1.3 What is Abuse and Neglect

1. Introduction

This outlines the different types and patterns of abuse and neglect described in the Care and Support Statutory Guidance. Practitioners should not limit their view of what constitutes abuse or neglect, as it can take many forms. The circumstances of the individual case should always be considered. Exploitation, in particular, is a common theme in all types of abuse and neglect.

2. Categories of Abuse

2.1 Physical Abuse

This includes:

• assault;
• hitting;
• slapping;
• pushing;
• misuse of medication;
• inappropriate use of restraint;
• use of physical sanctions.

2.2 Domestic abuse

See also Domestic Abuse chapter

Domestic abuse can take many different forms including psychological, physical, sexual, financial or emotional abuse. The Domestic Abuse Act 2021 defines domestic abuse as occurring between two people (aged 16 or over) who are ‘personally connected to each other’ and the behaviour is deemed ‘abusive’. (Please note, concerns in relation to those aged 16-18 years should be referred to Children’s Social Care).

Behaviour is ‘abusive’ when any of the following is identified:

• physical or sexual abuse;
• violent or threatening behaviour;
• controlling or coercive behaviour;
• economic abuse;
• psychological, emotional or other abuse.

It also includes  so-called ‘honour’ based abuse (see ‘Honour’ Based Abuse); female genital mutilation (see Female Genital Mutilation) and forced marriage (see Forced Marriage).

2.3 Sexual abuse

This includes:

• rape;
• indecent exposure;
• sexual harassment;
• inappropriate looking or touching;
• sexual teasing or innuendo;
• sexual photography;
• subjection to pornography or witnessing sexual acts;
• sexual assault;
• sexual acts to which the adult has not consented or was pressured into consenting.

Sexual abuse may also take the form of sexual exploitation which can involve coercion and an exchange for basic necessities or something that the perpetrator seeks to gain from the victim (see Working with Adults Affected by Child Sexual Exploitation and Organised Sexual Abuse chapter).

2.4 Psychological abuse

This includes:

• emotional abuse;
• threats of harm or abandonment;
• deprivation of contact;
• humiliation;
• blaming;
• controlling;
• intimidation;
• coercion;
• harassment;
• verbal abuse;
• cyber bullying;
• isolation;
• unreasonable and unjustified withdrawal of services or supportive networks.

2.5 Financial abuse

See also Friends Against Scams website (National Trading Standards)

This includes:

• theft;
• fraud;
• scams including internet scamming;
• coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions;
• the misuse or misappropriation of property, possessions or benefits.

Potential indicators of a person being financially abused include:

• change in living conditions;
• lack of heating, clothing or food;
• inability to pay bills / unexplained shortage of money;
• unexplained withdrawals from an account;
• unexplained loss / misplacement of financial documents;
• the recent addition of authorised signers on a client or donor’s signature card;
• sudden or unexpected changes in a will or other financial documents;
• unexpected change of behaviour or loss of trust in professionals.

2.5.1 Internet, postal and doorstep scams

Internet scams, postal scams and doorstep crime are more often than not, targeted at adults and are forms of financial abuse.

These scams are becoming ever more sophisticated and elaborate. For example:

• internet scammers can build very convincing websites;
• people can be referred to a website to check the caller’s legitimacy but this may be a copy of a legitimate website;
• postal scams are mass produced letters which are made to look like personal letters or important documents;
• doorstep criminals call unannounced at the adult’s home under the guise of legitimate business and offering to fix an often non-existent problem with their property. Sometimes they pose as police officers or someone in a position of authority.

All of these scams constitute financial abuse as the adult can be persuaded to part with large sums of money and in some cases their life savings. Such scams should always be reported to the police  and local authority trading standards services for investigation. The SAB should consider how to involve local trading standards in its work.

2.6 Modern slavery

This includes:

• slavery;
• human trafficking;
• forced labour and domestic servitude.

Perpetrators of modern slavery coerce, deceive and force individuals into a cycle of abuse, servitude or inhumane treatment.

