3.1 Types of Abuse and Neglect

1. Introduction

This chapter provides an overview of the different types of abuse and neglect outlined in the Care and Support Statutory Guidance. However, practitioners should keep an open mind about what abuse or neglect are, as they can take many forms.

The circumstances, and views of, the individual adult should always be considered when deciding the most appropriate response to any concerns.

2. Categories of Abuse

The categories of abuse as stated in the Care and Support Statutory Guidance are as follows:

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 considered to be ‘abusive’. 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 ‘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.

2.3 Sexual abuse

This includes:

• rape;
• sexual assault;
• indecent exposure;
• sexual harassment;
• inappropriate looking or touching;
• sexual teasing or innuendo;
• sexual photography;
• being made to watch pornography or witness sexual acts;
• 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 abuse may also take the form of sexual exploitation.

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 includes:

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

2.5 Financial or material abuse

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.

2.6 Modern slavery

Modern slavery is a serious and often hidden crime where people are exploited by criminals, usually for profit. It includes:

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

Adult victims are usually coerced or forced into modern slavery using threats, force, deception or by someone abusing their position of power over the victim. However, vulnerable adults (and children) cannot consent to be in such a position and therefore exploitation – even without any type of coercion – could still be modern slavery

See also Modern Slavery and Forced Marriage

2.7 Discriminatory abuse

Discriminatory abuse focuses on a difference or perceived difference such as race, gender, disability, or any of the protected characteristics of the Equality Act.

It includes forms of:

• harassment, slurs or similar treatment because of a person’s
  • race;
  • gender or gender identity;
  • age;
  •  disability;
  • sexual orientation; or
  • religion.

See also Equality, Diversity and Human Rights in a Safeguarding Context.

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 Stop Hate Crime.

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

Organisational abuse (also called institutional abuse) includes neglect and physical and / or psychological abuse or poor care practices within a residential or other specific care setting; including care provided to an adult in their own home. This could be a one-off incident or involve ongoing, long term or recurring poor treatment of an adult.

Organisational abuse can include neglect or poor professional practices linked to the structure, policies, processes and practices in place in an organisation. In some organisations, poor practices can result in a ‘closed culture’ where not many people visit the care setting (if the care setting is located away from towns and cities and not easily accessible by transport for example) and adults are at risk of harm, including human rights breaches and abuse. See also Closed Cultures (CQC).

Organisational abuse can include:

• inappropriate use of power or control over the adult;
• inappropriate confinement, restraint, or restriction of the adult;
• lack of choice – including food, decoration of their rooms, lighting and heating levels, and in other aspects of their environment;
• not being allowed or encouraged to have personal clothing or possessions;
• no flexibility in the adult’s daily routines, for example the times they have to be in bed;
• financial abuse;
• physical or verbal abuse.

Where there are concerns about the quality of a service provided by a home or a service provided to an adult in their own home and possible poor practice, these should usually be raised with the service provider in the first instance, then escalated to the local authority, Integrated Care Board or Care Quality Commission (CQC) using local reporting systems.

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, Whistleblowing and Kindness, Respect and Compassion chapters.

2.9 Neglect and acts of omission

Neglect or an act of omission is when someone who is responsible for caring for an adult who has care and support needs fails to provide them with the care they need. This can be intentional or unintentional.

It includes:

• ignoring the adult’s medical, emotional or physical care needs;
• failing to provide the adult with access to appropriate health, care and support or educational services;
• the withholding he necessities of life from the adult, such as medication, adequate nutrition and heating.

Where an adult is receiving care from a family member or friend (also known as unpaid carers), the adult who is providing the care should be referred to the local authority for a carer’s assessment (if they have not already had one) as they may be eligible for support to help them in their role as a carer. This can help to reduce the likelihood of unintentional neglect.

If there are any concerns that the adult is experiencing unintentional neglect as a result of an unpaid family or friend carer who is struggling to provide care, the most appropriate response will usually be to revise the package of care and ensure the carer has the information, support and equipment needed to be able to care for the adult safely. Conversations with carers about this can be difficult, especially where carers have been dedicated in providing care, but the aim is to ensure they are supported in their caring role and continue to provide care for the adult. See also Carers chapter and Pressure Ulcers.

2.10 Self-neglect

See also Self-Neglect and Hoarding chapter

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 that their behaviour can have on others, including family and neighbours, or may not describe their situation in the same way as practitioners. A safeguarding adults referral may be needed when the adult, or others, are at risk of harm due to self-neglect.

However, it should be noted that 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 be professionally 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. . 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 affect one person or a number of different people.

It is important to look beyond any single incidents or concerns which have been raised, to identify potential patterns of harm. Repeated instances of poor care may be a sign that there are more serious problems or organisational abuse. To be identify patterns or abuse or neglect, it is important that information is recorded and appropriately shared (see also Information Sharing and Confidentiality and Case Recording).

Patterns of abuse vary and include:

• serial abuse which is when a single perpetrator seeks out and ‘grooms’ individual adults. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse;
• long term abuse in ongoing family relationships such as domestic abuse or persistent psychological abuse;
• opportunistic abuse such as theft because money or jewellery has for example are easily accessible;
• 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; and
• strangers, including online abuse

While fraud or internet scams committed by complete strangers receive a lot of publicity, it is more likely the person responsible for any abuse will be known to the adult or in a position of trust and power to them.

Abuse can happen anywhere: for example, the adult’s own home, in a public place, in hospital, in a care home or in a college. It can take place when an adult lives alone or with others.

See also Preventing Abuse and Neglect.