic violence and abuse between spouses or generations or persistent psychological abuse; or
- opportunistic abuse such as theft occurring because money or jewellery has been left lying around.
3. Location of Abuse
Abuse can take place anywhere, for example:
- the person’s own home, whether living alone, with relatives or others;
- day or residential centres;
- supported housing;
- work settings;
- educational establishments;
- care homes;
- other places in the community;
- Abuse can happen anywhere: for example, in someone’s own home, in a public place, in hospital, in a care home or in college. It can take place when an adult lives alone or with others.
Abuse can also occur through the use of technology, which may include:
- mobile phones;
- internet chat rooms;
- social networking sites;
- fraudulent websites.
4. Who might Abuse?
Abuse can occur in any relationship and may result in significant harm to, or exploitation of, the adult/s at risk.
A wide range of people may harm adults. These include:
- a member of staff, owner or manager at a residential or nursing home;
- a professional worker such as a nurse, social worker or general practitioner (GP);
- a volunteer or member of a ‘community group’ such as a social club or place of worship;
- another service user;
- a spouse, partner, relative or friend;
- a carer;
- a neighbour, local resident, member of the public or a stranger;
- a person who deliberately targets adults they perceive as vulnerable in order to exploit them.
While a lot of attention is paid, for example, to targeted fraud or internet scams perpetrated by complete strangers, it is far more likely the person responsible for abuse is known to the adult and is in a position of trust and power.
See also Preventing Abuse and Neglect
5 The Legal framework for Safeguarding Concerns
The local authority must enquiries where it has reasonable cause to suspect an adult in its area (whether or not ordinarily resident there):
- has needs for care and support (whether or not the authority is meeting any of those needs);
- is experiencing, or is at risk of, abuse or neglect; and
- as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it.
The Care Act 2014 states the following factors are to be taken into account when making an assessment of the seriousness of risk to the person:
- vulnerability of the person;
- nature and extent of the abuse or neglect;
- length of time the abuse or neglect has been occurring;
- impact of the alleged abuse on the adult;
- risk of repeated or increasingly serious acts of abuse or neglect;
- risk that serious harm could result if no action is taken;
- illegality of the act/s.
6. Types of Abuse and Neglect
Abusive behaviours may constitute a criminal offence. All suspected abuse must be investigated.
The presence of one or more of these signs does not confirm abuse. However, the presence of one or a number of these indicators may suggest the potential for abuse and a safeguarding referral must be made. See also Safeguarding Adults Process: Introduction and the Safeguarding Adults Process Flowchart.
Abuse can be viewed in terms of the following categories (although this is not an exhaustive list).
6.1 Physical abuse
Physical abuse includes hitting, slapping, pushing, kicking, misuse of medication, being locked in a room, inappropriate sanctions or force feeding, inappropriate methods of restraint, and unlawfully depriving a person of their liberty.
6.1.1 Possible indicators
- unexplained or inappropriately explained injuries;.
- person exhibiting untypical self-harm;
- unexplained cuts or scratches to mouth, lips, gums, eyes or external genitalia;
- unexplained bruising to the face, torso, arms, back, buttocks, thighs, in various stages of healing. Collections of bruises that form regular patterns which correspond to the shape of an object or which appear on several areas of the body;
- unexplained burns on unlikely areas of the body (for example, soles of the feet, palms of the hands, back), immersion burns (from scalding in hot water/liquid), rope burns, burns from an electrical appliance;
- unexplained or inappropriately explained fractures at various stages of healing to any part of the body;
- medical problems that go unattended;
- sudden and unexplained urinary and / or faecal incontinence;
- evidence of over-/under-medicating;
- person flinches at physical contact;
- person appears frightened or subdued in the presence of particular people;.
- person asks not to be hurt;
- person may repeat what the alleged abuser has said (for example ‘shut up or I’ll hit you’);
- reluctance to undress or uncover parts of the body;
- person wears clothes that cover all parts of their body or specific parts of their body;
- a person without capacity not being allowed to go out of a care home when they ask to;
- a person without capacity not being allowed to be discharged at the request of an unpaid carer / family member.
