The Types of Abuse Vulnerable Adults can Experience

Safeguarding adults is an important role for anyone working in the education or care sectors. It’s vital that you understand not only what safeguarding and abuse is, but what you can and must do to stop it happening.

NHS statistics say that in 2019-20, over 475,000 concerns of adult abuse were reported through official channels, an increase of 14.6 per cent on the previous year. This is a clear indication that abuse is a major issue within the UK and everyone who works with vulnerable adults needs to work to stop these incidences.

Section 42 enquiries, where actions are taken by a local authority regarding adult abuse, went up by 12.6 per cent in the same period to 161,910. The outcomes of those enquiries were overall positive, with 89 per cent of identified risks being reduced or removed. This shows how important it is to raise issues when they’re seen – you can have a direct impact on helping reduce a person’s risk.

With these pertinent numbers, we want to give you clear and helpful guidance about the types of abuse vulnerable adults can face and how you can go about reporting your concerns.

To do that, we’re going to cover:

• The importance of safeguarding vulnerable adults.
• Where the responsibility for safeguarding adults lies.
• Signs and symptoms of abuse in its different forms.
• How you can report concerns of vulnerable adults being abused.

Why is safeguarding vulnerable adults important?

Vulnerable adults can struggle to make low-risk decisions without support and guidance. The UK has laws and regulations about safeguarding adults to ensure that neglect, abuse, and harm to them is reduced or removed completely whilst also empowering them.

It is important to understand what we mean when we talk about vulnerable adults. There are definitions that need to be followed.

In general, an adult may be termed vulnerable if they:

• Are elderly and frail.
• Have a learning disability.
• Suffer from addiction.
• Have a long-term illness.
• Are a carer.
• Live with a physical disability.
• Have mental health difficulties such as dementia, bipolar disorder, etc.
• Aren’t capable of making decisions.

Just because someone is vulnerable, it doesn’t mean they should lose all autonomy. Once a person has been identified as vulnerable, they should be given the chance to make decisions about their life and care that removes or at least reduces risk to them.

Safeguarding isn’t merely about care and protection. There are broader concerns that need to be considered to ensure that anything that any intervention in the life of an adult who’s vulnerable is:

• Empowering.
• Focussed on prevention.
• Proportional.
• Protective.
• Done through partnership.
• Accountable.

As you can see from the statistics quoted above, safeguarding measures for adults can be very effective, with high rates of successful actions taken when concerns are raised.

Who is responsible for safeguarding adults?

Safeguarding adults is primarily the responsibility of the local authority they live under. The local authority is tasked with creating a Safeguarding Adults Board (SAB), a legal requirement under the Care Act 2014.

A local SAB needs to:

• Ensure that safeguarding arrangements are in place at a local level.
• Be sure that safeguarding practices are focussed on the person and outcomes.
• Collaborate with people, organisations, and agencies to prevent abuse and neglect where possible.
• Check that responses to reports of neglect and abuse are timely and proportionate.
• Be sure that local safeguarding is continually improving the quality of life for adults under its supervision.

Along with representatives from the local authority, the SAB needs to include the Chief of Police for the area and members from local clinical commissioning groups. The local authority can also invite others to the board where needed, such as the local ambulance services, advocacy groups, trading standards, etc.

Every workplace that encounters vulnerable adults also needs to have a safeguarding policy in place. A good safeguarding policy will have details about:

• The aims of the policy.
• The principles of safeguarding adults.
• What abuse of vulnerable adults looks like.
• How to handle reports of abuse.
• Who to contact when abuse is recognised.

Any person who works with vulnerable adults should have training about how to safeguard vulnerable adults, too.

What are the different types of abuse?

Abuse is broadly defined as a person who has power or control over someone and misuses it, leading to distress or harm. As adults, there are more things that we have to be responsible for, and sadly this means there are more avenues to be able to abuse someone.

It’s important to have a deep understanding of the different types of abuse vulnerable adults can face. This will help you to be able to identify abusive situations whilst undertaking your professional responsibilities.

Different types of abuse can manifest themselves in lots of ways. It is possible you may only see the abuse rather than the effect, or vice versa – you many only see the effect on the vulnerable adult and not be sure where the abuse is being perpetrated. Either way, it’s important you still follow your workplace policy on reporting concerns about adult abuse.

Here, we’re going to go through the different types of abuse that adults can face. We’ll look at the signs and symptoms of each and offer some examples. It’s important to note that you don’t need to define the type of abuse that you see when you report it, and also that these examples are by no means exhaustive.

Neglect

Neglect, or the act of omission, can cover a lot of different behaviours. In general, it means not providing what a person needs.

Some of the things that can be deprived from a person include:

• Food or the right type of food.
• Water.
• Clean clothes.
• Medical attention.
• Necessary medication.

