Mental health support workers are the frontline support for people with mental health issues. The primary role of mental health support workers is to contribute to their patients’ overall wellbeing and mental health. They also share a responsibility with all other members of the healthcare professions for the safety and wellbeing of all clients, their protection from harm, abuse, exploitation or unsafe practice, and to take action if they suspect that someone is being abused.
What is safeguarding?
Mental health support workers work with a diversity of clients in a variety of settings including the clients’ own homes. They support and enable the client’s life as a part of a larger multidisciplinary team by improving their functioning and encouraging them to continue with activities such as employment and their everyday responsibilities.
Not all people who experience mental health problems will be classed as an adult at risk; however, there are people who experience mental health problems who have care or support needs, experience abuse or neglect and are unable to protect themselves. A mental health support worker has a duty to care for the welfare and wellbeing of vulnerable adults with care and support needs, and to safeguard them from abuse or neglect.
Safeguarding means protecting people from harm including physical, emotional, sexual and financial harm and neglect. Mental health support workers have a duty to recognise the signs and symptoms of abuse and to act on any concerns. Duties to safeguard people are required by professional regulators and service regulators and are supported by law.
Safeguarding adults at risk means protecting their right to live in safety and free from abuse and neglect.
Adults at risk means anyone aged 18 or over who:
- Has needs for care and support.
- Is experiencing, or is at risk of, abuse or neglect.
- As a result of those care and support needs, is unable to protect themselves from either the risk of or the experience of abuse or neglect.
Safeguarding also means that individuals are adequately supported to access care and support where this is needed, so that they are able to stay well and maintain a high quality of life. This is achieved by different organisations working effectively together to prevent and stop both the risks and experience of abuse or neglect. Safeguarding aims to balance the right to be safe with the right of the individual to make informed choices and to have their wellbeing promoted at all times.
The Care Act 2014 lists six key principles of safeguarding. These are intended to form a core set of standards for anyone who has a responsibility for safeguarding. Although these principles have been designed with a focus on vulnerable adults, they should be applied to any type of vulnerable individual, children included.
The principles are as follows:
- Accountability – in the event of a disclosure, if an adult or young person entrusts you with information that you know could be indicative of abuse, you must be clear with the individual that you need to report what you have heard.
- Empowerment – it’s important for any person who has been a victim of abuse to feel that they have control over their situation. Support and encouragement are key to effective working with a victim of abuse or neglect.
- Partnership – it is important to work in partnership with your local authority and all services or organisations in your community that might be able to assist in detecting and reporting abuse.
- Prevention – it is sometimes possible to take action before harm has come to an individual. If you know the signs and indicators of abuse, you will understand when something is not quite right and will be better placed to report any concerns for an individual’s wellbeing.
- Proportionality – when a safeguarding incident occurs, you should report your concerns in a manner that is appropriate for the risk presented. For example, if you suspect that a child is in immediate danger, dialling 999 is the recommended response.
- Protection – it is crucial to be an ally for individuals who have experienced or who are at risk of abuse. Supporting and representing these individuals in the appropriate manner can help to protect them from further harm.
What risk factors make someone more likely to experience abuse?
Abuse and neglect can occur anywhere to anyone; however, there are risk factors, particularly in drug abuse, that can make a person more vulnerable to abuse.
An adult at risk of abuse may:
- Have an illness affecting their mental or physical health.
- Be physically dependent on others.
- Have a sensory impairment.
- Have a learning disability.
- Suffer from drug or alcohol problems.
- Have low self-esteem.
- Be unable to make their own decisions.
- Have a previous history of abuse.
- Have negative experiences of disclosing abuse.
- Be frail.
- Have experienced a lack of access to health and social services or high-quality information.
The types of abuse adults can encounter
There are ten types of abuse listed in the Care Act (2014).
These are:
- Physical abuse – this may involve physical violence, misuse of medication, inappropriate restraint or sanctions.
- Sexual abuse – this can include verbal sexual abuse, non-consensual touching, fondling, physical restraint, cornering, tickling, kissing, excessive cleaning of genitals, enemas, intercourse, sodomy, oral sex, invasion of privacy and stalking.
- Psychological abuse – this includes emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, harassment and verbal abuse.
- Financial or material abuse – including theft, fraud, exploitation, pressure in connection with wills, property, inheritance or financial transactions, and misuse or misappropriation of property, possessions or benefits.
- Neglect and acts of omission – including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, withholding medication, and inadequate nutrition and heating.
- Discriminatory abuse – including racist and sexist abuse or abuse based on a person’s disability.
- Domestic abuse – including psychological, physical, sexual, financial and emotional abuse, and so-called honour-based violence.