6.2 Sexual abuse
Sexual abuse includes rape and sexual assault or sexual acts that the adult has not consented to or could not consent to, or was pressured into.
It includes penetration of any sort, incest and situations where the alleged abuser touches the abused person’s body (for example breasts, buttocks, genital area), exposes his or her genitals (possibly encouraging the abused person to touch them) or coerces the abused person into participating in or looking at pornographic videos or photographs. Denial of a sexual life to consenting adults is also considered abusive practice.
Any sexual relationship that develops between adults where one is in a position of trust, power or authority in relation to the other (for example day centre worker / social worker / residential worker / health worker) may also constitute sexual abuse (see Stage 3: Undertaking Enquiries, Section 4.1, If the alleged person causing harm is an employee).
6.2.1 Possible Indicators
- person has urinary tract infections, vaginal infections or sexually transmitted diseases that are not otherwise explained;
- person appears unusually subdued, withdrawn or has poor concentration;
- person exhibits significant changes in sexual behaviour or outlook;
- person experiences pain, itching or bleeding in the genital / anal area;
- person’s underclothing is torn, stained or bloody;
- a woman who lacks the mental capacity to consent to sexual intercourse becomes pregnant;
- sexual exploitation.
The sexual exploitation of adults involves exploitative situations, contexts and relationships where adults (or a third person or persons) receive ‘something’ (for example food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of performing, and / or others performing on them, sexual activities.
Sexual exploitation can occur through the use of technology without the person’s immediate recognition: this can include, being persuaded to post sexual images on the internet/a mobile phone or being sent such an image by the person alleged to be causing harm. In all cases those exploiting the adult have power over them by virtue of their age, gender, intellect, physical strength and/or economic or other resources.
6.3 Psychological abuse
Psychological abuse includes ‘emotional abuse’ and takes the form of threats of harm or abandonment, deprivation of contact, humiliation, rejection, blaming, controlling, intimidation, coercion, indifference, harassment, verbal abuse (including shouting or swearing), and isolation or withdrawal from services or support networks.
Psychological abuse is the denial of a person’s human and civil rights including choice and opinion, privacy and dignity and being able to follow one’s own spiritual and cultural beliefs or sexual orientation.
It includes preventing the adult from using services that would otherwise support them and enhance their lives. It also includes the intentional and / or unintentional withholding of information (for example information not being available in different formats / languages and so on).
6.3.1 Possible indicators
- untypical ambivalence, deference, passivity, resignation;
- person appears anxious or withdrawn, especially in the presence of the alleged abuser;
- person exhibits low self-esteem;
- untypical changes in behaviour (for example continence problems, sleep disturbance);
- person is not allowed visitors / phone calls;
- person is locked in a room / in their home;
- person is denied access to aids or equipment, (for example glasses, dentures, hearing aid, crutches, etc.);
- person’s access to personal hygiene and toilet is restricted;
- person’s movement is restricted by use of furniture or other equipment;
- bullying via social networking internet sites and persistent texting.
6.4 Financial or material abuse
This includes theft, fraud, exploitation, internet scamming, pressure/ coercion in connection with an adult’s financial affairs or arrangements including wills, property inheritance or financial transactions or the misappropriation of property, possessions or benefits. It also includes the withholding of money or the unauthorised or improper use of a person’s money or property, usually to the disadvantage of the person to whom it belongs. Staff borrowing money or objects from a service user is also considered financial abuse.
Financial abuse can significantly impact on an adult’s health and well-being, and research has shown that where there are other forms of abuse, financial abuse is likely to be occurring.
According to the Office of the Public Guardian financial abuse is the most common form of abuse. Financial abuse can occur in isolation, but where there are also other forms of abuse, it is also likely to be a feature.
Financial abuse may amount to theft or fraud which the police should investigate. It may also require attention and collaboration from a wider group of organisations, including shops and financial institutions such as banks.
Where abuse is perpetrated by someone who has the authority to manage and adult’s money, the relevant body should be informed. In the case of a deputy or attorney this will be the Office of the Public Guardian, and for appointees the Department for Work and Pensions.
