2.6 Why and where does abuse occur?
Abuse can occur for a number of reasons that may be inter-related and complex. The following factors could indicate that an adult may be at risk of abuse, due to their situation or circumstances.
- Poor communication or communication difficulties.
- History of falls and / or minor injuries.
- Physical and / or emotional dependence on others.
- Mental health needs, including moderate or severe dementia.
- Lacking capacity to make key decisions.
- Rejection of help.
- Self-injurious behaviour.
- History of repeatedly making allegations of abuse.
- High level of reliance on others to meet their care needs or manage their financial affairs.
- Substance misuse.
- History of violent relationships within the family or social networks.
- Having a role as a carer.
- Poor or insecure living conditions, homelessness.
- Geographical isolation.
- Poor management and / or high staff turnover or insufficient staff.
- Other adults with challenging behaviour.
- Unequal power relationships (that include controlling, coercive or threatening behaviour).
- Increased reliance on others by the person.
- Reliance on more than one person within the family or social networks.
- Multi-generational family structure where conflicts of interest and loyalties may exist.
- Role reversal or significant change in the relationship between the person and their carer.
- History of abuse within the family, either being abused or responsible for previous abuse.
- Isolation of the carer, due to the demands of caring, leading to a lack of practical and emotional support.
- Lack of understanding about the person’s condition, resulting in inappropriate care.
- Reliance on the person by others.
- Difficult or challenging behaviour by the person which the carer finds intolerable or stressful, or which puts the carer at risk.
- Financial difficulties.
- Illness or disability of the carer.
- Significant and long-term stress of the carer.
- Inappropriate care responses eg. poor quality care, support or treatment.
Abuse can include targeted fraud or scams perpetrated by complete strangers, or the person responsible for abuse can be someone known to the adult who is in a position of trust and power.
Anyone can carry out abuse or neglect, including:
- Spouses or partners.
- Other family members.
- Local residents.
- People who deliberately exploit adults they perceive as vulnerable to abuse.
- Paid staff or professionals.
- Volunteers and strangers.
- An adult with care and support needs.
Where the person responsible for the abuse is an adult with care and support needs themselves
Abuse is unacceptable, regardless of the individual’s capacity to understand or be responsible for their actions.
In some situations, the person responsible for abuse may also be an adult with care and support needs. This could leave them at risk eg. due to retaliation or loss of care or support. It is important to ensure that the needs of both adults involved are addressed. Abuse of this kind may indicate shortcomings or failings in the care or support arrangements in place for both individuals, and possibly for others.
In this situation robust risk assessment and support planning is essential to ensure any future risks are minimised.
Where does abuse happen?
Abuse can happen anywhere. For example, in someone’s own home, in a public place, in hospital, in a care home or in college. It can take place when an adult lives alone or with others.
Identifying signs of abuse and neglect
Anyone can witness or become aware of information suggesting that abuse and neglect is occurring. The matter may, for example, be raised by a worried neighbour, a concerned bank cashier, a GP, a welfare benefits officer, a housing support worker or a nurse on a ward. Primary care staff may be particularly well-placed to spot abuse and neglect, as in many cases they may be the only professionals with whom the adult has contact.
The adult may say or do things that hint that all is not well. It may come in the form of a complaint, a call for a police response, an expression of concern, or come to light during a needs assessment.
Regardless of how the safeguarding concern is identified, everyone should understand what to do, and where to go locally to get help and advice.
It is vital that professionals, other staff and members of the public are vigilant on behalf of those unable to protect themselves. This will include:
- Knowing about different types of abuse and neglect, and their signs.
- Supporting adults to keep them safe.
- Knowing who to tell about suspected abuse or neglect.
- Supporting adults to think about and weigh up the risks and benefits of different options when exercising choice and control.
Awareness campaigns for the general public and multi-agency training for all staff should be in place to contribute to achieving these objectives.
Workers across a wide range of organisations need to be vigilant about safeguarding adults concerns in all walks of life. This includes, amongst others, staff in health and social care, welfare, policing, banking, fire and rescue services, trading standards, leisure services, faith groups, and housing.
GPs, in particular, are often well-placed to notice changes in an adult that may indicate they are being abused or neglected.
Professionals and other staff should understand that acting upon their concerns or seeking more information can help to prevent death or serious harm from occurring.
The following example illustrates that someone who might not typically be thought of, in this case the neighbour, does in fact have an important role to play in identifying when an adult is at risk.
Case study 4
Mr A is in his 40s, and lives in a housing association flat with little family contact. His mental health is relatively stable, after a previous period of hospitalisation, and he has visits from a mental health support worker. He rarely goes out, but he lets people into his flat because of his loneliness.
Although Mr A initially insisted they were his friends, he did indicate he was frightened. He attended a case conference with representatives from Adult Social Care, mental health services and the police. This resulted in a plan to strengthen his own self-protective ability as well as to deal with the present abuse.
Mr A has made different arrangements for managing his money so that he does not accumulate large sums at home. A community-based visiting service has been engaged to keep him company through visits to his home, and with time his support worker aims to help him get involved in social activities that will bring more positive contacts to allay the loneliness that Mr A sees as his main challenge.
Case study 5
Miss P’s mental health social worker became concerned when she received reports that two of Miss P’s associates were visiting more regularly and sometimes staying over at her flat. Miss P was being coerced into prostitution and reportedly being physically assaulted by one of the men visiting her flat. There was also concern that she was being financially exploited. Miss P’s vulnerability was exacerbated by her mental health needs and consequent inability to set safe boundaries with the people she was associating with.
The social worker recognised that the most appropriate way to enable Miss P to manage the risk of harm was to develop and co-ordinate a plan which would enable her to continue living independently but provide a safety net for when the risk of harm became heightened. Development of the plan would involve Miss P’s family and other professionals which Miss P agreed to.
Tasks were divided between the police, family members and specialist support workers. The social worker had a role in ensuring that the plan was co-ordinated properly and that Miss P was fully aware of everyone’s role.
Miss P’s family were crucial to the success of the plan as they had always supported her and were able to advocate for her needs. They also had a trusting relationship with her and were able to notify the police and other professionals if they thought that the risk to Miss P was increasing.
The police played an active role in monitoring and preventing criminal activity towards Miss P, and ensured that they kept all of the other professionals and family up-to-date with what was happening.
Miss P is working with a domestic violence specialist to help her develop personal strategies to keep safe, and her support worker is helping her to build resilience through community support and activities.