See also Modern Slavery chapter.

2.7 Discriminatory abuse

This includes forms of:

• harassment;
• slurs or similar treatment:
  • because of race;
  • gender and gender identity;
  • age;
  • disability;
  • sexual orientation;
  • religion.

See Equality, Diversity and Human Rights chapter and Discrimination: Your Rights (UK Government) for further information

2.8 Organisational abuse

Organisational abuse refers to neglect and poor care practice within an institution or specific care setting, including, where care is provided in a person’s own home. This could be a one off incident or make take the form of ongoing, long term or recurring poor treatment of a person.

Organisational abuse can include neglect, and poor professional practices linked to the structure, policies, processes and practices in place in an organisation.

This type of abuse can include:

• Inappropriate use of power or control.
• Inappropriate confinement, restraint, or restriction.
• Lack of choice – in food, in decoration, in lighting and heating, and in other environmental aspects.
• Lack of personal clothing or possessions.
• No flexibility of schedule, particularly with bed times.
• Financial abuse.
• Physical or verbal abuse.

Under the Care Act, local authorities have a duty to carry out safeguarding enquiries where there are concerns about the abuse and neglect of an adult in its area, even if another local authority is responsible for arranging the adult’s care and support.

See Ill Treatment and Wilful / Deliberate Neglect.

2.9 Neglect and acts of omission

This includes:

• ignoring medical, emotional or physical care needs;
• failure to provide access to appropriate health, care and support or educational services;
• the withholding of the necessities of life, such as medication, adequate nutrition and heating.

2.10 Self-neglect

See also Self-Neglect and Hoarding

Self-neglect is a lack of self-care to an extent that it threatens an adult’s health, safety and well-being. It can include neglect of hygiene, health and surroundings (including hoarding), an inability or unwillingness to manage personal / financial affairs and a failure to seek help or access services.  The adult themselves may not recognise the impact of their behaviour or may not use the same terminology to describe their situation. Safeguarding adults procedures may need to be instigated when the adult, or others, are at risk of harm due to self-neglect.

However, self-neglect will not always prompt a section 42 (safeguarding) enquiry.

An assessment should be made on a case by case basis, and practitioners should remain curious as to whether incidents are one off or multiple, affect the people around the adult and whether there are any patterns of harm that may be an indication of other types of abuse or poor mental health.. A decision on whether a response is required under safeguarding or a decision to offer a care and support assessment of need / risk assessment 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.

3. Patterns of Abuse

Incidents of abuse may be one off or multiple, and can affect either one person or a number of different people.

Professionals and others should look beyond single incidents or individuals, to identify patterns of harm, just as the Care Quality Commission, as the regulator of service quality, does when it looks at the quality of care in health and care services. Repeated instances of poor care may be an indication of more serious problems and of what is now described as organisational abuse. In order to see these patterns it is important that information is recorded and appropriately shared (see also chapters on Information Sharing and Case Recording).

Patterns of abuse vary and include:

• serial abuse in which a 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 abuse between spouses or generations or persistent psychological abuse;
• opportunistic abuse such as theft occurring because money or jewellery has been left lying around; or
• organisational culture which is such that adults with care and support needs are dehumanised and abused by staff who are responsible for providing their care.

4. Who Abuses and Neglects Adults?

Anyone can carry out abuse or neglect, including:

• spouses / partners;
• other family members;
• carers;
• neighbours;
• friends or acquaintances;
• local residents / members of the community;
• people who deliberately exploit adults they perceive as vulnerable to abuse;
• paid staff or professionals, including tradespeople and volunteers;
• strangers, including online abuse which involves the internet, smartphones and social media.

While a lot of attention is paid, for example, to targeted fraud or internet scams perpetrated by complete strangers, it is far more likely the person responsible for abuse is known to the adult and is in a position of trust and power.

Abuse can happen anywhere: including in the adult’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.

See also Preventing Abuse and Neglect.