Types. risks and indicators of abuse

What is Abuse?

"No Secrets" (Department of Health, 2000) defines a vulnerable adult as;

 Any person aged eighteen or over who:

  • Is or may be in need of community care services by reason of mental or other disability, age or illness; and
  • Is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation.

The Association of Directors of Social Services guidance of 2005  changed the emphasis from the term 'vulnerable adult' to that of 'an adult in need of safeguarding'. This was because the term 'vulnerable adult' may imply that the cause of abuse is located with the victim rather than the perpetrator.

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Types of abuse

'"No Secrets" identifies the following main forms of abuse:

Physical abuse including hitting, slapping, pushing, kicking, misuse of medication, restraint, or inappropriate punishment.

Sexual abuse including rape and sexual assault or sexual acts to which the vulnerable adult has not consented, could not consent or was pressured into consenting;

Psychological abuse including emotional abuse, threats of harm, threats of leaving the person, stopping visits to or from family and friends, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or support networks;

Financial or material abuse including theft, fraud, exploitation, pressure in connection with wills, property, inheritance or financial transactions, or the misuse of property, possessions or benefits;

Neglect and acts of omission including ignoring medical or physical care needs, failure to provide access to appropriate healthcare, social care or educational support including medication and going to college.

Discrimination means treating someone unfairly or differently because of their race, gender, cultural background, religion, beliefs, physical or sensory impairment, sexual orientation, or age.

Institutional abuse occurs when a health/care/housing or other service routinely neglects individuals and/or violates their rights. 

Abuse may be a single act or many acts. It can occur in any relationship and may be the result of deliberate intent, ignorance or neglect. It may be a criminal offence, such as rape, assault or theft.

Abuse can take place anywhere.

  • in public places
  • in the victim's own home
  • at work
  • in hospital
  • in places of worship
  • in care homes
  • at day care.

The abuser could be anyone, a man or a woman. An abuser could be a

  • neighbour
  • someone who also goes to the day centre
  • family member
  • volunteer
  • paid health or social care worker
  • teacher
  • clergyman 

Risk Factors

Certain situations may place people at more risk of being abused. However, this does not mean that a person will be abused, only that it is more likely. These situations include:

  • A person needs support with personal care. Certain personal care needs may present more opportunity for abuse
  • Role reversal, for example the adult child taking over the parental role
  • When someone is living with a known abuser
  • Where there is a family history of abuse
  • Where an adult is dependant on others, or others are dependant on them
  • Inappropriate or dangerous physical or emotional environment, for example, lack of personal space
  • When there is a change in the lifestyle of a member of the household, for example, unemployment, employment, illness
  • A member of the household experiencing emotional or social isolation
  • Where there is an absence of local support networks
  • Alcohol/substance misuse
  • The existence of financial problems
  • Breakdown in communication

Situations may involve a combination of different kinds of abuse. However, it is useful to start by considering the definition of each category in turn, together with the indicators.

 

Indicators of Abuse

The following lists are purely indicators. The presence of one or more does not necessarily confirm abuse.

Physical Abuse

Physical Abuse is physical ill treatment, which may or may not cause physical injury. This includes pushing, shaking, pinching, slapping, punching and force-feeding. Physical abuse can occur through withholding care, preventing access to healthcare or applying inappropriate techniques or treatments. It can include forced isolation and confinement, for example, people being locked in their room, and inappropriate methods of restraint.

Indicators of Physical Abuse:

  • Injuries that are not fully explained
  • Person exhibiting untypical self harm
  • Unexplained bruising
  • Unexplained burns
  • Unexplained fractures
  • Unexplained cuts or scratches
  • Medical conditions which are not treated
  • Sudden or unexplained incontinence
  • Evidence of over or under medication
  • Person flinches at physical contact
  • Person appears frightened or subdued in the presence of particular people
  • Person may ask not to be hurt
  • Person may repeat what the perpetrator has said, for example, 'Shut up or I'll hit you'
  • Reluctance to undress or uncover parts of the body

 This list is not exhaustive 

 

Sexual Abuse 

Sexual Abuse is any form of sexual activity that the adult does not want and to which they have not consented, or to which they cannot give informed consent.

