Types of abuse
Physical injuries can occur through abuse. There may be no satisfactory explanation, definite knowledge, or a reasonable suspicion that injury was inflicted with intent, caused by lack of care by the person having custody, charge or care of that person.
The following could indicate physical abuse:
- History of unexplained falls
- Unexplained bruising in well protected areas or soft parts of the body
- Bruising in different stages of healing
- Unexplained burns - unusual location / type
- Unexplained fractures to any part of the body
- Unexplained lacerations or abrasions
- Slap, kick, punch or finger marks
- Injury shape similar to an object
- Untreated medical problems
- Over and under medication
- Weight loss due to malnutrition or dehydration
Sexual abuse is the involvement of vulnerable adults in sexual activities, which:
- they do not fully comprehend
- they cannot give consent to
- they object to, or
- may cause them harm.
The following list may indicate sexual abuse. They must be viewed in the context of the situation, taking account of other factors. Often more than one indicator may be apparent. There may be other causes for the indicators listed below but a combination of several factors is often found in sexual abuse cases:
- An adult discloses that they have been sexually abused or raped, or subjected to sexual assault or sexual harassment
- Sudden change in behaviour; sudden onset of confusion, or withdrawal
- Overt sexual behaviour/language by the vulnerable adult
- Self-inflicted injury and self-harm
- Disturbed sleep pattern/poor concentration
- Difficulty in walking
- Torn, stained underwear
- Love bites
- Pain or itching, bruising or bleeding in the genital area
- Sexually transmitted disease/urinary tract/vaginal infection
- Bruising to upper thighs and arms
- Frequent infection
- Severe upset or agitation when being bathed etc.
- Pregnancy in a person unable to consent
- Sexual exploitation
5% of abuse enquiries in Richmond relate to sexual abuse.
Financial or material abuse can take the form of fraud, theft or using the vulnerable adult’s property without their permission. This could involve large sums of money or just small amounts from a pension or allowance each week.
The following could indicate financial abuse:
- Sudden inability to pay bills
- Sudden withdrawal of money from an account
- Person lacks belongings that they can clearly afford
- Person’s relatives are not receptive to necessary expenditure
- Power of attorney is obtained when the person is unable to understand what they are signing
- Extraordinary interest by family members in the vulnerable adult’s assets
- Recent change of deeds to the house
- Carer’s main interest is financial with little regard for the health and welfare of the vulnerable adult
- The person managing the finances is evasive and uncooperative
- Reluctance to accept care services
- Purchase of items that the individual does not require or use
- Personal items going missing
- Unreasonable or inappropriate gifts
20% of cases investigated related to financial or material abuse.
Emotional or psychological
Emotional or psychological abuse can include intimidation, humiliation, shouting, swearing, emotional blackmail and denial of basic human rights, as well as using racist language and preventing someone from enjoying activities or meeting friends.
The following may indicate emotional abuse:
- Ambivalence about carer
- Fearfulness, avoiding eye contact, flinching on approach
- Insomnia or need for excessive sleep
- Change in appetite
- Unusual weight loss / gain
- Unexplained paranoia
- Low self esteem
- Confusion, agitation
- Possible violation of human and civil rights
- Distress caused by being locked in a home or car etc.
- Isolation - no visitors or phone calls allowed
- Inappropriate clothing
- Sensory deprivation
- Restricted access to hygiene facilities
- Lack of personal respect
- Lack of recognition of individuals rights
- Carer does not offer personal hygiene, medical care, regular food/drinks
- Use of furniture to restrict movement
14% of cases investigated last year resulted from emotional abuse.
A person can suffer because their physical and/or psychological needs are being neglected by a carer. This could include failure to keep them warm, clean and well-nourished or neglecting to give prescribed medication.
The following may indicate neglect:
- Poor environmental conditions
- Inadequate heating and lighting
- Poor physical condition of the vulnerable adult
- Person’s clothing is ill fitting, unclean and in poor condition
- Failure to give prescribed medication properly
- Failure to provide appropriate privacy and dignity
- Inconsistent or reluctant contact with health and social care agencies
- Isolation - denying access to callers or visitors
26% of safeguarding enquiries completed during 2016/17 related to allegations of neglect.