6.4.1 Possible indicators
- change in living conditions;
- lack of heating, clothing or food;
- unexplained loss/misplacement of financial documents;
- the recent addition of authorised signatories on a client or donor’s signature card; or
- sudden or unexpected changes in a will or other financial documents.
- lack of money, especially after benefit day;
- inadequately explained withdrawals from accounts;
- disparity between assets / income and living conditions;
- power of attorney obtained when the person lacks the capacity to make this decision;
- recent changes of deeds / title of house;
- recent acquaintances expressing sudden or disproportionate interest in the person and their money;
- service user not in control of their direct payment or individualised budget;
- misleading sales by door-to-door traders / cold callers;
- illegal money lending.
This is not an exhaustive list, nor do these examples prove that there is actual abuse occurring. However, they do indicate that a closer examination and possible investigation may be required.
6.4.2 Internet, postal and doorstep scams
Internet scams, postal scams and doorstep crime are more often than not, targeted at adults and are forms of financial abuse.
These scams are becoming ever more sophisticated and elaborate. For example:
- internet scammers can build very convincing websites;
- people can be referred to a website to check the caller’s legitimacy but this may be a copy of a legitimate website;
- postal scams are mass produced letters which are made to look like personal letters or important documents;
- doorstep criminals call unannounced at the adult’s home under the guise of legitimate business and offering to fix an often non-existent problem with their property. Sometimes they pose as police officers or someone in a position of authority.
All of these scams constitute financial abuse as the adult can be persuaded to part with large sums of money and in some cases their life savings. Such scams should always be reported to the police and local authority trading standards services for investigation. The SAB should consider how to involve local trading standards in its work.
These scams and crimes can seriously affect the health, including mental health, of an adult.
Agencies working together can better protect adults. Failure to do so can result in an increased cost to the state, especially if the adult loses their income and independence.
6.4.3 Perpetrators of financial abuse
Where the abuse is perpetrated by someone who has the authority to manage an adult’s money, the relevant body should be informed – for example, the Office of the Public Guardian for deputies or attorneys and Department for Work and Pensions (DWP) in relation to appointees.
If there are concerns that a DWP appointee is acting incorrectly, the DWP should be contacted immediately, having the person’s National Insurance number, name and address is helpful to the DWP. But the important thing is to alert DWP to the concern.
If DWP knows that the person is also known to the local authority, then it should also inform the relevant authority.
6.5 Neglect and acts of omission
These include ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, and the withholding of the necessities of life such as medication, adequate nutrition and heating. Neglect also includes a failure to intervene in situations that are dangerous to the person concerned or to others, particularly when the person lacks the mental capacity to assess risk for themselves.
Neglect and poor professional practice may take the form of isolated incidents or pervasive ill treatment and gross misconduct. Neglect of this type may happen within a person’s own home or in an organisation. Repeated instances of poor care may be an indication of more serious problems. Neglect can be intentional or unintentional.
6.5.1 Possible Indicators
- person has inadequate heating and / or lighting;
- person’s physical condition/appearance is poor (for example ulcers, pressure sores, soiled or wet clothing);
- person is malnourished, has sudden or continuous weight loss and / or is dehydrated;
- person cannot access appropriate medication or medical care;
- person is not afforded appropriate privacy or dignity;
- person and / or a carer has inconsistent or reluctant contact with health and social services;
- callers / visitors are refused access to the person;
- person is exposed to unacceptable risk.
6.6 Discriminatory abuse
This includes discrimination on the grounds of race, faith or religion, age, disability, gender, sexual orientation and political views, along with racist, sexist, homophobic or ageist comments or jokes, or comments and jokes based on a person’s disability or any other form of harassment. It also includes not responding to dietary needs and not providing appropriate spiritual support. Excluding a person from activities on the basis they are ‘not liked’ is also discriminatory abuse.
6.6.1 Possible Indicators
Indicators for discriminatory abuse may not always be obvious and may also be linked to acts of physical abuse and assault, sexual abuse and assault, financial abuse, neglect, psychological abuse and harassment, so all the indicators listed above may apply to discriminatory abuse.
