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. Types of Abuse

2.1 Disability Hate Crime

A disability hate crime as any criminal offence, which is perceived, by the victim or any other person, to be motivated by hostility or prejudice based on a person’s disability or perceived disability.

Forms of disability hate crime include:

• Verbal and physical abuse
• Threatening behaviour
• Damage to property
• Online abuse
• Stalking and harassment

2.2 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 Equality, Diversity and Human Rights in a Safeguarding Context

2.3 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.

Where a victim of domestic abuse is aged under 18 years, Safeguarding Children Procedures should be followed.

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

2.4 Female genital mutilation (FGM)

Involves procedures that intentionally alter or injure female genital organs for non-medical reasons. The procedure has no health benefits for girls and women. The Female Genital Mutilation Act (2003) makes it illegal to practise FGM in the UK or to take girls who are British nationals or permanent residents of the UK abroad for FGM whether or not it is lawful in another country. See also Female Genital Mutilation chapter.

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.

See also Financial or Material Abuse chapter.

2.6 Forced marriage

Is a term used to describe a marriage in which one or both of the parties are married without their consent or against their will. A forced marriage differs from an arranged marriage, in which both parties consent to the assistance of a third party in identifying a spouse. In a situation where there is concern that an adult is being forced into a marriage they do not or cannot consent to, there will be an overlap between action taken under the forced marriage provisions and the adult safeguarding process.

See also Forced Marriage chapter.

2.7 Hate crime

The police define Hate Crime as ‘any incident that is perceived by the victim, or any other person, to be racist, homophobic, transphobic or due to a person’s religion, belief, gender identity or disability’. 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.

2.8 So called ‘honour based’ abuse

So called honour based abuse is a term used to describe abuse committed within the context of the extended family which are usually motivated by a perceived need to restore standing within the community, which is presumed to have been lost through the behaviour of the victim. Women are predominantly (but not exclusively) the victims and the violence and abuse is often committed with a degree of collusion from family members and / or the community. Some of these victims will contact the police or other organisations. However, many others are so isolated and controlled that they are unable to seek help. See So Called ‘Honour Based’ Abuse chapter.

2.9 Human trafficking

Is actively being used by organised crime groups to make considerable amounts of money. This problem has a global reach covering a wide number of countries. It is run like a business with the supply of people and services to a customer, all for the purpose of making a profit. Traffickers exploit the social, cultural or financial vulnerability of the victim and place huge financial and ethical obligations on them. They control almost every aspect of the victim’s life, with little regard for the victim’s welfare and health. The organised crime groups will continue to be involved in the trafficking of people, whilst there is still a supply of victims, a demand for the services they provide and a lack of information and intelligence on the groups and their activities.

2.10 Mate crime

A ‘mate crime’ is ‘when a vulnerable person is befriended another person who goes on to exploit and take advantage of them. 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 Safeguarding Adult Reviews relating to people with a learning disability who were murdered or seriously harmed by people who purported to be their friend. See also Safe Places National Network (mate crime resources).

2.11 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 chapter.

2.12 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.

2.13 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 also Provider Concerns Process and Person / People in Positions of Trust (PIPOT) – Multi-Agency Practice Guidance.

2.14 Physical abuse

This includes:

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

2.15 Psychological / emotional 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.

2.16 Restraint

Unlawful or inappropriate use of restraint or physical interventions. In extreme circumstances unlawful or inappropriate use of restraint may constitute a criminal offence. Someone is using restraint if they use force, or threaten to use force, to make someone do something they are resisting, or where an adult’s freedom of movement is restricted, whether they are resisting or not (see also Provider Concerns Process).

Restraint covers a wide range of actions. It includes the use of active or passive means to ensure that the person concerned does something, or does not do something they want to do, for example, the use of key pads to prevent people from going where they want from a closed environment.

2.17 Self-neglect

See also Self-Neglect Guidance

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 (see Professional Curiosity chapter). 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.

2.18 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.

2.19 Sexual exploitation

Involves exploitative situations, contexts and relationships where adults (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 recognise that they are being exploited.

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

NB: Pressure Ulcers

Pressure ulcers may occur as a result of neglect. Where concerns are raised regarding skin damage as a result of pressure, there is a need to raise it as a safeguarding concern within the organisation. In a minority of cases it may warrant a safeguarding concern with the local authority. Please see Pressure Ulcers: Safeguarding Adults Protocol

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 South Tyneside Multi Agency Information Sharing Agreement and Case Recording chapter).

Patterns of abuse vary and include:

• serial abuse in which 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 an ongoing family relationships such as domestic abuse or persistent psychological abuse; or
• opportunistic abuse such as theft because money or jewellery, 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.