Discriminatory abuse is often on the grounds of age, gender, race, culture, religion, sexuality or disability. This type of abuse and others can be perpetrated through grooming. This can be called ‘Mate crime’ and it occurs when vulnerable adults are "befriended" with the intention to abuse.
Mencap have recently launched the "Stand by Me" campaign to eradicate Hate and Mate crime.
The following may indicate discriminatory abuse:
- Derogatory, offensive and racist comments and actions, graffiti, trolling etc.
- harassment and bullying due to a personal attribute
- being made to move to a different resource/ service based on age
- being denied medical treatment on grounds of age or mental health
- not providing access
There were only two cases of discriminatory abuse reported under safeguarding adults during 2016/17. 22 Disability hate crimes were investigated in Richmond during 2016.
Organisational abuse may include neglect and poor care practice within an institution or specific care setting such as a hospital or care home, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment, including acts of omission leading to harm.
It can be through neglect or poor individual professional practice or as a result of the structure, policies, processes and practices within an organisation or lack of effective joined working.
The following may indicate organisational abuse:
- No flexibility in bed time routine and/or deliberate waking
- People left on the commode or toilet for long periods of time
- Inappropriate care of possessions, clothing and living area
- Lack of personal clothes and belongings
- Un-homely or stark living environments
- Deprived environmental conditions and lack of stimulation
- Inappropriate use of medical procedures e.g. enemas, catheterisation
- 'Batch care' - lack of individual care programmes
- Illegal confinement or restrictions
- Inappropriate use of power or control
- People referred to, or spoken to with disrespect
- Inflexible services based, on convenience of the provider rather than the person receiving services
- Inappropriate physical intervention
- Service user removed from the home or establishment, without discussion with other appropriate people or agencies, because staff are unable to manage the behaviours
Self-neglect is any failure of an adult to take care of himself or herself that causes, or is reasonably likely to cause within a short period of time, serious physical, mental or emotional harm or substantial damage to or loss of assets.
Types of self-neglect
- Lack of self-care to an extent that it threatens personal health and safety
- Neglecting to care for one’s personal hygiene, health or surroundings
- Inability to avoid self-harm
- Failure to seek help or access services to meet health and social care needs
- Inability or unwillingness to manage one’s personal affairs
The following may indicate self-neglect:
- Very poor personal hygiene
- Unkempt appearance
- Lack of essential food, clothing or shelter
- Malnutrition and/or dehydration
- Living in squalid or unsanitary conditions
- Neglecting household maintenance
- Collecting a large number of animals in inappropriate conditions
- Non-compliance with health or care services
- Inability or unwillingness to take medication or treat illness or injury
As a SAB we have not received or investigated modern slavery or trafficking of adults with care and support needs locally. However this does not indicate that it does not occur and in fact the SAB has taken action, through training local professionals and raising awareness locally.
Types of modern slavery
- Human trafficking
- Forced labour
- Domestic servitude
- Sexual exploitation, such as escort work, prostitution and pornography
- Debt bondage – being forced to work to pay off debts that realistically they never will be able to
The following may indicate modern slavery:
- Signs of physical or emotional abuse
- Impingement on human rights, removal of personal ID, passport etc. and substantial control of one person by another
- Appearing to be malnourished, unkempt or withdrawn
- Isolation from the community, seeming under the control or influence of others
- Living in dirty, cramped or overcrowded accommodation and or living and working at the same address
- Lack of personal effects or identification documents
- Always wearing the same clothes
- Avoidance of eye contact, appearing frightened or hesitant to talk to strangers
- Fear of law enforcers
The Home Office provides information on identifying and reporting modern slavery.
Domestic violence and abuse includes any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been, intimate partners or family members regardless of gender or sexuality. It also includes so called 'honour’-based violence, female genital mutilation and forced marriage.
Coercive or controlling behaviour is a core part of domestic violence. Coercive behaviour can include:
- acts of assault, threats, humiliation and intimidation
- harming, punishing, or frightening the person
- isolating the person from sources of support
- exploitation of resources or money
- preventing the person from escaping abuse
- controlling everyday behaviour
The Safeguarding Adults Board will be involved when domestic abuse involves adults with care and support needs, or has an impact on a person with care and support needs (for example when a disabled or older person is affected by domestic violence perpetrated against them or around them resulting in their harm).