Abuse and Neglect

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

Indicators of physical abuse may include:

• Any injury not fully explained by the history given
• Injuries inconsistent with the lifestyle of the adult
• Bruises and/or welts on face, lips, mouth, torso, arms, back, buttocks, thighs
• Clusters of injuries forming regular patterns
• Burns, especially on soles, palms or back: friction burns, rope or electrical appliance burns
• Multiple fractures, bleeding, slap marks, finger marks
• Lacerations or abrasions to mouth, lips, gums, eyes, genitalia
• Injuries at different stages of healing
• Medication misuse
• Fear or emotional distress.

The Home Office (2013) defines domestic abuse as;

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

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.

This definition, which is not a legal definition, includes so called ‘honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group.

Sexual abuse 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.

Indicators of Sexual Abuse:

• significant change in sexual behaviour or attitude
• Pregnancy in a woman who is unable to consent to sexual intercourse
• Wetting or soiling
• Poor concentration, withdrawn. depressed or stressed
• Unusual difficulty in walking or sitting
• Torn, stained or bloody underclothing
• Bruises, bleeding, pain or itching in genital area
• Sexually transmitted diseases, urinary tract or vaginal infection, love bites
• Bruising to thighs, upper arm,
• self harming behavior, fear or emotional distress

Types of psychological or emotional abuse can include

• Enforced social isolation – preventing someone accessing services, educational and social opportunities and seeing friends
• Removing mobility or communication aids or intentionally leaving someone unattended when they need assistance
• Preventing someone from meeting their religious and cultural needs
• Preventing the expression of choice and opinion. Controlling behaviour
• Failure to respect privacy
• Preventing stimulation, meaningful occupation or activities
• Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse
• Addressing a person in a patronising or infantilising way
• Threats of harm or abandonment
• Cyber bullying
• Blaming
• Verbal abuse

Possible indicators of psychological or emotional abuse

• An air of silence when a particular person is present
• Withdrawal or change in the psychological state of the person
• Insomnia
• Low self-esteem
• Uncooperative and aggressive behaviour
• A change of appetite, weight loss/gain
• Signs of distress: tearfulness, anger
• Apparent false claims, by someone involved with the person, to attract unnecessary treatment

Financial or material abuse includes theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits.

Indicators of financial or material abuse may include:

• Change in living conditions
• lack of heating, clothing or food
• Inability to pay bills or unexplained shortage or money
• Unexplained withdrawals from an account
• Unexplained loss or misplacement of financial documents
• The recent addition of authorised signatories on a client’s signature card
• Sudden or unexpected changes in a will or other financial documents

Modern slavery exists in the UK and destroys lives. Men, women and children – UK nationals and those from abroad – are exploited in the sex industry, through forced labour, domestic servitude in the home and forced criminal activity. These types of crime are often called human trafficking.

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.

Indicators of Modern Slavery:

• Victims may show signs of physical or psychological abuse, look malnourished, unkempt, withdrawn
• May seem under control of others, not travel alon, rarely interact or appear unfamiliar with the neighbourhood
• May be living in dirty cramped conditions
• May have no identification documents, few personal possessions, wear the same clothes everyday
• May have to be dropped of or picked up for work on a regular basis either very early or late at night
• May appear frightened or hesitant to talk, avoid eye contact

Government guidance on  Victims of Modern Slavery is designed to help staff identify and help potential victims of modern slavery (including human trafficking) in England and Wales. It reflects relevant provisions of the Modern Slavery Act 2015 and the Human Trafficking and Exploitation (Criminal Justice and Support for Victims) Act (Northern Ireland) 2015. If staff suspect a person is a potential victim of modern slavery due to human trafficking in any part of the UK (or slavery, servitude, or forced or compulsory labour in cases identified in England or Wales) they must consider a referral into the national referral mechanism (NRM). Under the NRM, a trained specialist in a designated competent authority will investigate the matter further.

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

Indicators of discriminatory abuse:

• Lack of respect shown to an individual
• Signs of a sub-standard service
• Repeated exclusion from rights afforded to citizens such as health, education, employment and criminal justice
• Failure to follow aspects of a person’s agreed support or care plan that reflects their individual identity

Further information on discrimination can be found here

Organisational abuse is 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 on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.

Indicators of organisational abuse include:

• Misuse of medication / inappropriate restraint methods
• Sensory deprivation e.g. denial of use of spectacles, hearing aids / denial of visitors or phone calls
• Restricted access to toilet or bathing facilities, medical or social care, lack of clothing or possessions
• Controlling relationships between staff and service users
• Poor professional practice, poor communication and recording of essential care information
• Lack of respect shown to person
• Failure to ensure privacy, personal dignity
• Lack of flexibility and choice
• Insufficient account taken of views of adult, relatives or carers
• Significant numbers of low level concerns

Neglect and acts of omission include 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

Indicators of neglect include:

• Physical condition of person is poor e.g. bed sores, unwashed, ulcers, personal hygiene
• Clothing in poor condition e.g. unclean, wet, ragged
• Inadequate physical environment, inadequate protection from sun, inadequate heating
• Malnutrition, dehydration, inadequate diet
• Untreated injures or medical problems
• Inconsistent or reluctant contact with health or social care agencies
• Failure to engage in social interaction / give prescribed medication

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

Indicators of self neglect include:

• Living in a very unclean environment e.g. rodent infested or blocked toilet
• Neglecting household maintenance
• Having eccentric behaviour or lifestyles such as obsessive hoarding
• Poor diet and nutrition, little or no fresh food in fridge, mouldy or out of date food
• Refusing necessary help from health or social care staff in relation to personal hygiene and care
• Having poor personal hygiene, poor health, sores or long toe nails

Identification

Here are examples of indicators that may suggest vulnerability to violent extremism:

• Expressed opinions – such as support for violence and terrorism or the values of extremist organisations, airing of political or religious based grievances, unaccepting of other nationalities, religions or cultures.
• Material – possession of extremist literature; attempts to access extremist websites and associated password protected chat rooms; possession of material regarding weapons, explosives or military training
• Behaviour and behavioural changes – such as withdrawal from family and peers; hostility towards former associates and family; association with proscribed* organisations and those that hold extremist views (Under the Terrorism Act 2000 the Home Secretary has the power to proscribe – forbid by law – an organisation believed to be concerned in terrorism. Details of each organisation proscribed by the UK government can be viewed here)
• Personal history – Claims or evidence of involvement in organisations voicing violent extremist ideology and identifying with their cause.

Prevent Duty