Types of abuse
Safeguarding is everyone’s business. Your action will prevent abuse.
The information below outlines the different types of abuse and neglect. If you suspect an adult is being abused or neglected or you suspect something is wrong report it to us now.
Types of abuse and neglect
There are many forms of abuse and neglect, including the signs, symptoms and circumstances in which it may occur. The below is intended to illustrate what adult abuse and neglect can look like. It is not an exhaustive list but a guideline. If you suspect abuse you should report it to us now.
- Domestic violence
- Emotional or psychological
- Modern slavery
- Sexual abuse
- Physical abuse
Discriminatory abuse is often on the grounds of age, gender, race, culture, religion, sexuality or disability. This type of abuse and others can be perpetrated through grooming. This can be called 'mate crime' and occurs when vulnerable adults are 'befriended' with the intention to abuse.
Mencap launched the "Stand by Me" campaign to eradicate hate and mate crime.
The following may indicate discriminatory abuse:
- Being denied medical treatment on grounds of age or mental health
- Being made to move to a different resource/ service based on age
- Derogatory, offensive and racist comments and actions, graffiti, trolling etc.
- Harassment and bullying due to a personal attribute
- Not providing access
Domestic violence and abuse include 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. It also includes so called 'honour' based violence, female genital mutilation and forced marriage.
Coercive or controlling behaviour is a core part of domestic violence. Coercive behaviour can include:
- Acts of assault, threats, humiliation and intimidation
- Controlling everyday behaviour
- Exploitation of resources or money
- Harming, punishing, or frightening the person
- Isolating the person from sources of support
- Preventing the person from escaping abuse
The Safeguarding Adults Board will be involved when domestic abuse involves adults with care and support needs or has an impact on a person with care and support needs (for example when a disabled or older person is affected by domestic violence perpetrated against them or around them resulting in their harm).
Emotional or psychological abuse can include intimidation, humiliation, shouting, swearing, emotional blackmail and denial of basic human rights, as well as using racist language and preventing someone from enjoying activities or meeting friends.
The following may indicate emotional abuse:
- Ambivalence about carer
- Carer does not offer personal hygiene, medical care, regular food/drinks
- Change in appetite, unusual weight loss/gain
- Coercion, deference
- Confusion, agitation
- Distress caused by being locked in a home or car
- Fearfulness, avoiding eye contact, flinching on approach, inappropriate clothing
- Insomnia or need for excessive sleep
- Isolation - no visitors or phone calls allowed
- Lack of personal respect
- Possible violation of human and civil rights/lack of recognition of individuals rights
- Restricted access to hygiene facilities
- Sensory deprivation
- Tearfulness, low self esteem
- Unexplained paranoia
- Use of furniture to restrict movement
Financial or material abuse can take the form of fraud, theft or using the vulnerable adult's property without their permission. This could involve large sums of money or just small amounts from a pension or allowance each week.
The following could indicate financial abuse:
- Carer's main interest is financial with little regard for the health and welfare of the vulnerable adult
- Extraordinary interest by family members in the vulnerable adult’s assets
- Person lacks belongings that they can clearly afford
- Person’s relatives are not receptive to necessary expenditure
- Power of attorney is obtained when the person is unable to understand what they are signing
- Recent change of deeds to the house
- Sudden inability to pay bills
- Sudden withdrawal of money from an account
Modern slavery is the severe exploitation of other people for personal or commercial gain. Modern slavery is all around us, but often just out of sight. From the outside, it can look like a normal job but people are being controlled.
Types of modern slavery:
- Debt bondage - being forced to work to pay off debts that realistically they never will be able to
- Domestic servitude
- Forced labour
- Human trafficking
- Sexual exploitation, such as escort work, prostitution and pornography
The following may indicate modern slavery:
- Always wearing the same clothes
- Appearing to be malnourished, unkempt or withdrawn
- Avoidance of eye contact, appearing frightened or hesitant to talk to strangers
- Fear of law enforcers
- Impingement on human rights, removal of personal ID, passport etc. and substantial control of one person by another
- Isolation from the community, seeming under the control or influence of others
- Lack of personal effects or identification documents
- Living in dirty, cramped or overcrowded accommodation and or living and working at the same address
- Signs of physical or emotional abuse
The Home Office provides information on identifying and reporting modern slavery.
A person can suffer because their physical and/or psychological needs are being neglected by a carer. This could include failure to keep them warm, clean and well-nourished or neglecting to give prescribed medication.