These are some of the absolute basic things that can be kept from a person. Neglect can also mean to stop a person getting social contact, attending college or other education, stopping someone being able to pray or do other religious activities, or not keeping a person warm or cool enough.

If you see a person not getting what they need as laid out in their care plan, or not receiving the care you think they need, you should raise it as a concern.

Although you may not directly see a person being neglected, there are symptoms that you can look out for. For example, a person may look dishevelled or not smell clean, you might see a deterioration in their physical or mental health, or they may tell you about something that constitutes neglect.

Many situations can allow for neglect. A carer may not be washing the vulnerable adult properly or a person may not be given food in line with their dietary needs. Not being given enough pain medication or being forced to wear the same clothes for days on end are other examples of neglect that should be reported when you notice them.

Physical abuse

Physical abuse is when someone uses physical force or mistreatment against a vulnerable person. There doesn’t need to be physical injury from the abuse for it to need to be reported.

Physical abuse can constitute many types of activity, including:

• Getting hit.
• Being pushed.
• Being handled roughly.
• Being exposed to extreme heat or cold.
• Getting forced to eat food.
• Not being given medication the right way.
• Not being able to go to the doctor or see a nurse.
• Being restrained illegally.
• Being stopped from going where you want when you want.

When we think of physical abuse, it is easy to immediately think of more extreme forms of violence. Of course, you still need to be vigilant for this, but physical abuse can be more subtle. Forcing a person to take a tablet rather than an oral suspension won’t necessarily leave a mark, but it’s abuse nonetheless.

Some physical abuse might leave visible signs, such as broken bones, bruises, or other marks. Unexplained pain or fear of you touching or approaching the person could be less obvious signs that they’re being abused.

It’s important to listen as well as look for signs of abuse. You might be told that a person you’re working with wasn’t allowed to go and see their friends or had to eat food they didn’t like, for example. If you feel uncomfortable with anything you’re told about how a vulnerable adult is treated physically, be sure that you report it.

Emotional abuse

This may also be termed psychological abuse; whichever way it is referred to the same signs and symptoms will be present. Emotional abuse is about the words and language used towards a person, so can be harder to pick up.

The evidence of emotional abuse can be based on what the vulnerable adult tells you, but you may also see it in messages, emails, or voice notes that they receive, too. It doesn’t matter how the emotional abuse takes place, it’s still vital that you report it once you know about it.

Emotional abuse covers a person being:

• Threatened.
• Humiliated or ridiculed.
• Made to fear violence.
• Shouted, yelled, or sworn at.
• Blamed.
• Controlled.
• Intimidated.
• Coerced.

How is it possible to know a person is being emotionally abused without seeing it? An abuser is unlikely to let you hear their words, so you need to look for signs and changes in the behaviour of the vulnerable adult.

Your suspicions should be raised when a person is very eager to do what you ask of them, loses the confidence or the ability to do things they could do before, loses their concentration or focus, becomes withdrawn, or starts to show signs of compulsive behaviour.

Examples of emotional abuse can include a person being told that they’re worthless, being told their disability has been caused by them, or being told that they have to behave in a certain way to be treated with dignity and respect.

Sexual abuse

Sexual abuse can run a gamut of activities, from words to actions of a sexual nature. You may witness less explicit abuse such as sexually suggestive language but it is unlikely you would see a physical act.

Acts of sexual abuse come in many forms, which are:

• Rape.
• Sexual assault – non-consensual touching or masturbation.
• Verbal sexual harassment.
• Grooming activities.
• Forced viewing of pornography or sexual photos or videos.
• Indecent exposure.

Or indeed any act of a sexual nature that the vulnerable adult isn’t capable of consenting to. You don’t need to make the decision whether there was consent or abuse – if you are at all unsure whether sexual abuse of a vulnerable adult has taken place you need be reporting your concerns.

Noticing that a person is being sexually abused or groomed can be difficult. Things to watch out for include being in pain or discomfort around their genitals or having a sexually transmitted disease, finding evidence of sexual activity like used condoms or sex toys, the person talking about sex in a different way, or not wanting to be touched at all or around the genitals when being washed.

Sexual abuse can be in situations when the person is most vulnerable such as during bathing or when their clothes are being changed, but it could be more subtle like having explicit photos sent to their mobile phone.

Domestic abuse

Domestic abuse can be made up of most other types of abuse, but it is carried out in the home by a partner or family member.

The people who perpetrate domestic violence, by definition, are likely to be the closest and most trusted people in the vulnerable adult’s life. It can be more difficult to identify domestic abuse since the chances of being told about it directly are lower.

Many of the signs to look for in domestic abuse will be the same as for other types of abuse.