- Modern slavery – includes slavery, human trafficking, forced labour and domestic servitude.
- Organisational abuse – including neglect and poor care practice within an institution or specific care setting such as a hospital or care home.
- Self-neglect – includes a wide range of behaviour neglecting to care for personal hygiene, health or surroundings and includes behaviour such as hoarding.
What adult safeguarding issues do mental health support workers need to be aware of?
Abuse and neglect can take many forms, ranging from exploitation and disrespectful treatment to physical harm. It can be at a low level, and take place over a long time, or it can take place over a short time and be more extreme. It is all abuse.
Organisations and individuals should not be constrained in their view of what constitutes abuse, neglect or harm and should always consider the circumstances on a person-centred basis. Adult safeguarding concerns vary according to the nature of harm, the circumstances it arose in and the people concerned.
Abuse and neglect may be carried out by anyone in contact with adults including spouses, friends, family, neighbours, people employed to provide care, paid staff or professionals, volunteers and strangers. In addition, adult mental health support workers need to be aware of the possibilities of adults who are at risk from themselves, rather than someone else. This could be because they are considering self-harm or suicide.
The abuse or neglect can be deliberate, or the result of ignorance or a lack of proper training. Recognising abuse or neglect is crucial, as it may:
- Be a single act or repeated acts.
- Cause harm temporarily or over a period of time.
- Occur when a person is persuaded to enter into a transaction to which they have not consented to, or cannot consent to.
- Be an act of neglect or an omission to act.
- Occur through deliberate targeting/grooming.
- Occur in any relationship.
- Be perpetrated by an individual or as part of a group/organisation.
- Be the result of deliberate intent, or be unintentional, through negligence or ignorance.
- Involve several abusive acts which are crimes, and informing the police must be a key consideration.
The roles and responsibilities of mental health support workers in regard to adult safeguarding
Safeguarding adults is a huge part of the mental health support worker’s role, because they are working with some of the most vulnerable people in the country. They balance support and protection/safeguarding roles carefully and in keeping with the specific needs and circumstances of the person or family.
Safeguarding adults covers a spectrum of activity from prevention through to multi-agency responses where harm and abuse occurs. Multi-agency procedures apply where there is concern of neglect, harm or abuse to a client defined under the Care Act (2014) guidance as vulnerable.
A mental health support worker’s role in safeguarding adults is to:
- Recognise – you should have a clear understanding of what the different signs and symptoms of potential abuse, harm and neglect can be. Robust safeguarding training can help you to spot these signs and symptoms.
- Respond – it is essential that you respond appropriately and do not ignore the situation.
- Report – concerns need to be reported without delay. Confidentiality is important, so only share information with those who are a part of the safeguarding process.
- Record – you should make precise, comprehensive notes that detail everything about your safeguarding concern.
- Refer – if the safeguarding risk is urgent and you suspect somebody is under immediate or severe threat, you should contact the relevant local authority or police services.
Adult mental health support workers have a duty to make sure that:
- Safeguarding concerns are dealt with promptly, appropriately and reported in a secure and responsible way to all relevant agencies.
- Steps are taken to escalate or alert those able to protect adults and/or children at risk from harm and minimise the risk of abuse.
- Appropriate and proportionate measures are in place to protect from harm all those who work for them, or with them, or come into contact with them.
The adult safeguarding issues mental health support workers may come across
Understanding what abuse and neglect might look like and how to recognise warning signs is an important aspect of safeguarding.
Some examples mental health support workers might encounter may include, but are not limited to:
- Mate crime – a mate crime is when someone pretends to be friends with a person with mental healthcare and support needs but then goes on to exploit or abuse them. The way they are exploited may not always be illegal, but it still has a negative impact on the person. Mate crime is carried out by someone the person knows, and often happens in private.
- Financial abuse – this could be someone stealing money or other valuables from a vulnerable person, or it might be that someone appointed to look after their money on their behalf is using it inappropriately or coercing them to spend it in a way that they are not happy with. Internet scams and doorstep crime are also common forms of financial abuse that may be perpetrated against vulnerable adults.
- Domestic abuse – this is typically an incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse by someone who is, or has been, an intimate partner or family member.
- Cyberbullying – this can be defined as the use of internet and/or mobile technology to harass, intimidate, or cause harm to another and can include trolling. Cyberbullying can take many forms, and often it looks like calling people names, cursing them, spreading lies about them, or any other behaviour that can be construed as trying to hurt or bully them.
- A client with depression and an eating disorder tells the adult mental health support worker that they are finding it difficult not to hurt their children.
- Neglecting household maintenance, and therefore creating hazards within and surrounding the property.
- Portraying eccentric behaviour/lifestyles.
- Obsessive hoarding.
