Definitions of abuse
The Department of Health guidance No Secrets states that the starting point for a definition is:
"Abuse is a violation of an individual's human and civil rights by any other person or persons".
Abuse may consist of a single act or repeated acts. It may be physical, verbal or psychological, it may be an act of neglect or an omission to act, or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent. Abuse can occur in any relationship and may result in significant harm to, or exploitation of, the person subjected to it.
A consensus has emerged identifying the following main forms of abuse
- Physical abuse
- Sexual abuse
- Psychological abuse
- Financial or material abuse
- Neglect and acts of omission
- Discriminatory abuse
- Institutional abuse
May include a person being
- hit, punched, kicked, slapped, pushed, thrown, pinched, shaken, strangled or suffocated
- hit or beaten with an object
- stabbed, burnt or scalded
It may also include
- inappropriate restraint or imprisonment
- abuse of medication
- deprivation of use, or misuse, of physical aids and adaptations
- neglect of personal care, food, drink, and warmth
Signs that physical abuse is taking place include
- injuries that are consistent with physical abuse
- injuries that are the shape of objects
- presence of several injuries of a variety of ages
- injuries that have not received medical attention
- a person being taken to many different places to receive medical attention
- pressure sores and skin infections
- dehydration or unexplained weight changes
- medication being "lost"
It may include physical conditions that mean a person is restrained or imprisoned, such as
- locks that the person cannot use
- wheel chair tyres deflated
It may include behaviour that indicates that the person is afraid of the perpetrator, for example
- flinching at movements made by the perpetrator
- change of behaviour in presence of the perpetrator
- avoiding the perpetrator
Any forced or coerced involvement in sexual activity.
It may involve physical contact such as
- rape (heteroexual, gay or lesbian), oral sex
- kissing and unwanted touching
- being coerced into physical activity such as masturbating the perpetrator or carrying out sexual acts for which others pay the perpetrator
Non-contact abuse can include
- being forced or coerced to be photographed or videoed, to allow others to look at their body or to watch them masturbate
- to look at photographs or DVDs
- being sexually harassed verbally or through the sending of unwanted gifts
Some sexual activity is defined as abuse because a person cannot legally consent to the activity.
- Sexual intercourse or sexual acts with an adult at risk/vulnerable adult who has not consented to, or could not consent to, or was pressurised into such acts and
sexual intercourse between male staff and female residents of a mental hospital or home
Sexual abuse may be heterosexual, gay or lesbian. Healthy approaches to sexuality assist people who may be at risk of abuse understand what they want and do not want to happen to them.
A good example of positive work is that carried out under the Learning Difficulty Services "Healthy Sexuality Policy". Services should adopt a clear and open approach to the sexuality and sexual needs of the people they support or care for.
It is helpful to have an understanding of the alleged victims attitude and orientation to sexual matters when assessing risk and harm done.
Signs that sexual abuse may be taking place
The signs that a person is experiencing psychological abuse and that they are experiencing sexual abuse are often similar. This is due to the emotional impact of sexual abuse on a person's sense of identity and boundaries and to the emotional manipulation that a perpetrator may carry out in "grooming" a person they plan to abuse sexually.
The signs may include
- signs of sexual activity such as sexually transmitted diseases or pregnancy
- pain, soreness, itchiness, tears or bruises in genital or anal areas, breasts, or inner thighs
- unusual difficulty in walking and sitting
- signs that someone is trying to take control of their body or body image, such as head banging, self-harm, putting on or losing a lot of weight, anorexia or bulimia
- sexualised behaviour by the person experiencing the abuse towards the perpetrator and/or towards other people
- behaviour that indicates that the person is afraid of the perpetrator, or a change of behaviour in presence of the perpetrator or avoiding the perpetrator.
- It may be that the perpetrator is observed to have an overly familiar or sexualised relationship with the person experiencing abuse
- intimidation and threats
- racial, sexual or homophobic abuse
- harassment, coercion and extortion
- being isolated from people other than the abuser and from other sources of information
- being made to say or do things, or think in ways prescribed by the abuser
- being deprived of sleep
- being kept exhausted and debilitated
- having one's sense of reality distorted by misinformation and lies, or misuse of medication
It may also include
- denying choice
- deprivation of privacy and other human rights
- lack of access to activities
- an abusive institutional "regime"
- difficulty gaining access to the person on their own, or the adult gaining opportunities to contact you
- the person not getting access to medical care, or appointments with other agencies
- low self-esteem
- anxiety and lack of confidence.