- a person may reject their own cultural background and / or racial origin or other personal beliefs, sexual practices or lifestyle choices;
- a person making complaints about the service not meeting their needs.
6.6.2 Hate crime
A hate crime is any incident or criminal offence that is motivated by hostility or prejudice based upon the victim’s:
- religion or beliefs
- sexual orientation;
- transgender identity.
It should be noted that this definition is based on the perception of the victim or anyone else and is not reliant on evidence. It includes incidents that do not constitute a criminal offence.
Hate crime can take many forms, including:
- physical attacks, such as physical assault, damage to property, offensive graffiti and arson;
- threat of attack, including offensive letters, abusive or obscene telephone calls, groups hanging around to intimidate and unfounded, malicious complaints;
- verbal abuse, insults or harassment taunting, offensive leaflets and posters, abusive gestures, dumping of rubbish outside homes or through letterboxes, and bullying at school or in the workplace.
A victim does not have to be a member of the group at which the hostility is targeted; anyone can be a victim of a hate crime.
If a person is convicted of a criminal offence, and hostility in relation to any of the above five categories is proven, any sentence they receive will be increased to take in to account that it is a hate crime. For more information about hate crime, and the police, see True Vision website. For more information on local support, please see Local Contacts.
See also local information about reporting hated crime:
Please note – definition of alternative sub-culture:alternative sub-culture means a discernible group that is characterised by a strong sense of collective identity and values and taste, for example Goths, Emos, Punks, Metallers and some variants of hippy and dance culture.
6.6.3 Mate crime
The Safety Net Project defines mate crime as:
‘when vulnerable people are befriended by members of the community who go on to exploit and take advantage of them. It may not be an illegal act but still has a negative effect on the individual.’
- perpetrators routinely going to a vulnerable person’s house and clearing their cupboards of food and alcohol;
- people being persuaded to part with or having their benefits taken from them;
- being exploited sexually or coerced into prostitution;
- being physically harmed for the amusement of others;
- having their home used as a place for others to meet, gather, sleep, take drugs or hold parties or having their home taken over altogether by someone else;
- women or men can be sexually exploited by someone who pretends to be their partner;
- adults who are at risk of experiencing abuse may be asked to look after a package that contains drugs, guns or ammunition;
- they may go shoplifting with their new ‘friends’ to support the friends’ drug or alcohol dependency, only to be caught by the police. The adult may not realise that what is happening is wrong;
- the adult may think ‘He’s my friend, that’s what friends do’. Many vulnerable adults have few friends and for some vulnerable people, having any friends is better than no friends at all.
Mate crime centres around issues of self-belief and self-worth in the adult with care and support needs. They may come to expect that people will ‘walk all over them’, because that is what has often happened previously and they may perceive this behaviour as normal.
Mate crime is often difficult for police to investigate, due to its sometimes ambiguous nature, but should be reported to the police who will make a decision about whether or not a criminal offence has been committed. Mate crime is carried out by someone the adult knows and often happens in private. In recent years there have been a number of serious case reviews relating to people with a learning disability who were murdered or seriously harmed by people who purported to be their friend.
See also WhoRya
6.7 Organisational abuse
See also Inquiry Reports.
Organisational abuse is the mistreatment, abuse or neglect of an adult by a regime or individuals in a setting or service where the adult lives or that they use. Such abuse violates the person’s dignity and represents a lack of respect for their human rights.
Organisational abuse occurs when the routines, systems and regimes of an organisation result in poor or inadequate standards of care and poor practice which affect the whole setting and deny, restrict or curtail the dignity, privacy, choice, independence or fulfilment of adults.
Organisational abuse can occur in any setting providing health or social care. A number of inquiries into care in residential settings have highlighted that organisational abuse is most likely to occur when staff:
- receive little support from management;
- are inadequately trained;
- are poorly supervised and poorly supported in their work;
- receive inadequate guidance;
Such abuse is also more likely where there are inadequate quality assurance and monitoring systems in place.
6.7.1 Possible indicators
- unnecessary or inappropriate rules and regulations;
- lack of stimulation or the development of individual interests;
- inappropriate staff behaviour, such as the development of factions, misuse of drugs or alcohol, failure to respond to leadership;
- restriction of external contacts or opportunities to socialise.
