Categories, Signs and Symptoms of Adult Abuse

This covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. A decision on whether a response is required under safeguarding will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support.

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. Repeated instances of poor care may be an indication of more serious problems and of what is described as organisational abuse. In order to see these patterns it is important that information is recorded and appropriately shared.

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 between spouses or generations or persistent psychological abuse;
• Opportunistic abuse, such as theft occurring because money or jewellery has been left lying around.
  
  

• Institutional Abuse - arises from an unsatisfactory regime. It occurs when the routines, systems and norms of an institution override the needs of those it is there to support. It may take the form of isolated incidents of poor practice at one end of the spectrum, through to pervasive ill treatment or gross misconduct at the other. It can occur when the routines, systems, communications and norms of an institution compel individuals to sacrifice their preferred lifestyle and cultural diversity to the needs of that institution. Repeated instances of poor care may be an indication of more serious problems:
  • Examples of behaviour: Inflexible routines set around the needs of staff rather than individual service users, e.g. requiring everyone to eat together at specified times, bathing limited to times to suit staff, no doors on toilets. These can arise through lax, uninformed or punitive management regimes;
  • Signs and Symptoms: inappropriate or poor care; misuse of medication; restraint methods; sensory deprivation, e.g. denial of use of spectacles or hearing aid; lack of respect shown to the Adult at Risk; denial of visitors or phone calls; restricted access to toilet or bathing facilities; restricted access to appropriate medical or social care; failure to ensure appropriate privacy or personal dignity; lack of flexibility and choice, e.g. mealtimes and bedtimes, choice of food; lack of personal clothing or possessions; lack of privacy; lack of adequate procedures, e.g. for medication, financial management; controlling relationships between staff and service users; poor professional practice.
• The Use of Restrictive Physical Interventions: Restrictive physical interventions are only justified when they are used in the best interests of the service user him or herself or to protect the safety of others. Intrusive forms of physical interventions, which are often used as a response to violence, are potentially harmful:
  • A care service will always have a policy statement which makes explicit the safeguards which must be in place before physical intervention is used. This affords protection to a service user, to staff and to the organisation;
  • Physical interventions which are used routinely and which are not the subject of consultation (i.e. with the person him or herself or with relatives, professionals and others with a legitimate interest), recording and review will normally be considered abusive.

Restraint is defined under the Mental Capacity Act as;

1. Any act that uses, or threatens to use, force to carry out another function to which the person resists; or
2. Any act that restricts the person’s freedom of movement, whether or not they resist.

If the adult has capacity then no form of restraint can be used against them without their consent. This is abuse.

If the adult lacks capacity the decision to use restraint must be made in their Best Interests, and only when;

1. The Decision Maker believes that it is necessary to restrain the adult in order to prevent them from being harmed; and
2. There is evidence that restraint is a proportionate response to the likelihood and seriousness of harm.

The use of restraint outside of these circumstances is likely to be either;

1. Abuse; or
2. A Deprivation of Liberty (which requires appropriate authorisation).

Indicators that the restraint may require authorisation under the relevant Deprivation of Liberty framework include;

1. Frequent use of restraint;
2. Cumulative use of restraint;
3. Ongoing use of restraint.

The cross-government definition of domestic violence and abuse is: any incident or pattern of incidents of controlling, coercive, 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. The abuse can encompass, but is not limited to:

• Psychological;
• Sexual;
• Financial;
• Emotional.

An offence of coercive and controlling behaviour in intimate and familial relationships was introduced into the Serious Crime Act 2015. The offence imposes a maximum 5 years imprisonment, a fine or both.

See: Controlling or Coercive Behaviour: Statutory Guidance Framework  for further information.

Modern slavery is also included as a category of abuse and neglect and encompasses:

• Slavery;
• Human trafficking;
• Forced labour and domestic servitude;
• Traffickers and slave masters using whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.