3.1 Categories of Abuse and Neglect

1. Introduction

This chapter considers the different types and patterns of abuse and neglect as specified in the Care Act 2014. Professionals should not limit their view of what constitutes abuse or neglect, as they can take many forms. The circumstances of the individual case should always be considered. Exploitation, in particular, is a common theme in the following list of the types of abuse and neglect.

2. Categories of Abuse

2.1 Physical Abuse

This type of abuse includes assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.

2.2 Domestic abuse

See also Domestic Abuse chapter and Coercive Control (Research in Practice)

This type of abuse is any incident or pattern of incidents of controlling, coercive or 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. This can encompass but is not limited to the following types of abuse:

• psychological;
• physical;
• sexual;
• financial;
• emotional;
• so called ‘honour’ based abuse.

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

Family members are defined as mother, father, son, daughter, brother, sister and grandparents, whether directly related, in-laws or step-family.

Domestic abuse occurs across society, regardless of age, gender, race, sexuality, wealth and geography. Children are also affected both directly and indirectly, and there is a strong correlation between domestic abuse and child abuse.

Financial abuse is a significant problem for people who are in abusive domestic arrangements. Control of money can sabotage efforts to gain independence through employment. This is usually linked to coercive and controlling behaviour (see 2.5 Financial or material abuse).

Although men experience domestic abuse, overall women are twice as likely as men to experience interpersonal abuse, and the more extensive the abuse the more likely that it is experienced by women rather than men.

Domestic abuse normally falls under the remit of the Greater Manchester Police (GMP). However, where the alleged victim has care and support needs, the police should contact the local authority to discuss whether a safeguarding referral would be appropriate.

GMP offers the Domestic Violence Disclosure Scheme under the ‘Right to Ask’ and ‘Right to Know’ procedures. More information about these schemes can be found on the GMP website. The police work together with local authorities, housing, victim support and local refuges to bring more abusers to justice and have established Specialist Domestic Violence Courts, which are led by specially trained magistrates and involve police, prosecutors and the probation service.

2.2.1 Controlling and coercive behaviour

This relates to coercive and controlling behaviour during a relationship between intimate partners, former partners who still live together, or family members.

Controlling behaviour is a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

Coercive behaviour is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.

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

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, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.

2.3.1 Sexual exploitation

See also Working with Adults Affected by Child Sexual Exploitation and Organised Sexual Abuse

Sexual exploitation involves exploitative situations, contexts and relationships where adults at risk (or a third person or persons) receive ‘something’ (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities. It affects men as well as women.

People who are sexually exploited do not always perceive that they are being exploited. Signs to look out for are not being able to speak to the adult alone, observation of the adult seeking approval from the exploiter to respond and the person exploiting the adult answering for them and making decisions without consulting them.

Sexual exploitation can occur through the use of technology without the person’s immediate recognition. This can include being persuaded to post sexual images on the internet or mobile phone with no immediate payment or gain, or being sent such an image by the person alleged to be causing harm.

In all cases, those exploiting the adult at risk have power over them by virtue of their age, gender, intellect, physical strength or economic or other resources. There is a distinct inequality in the relationship.

2.4 Psychological abuse

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

Psychological abuse is 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.

2.5 Financial or material abuse

See also Friends against Scams, Trading Standards

This includes theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits. The potential impact of financial abuse should not be underestimated. It could significantly threaten an adult’s health and wellbeing.

According to the Office of the Public Guardian financial abuse is the most common form of abuse. Financial abuse can occur in isolation, but where there are also other forms of abuse, it is also likely to be a feature.

Potential indicators of financial abuse 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 signatories on a client or donor’s signature card; or
• sudden or unexpected changes in a will or other financial documents.

This is not an exhaustive list, nor do these examples prove that there is actual abuse occurring. However, they do indicate that a closer examination and possible investigation may be required.

Financial abuse may amount to theft or fraud which the police should investigate. It may also require attention and collaboration from a wider group of organisations, including shops and financial institutions such as banks.

Where the abuse is by someone who has the authority to manage an adult’s money, the relevant body should be informed, for example, the Office of the Public Guardian for deputies and the Department for Work and Pensions (DWP) in relation to appointees.

If there are concerns that a DWP appointee is acting incorrectly, the DWP should be contacted immediately. The DWP should inform the local authority where it is aware that the adult is already known to the authority.

See also Safeguarding Case Studies.

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.

These scams and crimes can seriously affect the health, including mental health, of an adult.

Agencies working together can better protect adults. Failure to do so can result in an increased cost to the state, especially if the adult loses their income and independence.

Where the abuse is perpetrated by someone who has the authority to manage an adult’s money, the relevant body should be informed – for example, the Office of the Public Guardian for deputies or attorneys and Department for Work and Pensions (DWP) in relation to appointees.

If there are concerns that a DWP appointee is acting incorrectly, the DWP should be contacted immediately, having the person’s National Insurance number, name and address is helpful to the DWP. But the important thing is to alert DWP to the concern.

If DWP knows that the person is also known to the local authority, then it should also inform the relevant authority.

2.6 Modern slavery

Modern day slavery encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal
to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.

See also Modern Slavery and Forced Marriage

2.7 Discriminatory abuse

This type of abuse includes forms of harassment, slurs or similar treatment; because of race, gender and gender identity, age, disability, sexual orientation or religion.

2.7.1 Hate crime

A hate crime is any incident or criminal offence that is motivated by hostility or prejudice based upon the victim’s:

• disability;
• race;
• religion or beliefs
• sexual orientation;
• transgender identity.