Sexual abuse includes: rape; buggery; incest; and inappropriate touching; coercing a person into participating in or watching pornographic photographs or videos.

Any sexual relationship that develops between adults where one is in a position of trust, power or authority in relation to the other will be regarded as sexual abuse. This includes a day care worker; a social worker; a residential worker; a health worker or a personal assistant.

Indicators of Sexual Abuse:

  • Person discloses, either fully or partially, that sexual abuse is occurring or has occurred in the past
  • 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 change in sexual behaviour or outlook
  • Person experiences pain, itching or bleeding in 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
  • A person found having any sexual activity with a person with severe mental incapacity
  • Images of sexual abuse on the internet

This list is not exhaustive

 

Financial Abuse

Financial Abuse is the exploitation, inappropriate use or misappropriation of a person's financial resources, property, pension, allowances or insurance. This includes withholding money or the improper use of a person's money or property or denying the rights of an adult who may be competent to handle their own financial affairs.

Indicators of Financial Abuse:

  • Lack of money especially after benefit day
  • Inadequately explained withdrawals from accounts
  • Inadequately explained inability to pay bills
  • Objects of value going missing
  • Disparity between assets/income and the living conditions
  • Power of Attorney obtained when the person lacks the necessary capacity to make this decision
  • Recent changes to deeds/title of house
  • Recent acquaintances expressing a sudden or disproportionate interest in the person and their money
  • Reluctance to pay for necessary food, clothes or items

This list is not exhaustive

There are certain factors, which may increase the risk of a person being financially abused:

  • Person has guaranteed high benefit, income
  • Person is unable to administer their own money due to lack of capacity/numeracy skills
  • Person has several workers/ carers managing their money and accessing their PIN numbers
  • Carers becoming financially dependant on a person/service user
  • Person who is isolated or lonely being exposed to financial pressure, for example from loan firms
  • Person known as being isolated or is regarded as vulnerable within the community
  • Person has no real independent advocate

Bogus callers can trick their way into people's home to steal money and property. More information is available about Doorstep Safety.

Neglect

Neglect is the deliberate withholding or unintentional failure to provide help or support which is necessary for the adult to carry out activities of daily living.

Neglect also includes a failure to intervene in situations that are dangerous to the person, particularly when the person lacks the mental capacity to assess risk.

Indicators of Neglect:

  • 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 a sudden or continuous weight loss, and is dehydrated
  • Person cannot access appropriate medication or medical care
  • Person is not afforded appropriate privacy or dignity
  • Person and /or their carer has an inconsistent or reluctant contact with health and social services
  • Callers/visitors are not allowed access to the person
  • Person is exposed to unacceptable risk
  • Neglect of environment

This list is not exhaustive

 

Psychological or Emotional Abuse

This may be intentional or unintentional. It may involve the use of intimidation, indifference, hostility, rejection, threats, humiliation, shouting, swearing or the use of discriminatory and/or oppressive language, which results in:

  • The adult's choices, opinions and wishes being neglected
  • The adult becoming isolated or over-dependent
  • Racial or religious harassment

Psychological abuse includes 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 includes the intentional or unintentional withholding of information, for example, information not being available in different formats and/or languages on dress, diet, language or specific religious observations relating to the adult's background or culture.

Indicators of Psychological or Emotional Abuse:

  • Untypical ambivalence, deference, resignation, becoming passive
  • Person appears anxious or withdrawn, especially in the presence of the alleged perpetrator
  • Person exhibits low self esteem
  • Person rejects their own cultural background and/ or racial origin
  • Untypical changes in behaviour, for example, continence problems, sleep disturbance, depression or fear
  • Person is not allowed visitors or phone calls
  • Person locked in a room/in their home
  • Person is denied access to aids or equipment, for example, glasses, hearing aid, crutches
  • Person's access to personal hygiene and toilet is restricted
  • Person's freedom of movement is restricted by use of furniture or other equipment
  • Exposed to inappropriate stimuli
  • Person feels isolated

This list is not exhaustive

Be aware that every other category of abuse will almost inevitably involve elements of psychological abuse. Signs of psychological abuse may indicate that other forms of abuse are taking place.

Types. risks and indicators of abuse