The following may indicate neglect:
- Failure to give prescribed medication properly
- Failure to provide appropriate privacy and dignity
- Inadequate heating and lighting
- Inconsistent or reluctant contact with health and social care agencies
- Isolation - denying access to callers or visitors.
- Person’s clothing is ill fitting, unclean and in poor condition
- Poor environmental conditions
- Poor physical condition of the vulnerable adult
Sexual abuse is the involvement of vulnerable adults in sexual activities, which:
- They do not fully comprehend
- They cannot give consent to
- They object to, or
- May cause them harm
The following list may indicate sexual abuse. They must be viewed in the context of the situation, taking account of other factors. Often more than one indicator may be apparent. There may be other causes for the indicators listed below but a combination of several factors is often found in sexual abuse cases:
- An adult discloses that they have been sexually abused or raped, or subjected to sexual assault or sexual harassment
- Difficulty in walking
- Disturbed sleep pattern/poor concentration
- Frequent infection, incontinence
- Love bites, bruising to upper thighs and arms
- Overt sexual behaviour/language by the vulnerable adult
- Pain or itching, bruising or bleeding in the genital area
- Personal items going missing, unreasonable or inappropriate gifts
- Pregnancy in a person unable to consent
- Purchase of items that the individual does not require or use
- Reluctance to accept care services
- Self-inflicted injury and self-harm
- Severe upset or agitation when being bathed
- Sexual exploitation, such as escort work, prostitution and pornography
- Sexually transmitted disease/urinary tract/vaginal infection
- Sudden change in behaviour; sudden onset of confusion, or withdrawal
- The person managing the finances is evasive and uncooperative
- Torn, stained underwear
Physical injuries can occur through abuse. There may be no satisfactory explanation, definite knowledge, or a reasonable suspicion that injury was inflicted with intent, caused by lack of care by the person having custody, charge or care of that person.
The following could indicate physical abuse:
- Bruising in different stages of healing
- History of unexplained falls
- Injury shape similar to an object
- Over and under medication
- Slap, kick, punch or finger marks
- Unexplained bruising in well protected areas or soft parts of the body
- Unexplained burns - unusual location / type
- Unexplained fractures to any part of the body
- Unexplained lacerations or abrasions
- Untreated medical problems
- Weight loss due to malnutrition or dehydration
Organisational abuse may include neglect and poor care practice within an institution or specific care setting such as a hospital or care home, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment, including acts of omission leading to harm.
It can be through neglect or poor individual professional practice or as a result of the structure, policies, processes and practices within an organisation or lack of effective joined working.
The following may indicate organisational abuse:
- 'Batch care' - lack of individual care programmes
- Deprived environmental conditions and lack of stimulation
- Illegal confinement or restrictions
- Inappropriate care of possessions, clothing and living area
- Inappropriate physical intervention
- Inappropriate use of medical procedures for example enemas, catheterisation
- Inappropriate use of power or control
- Inflexible services based, on convenience of the provider rather than the person receiving services
- Lack of personal clothes and belongings
- No flexibility in bedtime routine and/or deliberate waking
- People left on the commode or toilet for long periods of time
- People referred to, or spoken to with disrespect
- Service user removed from the home or establishment, without discussion with other appropriate people or agencies, because staff are unable to manage the behaviours
- Un-homely or stark living environments
Self-neglect is when you neglect your own health, hygiene and surroundings. It is any failure of an adult to take care of himself/herself that causes or is reasonably likely to cause serious physical, mental or emotional harm or substantial damage to themselves or loss of assets.
Types of self-neglect
- Failure to seek help or access services to meet health and social care needs
- Inability or unwillingness to manage one's personal affairs
- Inability to avoid self-harm
- Lack of self-care to an extent that it threatens personal health and safety
- Neglecting to care for one’s personal hygiene, health or surroundings
The following may indicate self-neglect:
- Collecting a large number of animals in inappropriate conditions
- Inability or unwillingness to take medication or treat illness or injury
- Lack of essential food, clothing or shelter
- Living in squalid or unsanitary conditions
- Malnutrition and/or dehydration
- Neglecting household maintenance
- Non-compliance with health or care services
- Unkempt appearance
- Very poor personal hygiene
Our Community Adult Multi-Agency Risk Assessment Panel (CMARAP) considers cases of adults who remain at high risk of harm despite the best efforts of professionals or other networks to intervene.