RELEVANT CHAPTER / SECTION
November 2017: Section 4.9, Self-Neglect was updated to strengthen reference to mental capacity and best interests processes.
See also Local Contacts for contact information for the Safeguarding Teams and the Emergency Duty Team.
Abuse may be:
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.
Abuse can take place anywhere, for example:
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:
The local authority must enquiries where it has reasonable cause to suspect an adult in its area (whether or not ordinarily resident there):
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:
Abuse can be viewed in terms of the following categories (although this is not an exhaustive list):
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.
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.
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).
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.
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).
This includes theft, fraud, exploitation, pressure in connection with wills or property and the misappropriation of property 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.
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.
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.
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.
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.
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:
Such abuse is also more likely where there are inadequate quality assurance and monitoring systems in place.
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.
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 (see Safeguarding Adults Procedures).
See also Domestic Abuse and Violence, Home Office.
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.
A MARAC is a meeting where information is shared on the highest risk domestic abuse and violence cases between representatives of the local police, probation, health, children and adult safeguarding bodies, housing practitioners, substance misuse services, Independent Domestic Abuse and Violence Advisers (IDVAs) and other specialists from the statutory and voluntary sectors.
The four aims of a MARAC are as follows:
Domestic Homicide Reviews (DHRs) were established on a statutory basis under the Domestic Abuse and Violence, Crime and Victims Act 2004. This provision came into force in 2011 and the purpose is to:
DHRs are not inquiries into how the victim died or into who is culpable and are not specifically part of any disciplinary inquiry or process. The rationale for the review process is to ensure agencies are responding appropriately to victims of domestic abuse and violence by offering and putting in place:
A DHR will also assess whether agencies have sufficient and robust procedures and protocols in place, which were in turn understood and adhered to by staff. The DHR process is similar to that of adult reviews and children’s serious case reviews. The main purpose is to learn lessons.
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