- Poor diet and nutrition – for example, evidenced by little or no fresh food in the fridge, or what is there being unfit for consumption.
- Declining or refusing prescribed medication and/or other community healthcare support.
- Refusing to allow access to health and/or social care staff in relation to personal hygiene and care.
- Refusing to allow access to other organisations with an interest in the property, for example staff working for utility companies such as water, gas and electricity.
- Repeated episodes of anti-social behaviour – either as a victim or perpetrator.
- Being unwilling to attend external appointments with professional staff whether social care, health or other organisations such as housing.
- Organisational abuse – this doesn’t have to involve physical violence; some forms the abuse might take can include:
– Inappropriate use of power or control.
– Inappropriate confinement, restraint or restriction.
– Lack of choice, for example in food, in decoration, in lighting and heating, and in other environmental aspects.
– Lack of personal clothing or possessions.
– No flexibility of schedule, particularly with bedtimes.
– Financial abuse.
– Physical or verbal abuse.
There are many situations in safeguarding that pose ethical dilemmas for adult mental health support workers, including the appropriate management of risk in self-harm. A person clearly stating that they plan to take their life within the next 24 hours, or has already taken action which puts their life in danger, is experiencing a crisis which may require breaching confidentiality in order to get the support that they need.
It is also a good idea to look for signs that a person who is being supported might be an abuser.
Where should mental health support workers go with an adult safeguarding concern?
If you encounter a safeguarding incident at any point, whether that is while providing care or when interacting with a vulnerable individual, you will need to take responsibility for the situation and provide immediate action to ensure the person in question is properly protected.
Some concerns may be minor in nature but provide an opportunity for early intervention, for example advice to prevent a problem from escalating. Other safeguarding concerns may be more serious and need a response through multi-agency procedures and possible statutory intervention through regulators, the criminal justice system or civil courts.
Immediate concerns about abuse or neglect should be dealt with under local safeguarding procedures first. The person who raises a safeguarding concern within their own organisation should follow their organisation’s policy and procedures. This concern may result from something that you have seen, been told or heard. You have a responsibility to formally inform and consult the designated safeguarding lead in that setting at the earliest opportunity. The designated safeguarding lead will normally be someone who has been given special responsibility and training in dealing with employees’ concerns.
The role includes:
- Making sure appropriate systems for raising concerns are in place and that all staff can access them.
- Making sure staff can see all concerns are taken seriously, even if they are later seen to be unfounded.
- Investigating concerns promptly and including a full and objective assessment.
- Taking action to deal with the concern, and record and monitor this action.
- Keeping the employee who raised the concern up to date with what is happening.
- Having processes in place to support employees raising concerns.
- Having a role in highlighting learning and may facilitate or be part of learning events.
In following local procedures for reporting incidents/risks you may be required to report the concern to the Safeguarding Adults Board (SAB), which is a multi-agency partnership comprising statutory, independent and charitable organisations. The board’s objective is to protect and promote individual human rights and independence and improve wellbeing, so that adults at risk stay safe and are protected at all times from abuse, neglect, discrimination or poor treatment.
In all cases you should make a written statement of the individual’s account, using their words, your observations and any actions taken. It is vital that abuse is reported, as it can stop further abuse and ensure that those involved receive support. Overall, it is your professional responsibility.
You don’t need to have all the facts to prove your concern, but you must have a reasonable belief that wrongdoing is either happening now, took place in the past, or is likely to happen in the future. Speaking up on behalf of people in your care is an everyday part of your role. Just as raising genuine concerns represents good practice, doing nothing and failing to report concerns is unacceptable.
If you witness or suspect that there is a risk of immediate harm to a person in your care, you must act straight away to protect their safety. You should report your concerns to the appropriate person or authority immediately; this may be the police in some situations. Involvement of the police is indicated in incidents of suspected theft and common assault, including sexual assault, and assault causing actual bodily harm. However, the police may also be involved in other safety incidents such as wilful neglect of a person lacking capacity. In all cases full notes should be taken of your decision, actions and reasons for them.
What legislation do mental health support workers have to follow in regard to adult safeguarding?
The Care Act 2014 sets out statutory responsibility for the integration of care and support between health and local authorities. NHS England and Clinical Commissioning Groups are working in partnership with local and neighbouring social care services. Local Authorities have statutory responsibility for safeguarding. In partnership with health they have a duty to promote wellbeing within local communities.
Safeguarding Vulnerable Groups Act 2006 and the Protection of Freedoms Bill – this Act was passed to help avoid harm, or risk of harm, by preventing people who are deemed unsuitable to work with children and vulnerable adults from gaining access to them through their work. Organisations with responsibility for providing services or personnel to vulnerable groups have a legal obligation to refer relevant information to the Disclosure and Barring Service (DBS).