It should be noted that this definition is based on the perception of the victim or anyone else and is not reliant on evidence. In addition it includes incidents that do not constitute a criminal offence.

Hate crime can take many forms, including:

• physical attacks, such as physical assault, damage to property, offensive graffiti and arson;
• threat of attack, including offensive letters, abusive or obscene telephone calls, groups hanging around to intimidate and unfounded, malicious complaints;
• verbal abuse, insults or harassment taunting, offensive leaflets and posters, abusive gestures, dumping of rubbish outside homes or through letterboxes, and bullying at school or in the workplace.

A victim does not have to be a member of the group at which the hostility is targeted; anyone can be a victim of a hate crime.

If a person is convicted of a criminal offence, and hostility in relation to any of the above five categories is proven, any sentence they receive will be increased to take in to account that it is a hate crime. For more information about hate crime, and the police, see True Vision website. For more information on local support, please see Contact.

2.7.2 Mate crime

The Safety Net Project defines mate crime as:

‘when vulnerable people are befriended by members of the community who go on to exploit and take advantage of them. It may not be an illegal act but still has a negative effect on the individual.’

Examples include:

• perpetrators routinely going to a vulnerable person’s house and clearing their cupboards of food and alcohol;
• people being persuaded to part with or having their benefits taken from them;
• being exploited sexually or coerced into prostitution;
• being physically harmed for the amusement of others;
• having their home used as a place for others to meet, gather, sleep, take drugs or hold parties or having their home taken over altogether by someone else;
• women or men can be sexually exploited by someone who pretends to be their partner;
• adults who are at risk of experiencing abuse may be asked to look after a package that contains drugs, guns or ammunition;
• they may go shoplifting with their new ‘friends’ to support the friends’ drug or alcohol dependency, only to be caught by the police. The adult may not realise that what is happening is wrong;
• the adult may think ‘He’s my friend, that’s what friends do’. Many vulnerable adults have few friends and for some vulnerable people, having any friends is better than no friends at all.

Mate crime centres around issues of self-belief and self-worth in the adult with care and support needs. They may come to expect that people will ‘walk all over them’, because that is what has often happened previously and they may perceive this behaviour as normal.

Mate crime is often difficult for police to investigate, due to its sometimes ambiguous nature, but should be reported to the police who will make a decision about whether or not a criminal offence has been committed. Mate crime is carried out by someone the adult knows and often happens in private. In recent years there have been a number of serious case reviews relating to people with a learning disability who were murdered or seriously harmed by people who purported to be their friend. For more information on local support, please see Contact.

2.8 Organisational abuse

Previously known as institutional abuse, this type of abuse includes neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home. This may range from one off incidents to ongoing ill treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.

Organisational abuse occurs when the routines, systems and regimes of an institution or organisation result in poor or inadequate standards of care and poor practice which affect the whole setting and deny, restrict or curtail the dignity, privacy, choice, independence or fulfilment of the adults using the service.

2.9 Neglect and acts of omission

This type of abuse and other acts of omission 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.

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

Neglect and poor professional practice may take the form of isolated incidents or pervasive ill treatment and gross misconduct. Neglect of this type may happen within a person’s own home or in an institution / within an organisation or service (see 2.8 Organisational abuse). Repeated instances of poor care may be an indication of more serious problems. Neglect can be intentional or unintentional.

2.10 Self-neglect

See also Self-Neglect

This term covers a wide range of behavior including neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.

Self-neglect may not necessarily prompt a safeguarding enquiry. Assessments should be made on a case by case basis. A decision on whether a response is required 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.

The Safeguarding Adults Board can be a positive means of addressing issues of self-neglect, where strategic discussions can take place on dealing with what are often complex and challenging situations for practitioners and managers as well as communities more broadly (see Roles and Responsibilities of Safeguarding Adults Boards).

3. Other Types of Abuse

3.1 Children and young people who abuse

If a child or children is / are causing harm to an adult covered by the adult safeguarding procedures, action should be taken under these procedures, and a referral and close liaison with children’s services should take place. Physical and sexual abuse towards parents and other relatives (for example, grandparents, aunts, uncles) some of whom, may be adults at risk of, or experiencing abuse or neglect, can be carried out by adults and by young people and children, some of which can cause serious harm or death. The UK prevalence study of elder abuse identified younger adults (rather than the person’s partner) as the main perpetrators of financial abuse.

3.2 Abuse by another adult

Where the person causing the harm is also an adult at risk of, or experiencing abuse or neglect, the safety of the person who may have been abused is paramount. Organisations may also have responsibilities towards the person causing the harm. They will have if both the victim and the person causing harm are both in a care setting or have contact because they attend the same place (for example, a day centre). The person causing the harm may themselves be eligible to receive an assessment or require a reassessment. In this situation, it is important that the needs of the adult who is the alleged victim are addressed separately from the needs of the person causing the harm.

The principles and responsibilities of reporting a crime apply regardless of whether the person causing harm is deemed to be an adult at risk of, or experiencing abuse or neglect.

4. Patterns of Abuse

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, 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 Information Sharing and Case Recording).

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

5. Who Abuses and Neglects Adults?

Anyone can carry out abuse or neglect, including:

• spouses / partners;
• other family members;
• neighbours;
• friends;
• acquaintances;
• local residents;
• people who deliberately exploit adults they perceive as vulnerable to abuse;
• paid staff or professionals;
• volunteers; and
• 
strangers.

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: 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.

Abuse can also occur through the use of technology, which may include:

• mobile phones;
• internet chat rooms;
• social networking sites;
• email;
• fraudulent websites.

See also Preventing Abuse and Neglect.