- increased levels of confusion
- increased urinary or faecal incontinence
- sleep disturbance
- the person feeling or acting as if they are being watched all of the time
- decreased ability to communicate
- communication that sounds like things that the perpetrator would say
- deference or submission to the perpetrator
- behaviours that show resistance to the perpetrator
- any act of theft of money or property, or use of money or property, without the person's consent, or without the appropriate legal authority
- the misuse of money intended for, or belonging to, an adult by someone who has been trusted to handle their finances, or who has assumed control of their finances by default.
- The use of CHIP & PIN cards has caused increased concern that people at risk may be pressured into giving their Debit (Credit) Cards and PIN numbers to potential abusers. There is a close link to such activities as Doorstep Crime.
Signs that financial abuse may be occurring include
- sudden loss of assets
- unusual or inappropriate financial transactions
- change to, or pressure to change, signatories to bank accounts or house deeds
- visitors whose visits always coincide with the day a person's pension or benefits are cashed
- the person not receiving material goods such as clothes or food
- bills not being paid
- household repairs not being carried out even though the person has an income that could cover these items
- the person having no choice in how their money is spent on their behalf
- the person who is managing the adult's financial affairs is evasive or uncooperative, and only asks workers about financial aspects of the adult's care
- Failure to provide the elements necessary for life or to avoid harm
- To treat carelessly
- To pass by without notice
- To fail to give due care
Signs that neglect is occurring include
- rapid or continuous weight loss
- complaints of hunger
- lack of personal care
- pressure sores
- sensory deprivation / isolation (such as the lights or the television being left on constantly)
- inadequate or inappropriate clothing
- inadequate or excessive heating
- dirty clothing or bedding
- person being left wet or soiled
- untreated medical problems
- too much or too little exercise or social activity
- signs of medication over or under use
- not having access to necessary physical aids and adaptations
Refer to Appendix C Neglect checklist
Self Neglect - often services find themselves dealing with individuals who neglect their own well-being and perversely do not co-operate with services attempting to improve their health and welfare. Signs of self-neglect may be the same as neglect by others.
Concern may be expressed about the mental capacity of the individual and the guide to assessing capacity in this policy should be followed. If the individual is established to have capacity services there is the need to record all that has been done to assist the individual to maintain their health and safety. Clear recording should be made of concerns put to the individual with capacity and if necessary they may be asked to identify the services (legal advice must be sought) The Adult Safeguarding framework may be used to share information and record what actions services have taken and what concerns have been put to the individual.
An individual lacking capacity may need decisions to be taken on their behalf; this should be explained to them and they should be enabled to retain as much control over their lives as possible. Consideration may be necessary to using the Mental Health Act 1983 or Section 47 of the National Assistance Act.
Mental Capacity Act 2005
This Act has identified the new criminal offence of ill treatment or wilful neglect which applies to the following individuals:
- A person who has the care of a person who lacks or is reasonably believed by that person to lack capacity; or
- A person who is the attorney appointed under a Lasting Power of Attorney (LPA), or an existing Enduring Power of Attorney; or
- A person who is a deputy appointed by the Court of Protection
- That person is guilty of an offence if he /she ill-treats or wilfully neglects the person they have care of. The penalty for such an offence is a fine or imprisonment of up to 5 years.
- treatment which is based upon an individuals gender, race, disability, faith, culture or sexual orientation
Signs that discriminatory abuse may be taking place include
- low self esteem
- anxiety and lack of confidence
- deference or submission to the perpetrator
This may take the form of isolated incidents of poor or unprofessional practice at one end of the spectrum, through to pervasive ill treatment or gross misconduct at the other.
Neglect and poor professional practice can often develop into institutional abuse.
Signs that institutional abuse is occurring include
- poor care standards
- lack of positive responses to complex needs
- rigid routines
- inadequate staffing and an insufficient knowledge base within the service
- Failure of agencies to ensure staff receive appropriate guidance on anti-racist and anti-discriminatory practice
Some types of abuse will constitute a criminal offence. In this respect vulnerable adults are entitled to the protection of the law in the same way as any other member of the public. In addition statutory offences have been created which specifically protect those who may be incapacitated in various ways. Examples of actions which may constitute criminal offences are assault, whether physical or psychological, sexual assault and rape, theft, fraud or other forms of financial exploitation, and certain forms of discrimination, whether on racial or gender grounds. Alleged criminal offences differ from all other non-criminal forms of abuse in that the responsibility for initiating action invariably rests wit the state in the form of the police and the Crown Prosecution Service (private prosecutions are theoretically possible but wholly exceptional in practice) Accordingly, when complaints about alleged abuse suggest that a criminal offence may have been committed it is imperative that reference should be made to the police as a matter of urgency. Criminal investigation by the police takes priority over all other lines of enquiry.
This page was last updated on 4 April 2013