The Equality Act 2010 – this Act aims to protect people or groups of people who have one or more “protected characteristics”. These protected characteristics are features of people’s lives upon which discrimination, in the UK, is now illegal.
The protected characteristics listed in the Act are:
- Age
- Disability
- Sexual orientation
- Sex
- Gender reassignment
- Marriage and civil partnership
- Pregnancy and maternity
- Race
- Religion and belief.
Under the Act:
- Every individual has the right to be treated equally and fairly and not be discriminated against regardless of any “protected characteristics”.
- Every individual has the right to be treated with respect and dignity.
- Health services have a duty to ensure that services are fair and meet the needs of everyone, regardless of their background or current circumstances.
Sexual Offences Act 2003 – this Act modernised the law by prohibiting any sexual activity between a care worker and a person with a mental disorder while the relationship of care continues. A relationship of care exists where one person has a mental disorder and another person provides care.
It applies to people working both on a paid and an unpaid basis and includes:
- Social workers
- Doctors
- Nurses
- Care workers in homes
- Workers providing services in clinics or hospitals
- Volunteers.
The Mental Capacity Act 2005 – in order to protect those who lack capacity and to enable them to take part as much as possible in decisions that affect them, the following statutory principles apply:
- You must always assume a person has capacity unless it is proved otherwise.
- You must take all practicable steps to enable people to make their own decisions.
- You must not assume incapacity simply because someone makes an unwise decision.
- Always act, or decide, for a person without capacity in their best interests.
- Carefully consider actions to ensure the least restrictive option is taken.
The Deprivation of Liberty Safeguards 2009 (DoLS), an amendment to the Mental Capacity Act 2005, provide a legal framework to protect those who lack the capacity to consent to the arrangements for their treatment or care, for example by reason of their dementia, learning disability or brain injury and where levels of restriction or restraint used in delivering that care for the purpose of protection from risk/harm are so extensive as to potentially be depriving the person of their liberty.
The Human Rights Act 1998 applies to anyone whose care or treatment is funded or provided by a public body. Section 6 requires all public authorities to act in ways that are compatible with human rights when making decisions.
The Public Interest Disclosure Act 1998 – this Act, often referred to as the Whistleblowers Act, encourages staff to report suspected wrongdoing and protects those that do against being dismissed or suffering a detriment by their employers. It also gives protection to employees against suffering a detriment or retaliation from another employee for reporting suspected wrongdoing.
The General Data Protection Regulations (GDPR) and the Data Protection Act 2018 introduced new elements to the data protection regime, superseding the Data Protection Act 1998. Mental health support workers must have due regard to the relevant data protection principles which allow them to share personal information. However, the GDPR and Data Protection Act 2018 do not prevent, or limit, the sharing of information for the purposes of keeping vulnerable adults safe.
Why is safeguarding training important?
It is important that we all understand safeguarding, and know what to do should safeguarding concerns arise.
Safeguarding induction and training is essential for all staff appropriate to their role, including:
- Information on types of harm, abuse and neglect.
- How to spot abuse.
- How to respond to concerns.
- Who to report concerns to.
Training should be directly applicable to the responsibilities and daily practices of the person being trained, and to the care and support needs of the adults that they are working with. An example of appropriate safeguarding training includes Safeguarding Vulnerable Adults (SOVA) Level 2, designed for people who are working with vulnerable adults and teaches the skills needed to safeguard people who are at higher risk of abuse. Safeguarding Vulnerable Adults (SOVA) Level 3 is designed for people who are wanting more in-depth knowledge into safeguarding vulnerable adults.
Managers should evaluate changes in understanding and confidence before and after training, assessing this:
- Immediately after the training.
- In regular long-term evaluations, for example as part of supervision sessions.
- Annually, for example as part of the performance management/appraisal process.
Other training that is recommended for adult mental health support workers to provide the skills and knowledge for effective safeguarding include, but are not limited to:
- Domestic Violence Awareness
- Substance Misuse Awareness
- Modern Slavery Awareness
- Adolescent Mental Health Awareness
- Mental Health Awareness
- Self-Harming Awareness
- Suicide Awareness
- Mental Capacity Act
Line managers should provide feedback through supervision and appraisals, acknowledging how adult mental health support workers have learned from their experience of identifying, reporting and managing safeguarding concerns.
How often should adult mental health support workers renew their safeguarding training?
Managers should assess an adult mental health support worker’s safeguarding knowledge annually, and run refresher training if needed. To help mental health support workers increase their confidence in managing adult safeguarding concerns, they should at a minimum refresh their safeguarding training at least every 2 years and participate in continuing professional development (CPD).