On top of these, you might notice:

• Damage in or around the house.
• A fear of someone coming into their life from outside.
• Self-blaming for issues or problems.
• A lack of self-esteem.

Domestic abuse can be sexual, emotional, physical, or financial. The vulnerable person’s child might be demanding money from them or their wife might be telling their vulnerable husband that he’s not capable of looking after himself without her.

There are lots of ways domestic abuse can occur; even though it’s in someone’s home you still have an obligation to report it if you have concerns about the situation.

Financial abuse

Financial abuse is when a person has their access to money controlled. It can cover how a person is able to obtain money or how they get and use the money that they already have.

Manipulating someone’s money comes in many guises.

Financial abuse can be:

• Forcing someone to work for money that is already theirs
• Restricting or removing access to someone’s government benefits.
• Demanding that a will or inheritance arrangement are changed to include the abuser.
• Accessing benefits on behalf of the vulnerable adult.

It is possible that a vulnerable person may need help and support with their finances. Having someone help them manage their bank accounts or benefits claims in itself isn’t abuse – However, the person using their position to their advantage is.

An abuser might only allow the person to use their bank card when they’re present, or claim the person is less capable than they are to increase government benefits. Living with a person rent-free without informed consent from the vulnerable adult is another subtle type of financial abuse.

You’d notice a person was suffering from financial abuse when they lacked money even when you knew they had income, having problems paying their bills, loss of confidence in their ability to look after their finances, or being unusually protective of their purse, wallet, or belongings.

Institutional abuse

Institutional abuse is when an institution – e.g. company, agency, charity, or organisation – makes it unnecessarily and purposefully difficult for a person to access services they need.

It refers primarily to institutions that care for vulnerable adults and can mean that the routines or systems in place mean that care is sub-standard or there are poor practices and behaviours from the staff. It can also be that the institution deprives the adult of their rights and their dignity which violates their well-being.

You’d notice this type of abuse when a person who is cared for by an institution lacks personal belongings and doesn’t have a care plan. If they regularly get admitted to hospital or are treated badly by staff, this is also institutional abuse and you should be reporting your concerns.

Bullying

Bullying is a repetitive abuse. It can be verbal, physical, or emotional, and is designed to make a person feel unhappy and isolated. It can look and even feel insignificant but when there is a pattern of small acts it can have a long-term effect on the vulnerable adult.

Bullying can be in person, and increasingly online as well. Look for patterns of speech or behaviour that build into a negative experience for the person being bullied. It’s possible that a person is bullied by more than one person, such as a group of work colleagues or other people living in a block of flats for example.

You’ll notice a person being bullied will become withdrawn and change their behaviour. They may also become aggressive or defensive either verbally or physically. The signs may be very similar to other types of abuse but finding the issue may be harder since bullying is a pattern over time.

Modern slavery

Modern slavery has received a lot of attention in recent years. There are many circumstances that can constitute modern slavery, all of which are around forced labour or moving people to a place where they will be forced into labour.

Domestic servitude, debt bondage, and selling a person to allow them to be raped are examples of modern slavery. Some of the signs that should raise your suspicions about modern slavery include:

• Living in cramped spaces with lots of other people.
• Not having money, belongings, clothes, or documents when you expect a person to have them.
• A person showing signs of other types of abuse.
• Being scared of authorities and law enforcement.
• Not engaging with people or their community.

Adults who are victims of modern slavery can be extremely vulnerable and involved with criminal gangs in many circumstances. Be sure to raise your concerns and assess whether it is safe to advise the person that you’re doing so.

Discrimination

Discriminatory abuse means a person is being denied the right treatment due to protected characteristics. Protected characteristics under UK law are:

• Gender.
• Sex.
• Race.
• Age.
• Disability.
• Religion or belief.
• Sexual orientation.
• Gender reassignment.
• Marital or civil partnership status.

If a person isn’t being given the care or access to services based on any of these characteristics, they may be a victim of discriminatory abuse. Whenever a vulnerable adult comes into contact with services, these issues need to form part of assessments and care plans.

Examples of abuse due to discrimination can include not offering a care plan in Braille to a blind person, forcing a person to attend meetings when their religion expects them to be praying, or showing a movie that depicts harassment of a homosexual character.

A victim of this abuse may seem withdrawn and not keen on engaging with the services in place for them. You may also be able to identify the abuse by looking at a care plan and understanding how it isn’t suitable for that person.

How to report signs of abuse

In the first instance, if the abuse you see is putting someone at immediate risk or danger of harm you should call emergency services on 999. For any other suspected criminal acts that aren’t an emergency, you can call 111.

For other suspicions of abuse, refer to the guidelines that should be accessible in your workplace. All private organisations that come into contact with vulnerable adults should have a Safeguarding Officer who you can make a report to. If that isn’t possible, contact your local authority direct.