6.8 Modern Slavery
See also Modern Slavery.
Modern slavery encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, and inhumane treatment.
See also Self Neglect
Self-neglect includes a wide range of behaviour that threatens the person’s own health and / or safety. It may include failure to on the part of the person to provide themselves with adequate food, water, clothing and shelter. It may mean neglecting to care for one’s personal health, hygiene or surroundings, including hoarding, taking adequate safety precautions and the misuse of drugs and alcohol.
Self-neglect differs from other types of abuse in that there is no third party involved. Furthermore, the definition of self-neglect excludes a situation in which a person who has capacity makes a decision to engage in acts that threaten their health and safety as a matter of choice.
Where there is concern that an individual has needs for care and support, then the local authority should offer an assessment relating to this in the first instance. If the person refuses to engage with a needs assessment then a mental capacity assessment should be considered (see Mental Capacity and Deprivation of Liberty Safeguards). If the individual has capacity in relation to their needs for care and support then use of the Vulnerable Adults Risk Management (VARM) process must be considered (see VARM in Local Guidance and Templates). If the person is assessed as lacking capacity or refuses to engage in a mental capacity assessment and the safeguarding threshold is met, then follow the Mental Capacity Act and Best Interests process to inform decision making to safeguard the individual.
6.10 Domestic Abuse and Violence
Domestic abuse and violence is defined as ‘any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members regardless of gender or sexuality’. ‘Family members’ are defined as mother, father, son, daughter, brother, sister and grandparents, whether directly related, in-laws or step-family.
Whatever form it takes, domestic abuse and violence is rarely a one off incident and should instead be seen as a pattern of abusive and controlling behaviour through which the abuser seeks power over the victim. Domestic abuse and violence occurs across society, regardless of age, gender, race, sexuality, wealth and geography. The figures from reported incidents show, however, that it consists mainly of violence by men against women. Children are also affected both directly and indirectly and there is also a strong correlation between domestic abuse and violence and child abuse. See also the Domestic Abuse, Stalking and Harassment (DASH) Risk Assessment and Leicester, Leicestershire and Rutland Safeguarding Children Board procedures.
Effective safeguarding is achieved when agencies share information to obtain an accurate picture of the risk and then work together to ensure that the safety of the adult is prioritised. In high risk situations it may be relevant to access the Multi-agency Risk Assessment Conference (MARAC) process (see Multi-agency Risk Assessment Conference chapter).
7. Other Types of Abuse
7.1 Children and young people who abuse
If a child or children is / are causing harm to an adult, action should be taken under these procedures (see Safeguarding Adults Procedures), and a referral and close liaison with children’s services should take place. Physical and sexual abuse towards parents and other relatives (for example, grandparents, aunts, uncles) some of whom, may be adults at risk of, or experiencing abuse or neglect, can be carried out by adults and by young people and children, some of which can cause serious harm or death. The UK prevalence study of elder abuse identified younger adults (rather than the person’s partner) as the main perpetrators of financial abuse.
Click on the links below to view contact details for child protection referrals to each local authority:
7.2 Abuse by another adult
Where the person causing the harm is also an adult at risk of, or experiencing abuse or neglect, the safety of the person who may have been abused is paramount. Organisations may also have responsibilities towards the person causing the harm. They will have if both the victim and the person causing harm are both in a care setting or have contact because they attend the same place (for example, a day centre). In this situation it is important that the needs of the adult who is the alleged victim are addressed separately from the needs of the person allegedly causing harm.
It may be necessary to reassess the adult allegedly causing the harm. This will involve a meeting where the following could be addressed:
- the extent to which the person causing the harm is able to understand his or her actions;
- the extent to which the abuse or neglect reflects the needs of the person causing the harm not being met (e.g. risk assessment recommendations not being met);
- the likelihood that the person causing the harm will further abuse the victim or others.
The principles and responsibilities of reporting a crime apply regardless of whether the person causing harm is deemed to be an adult at risk of, or experiencing abuse or neglect.