The main categories of abuse

Domestic abuse

Women's Aid defines domestic abuse as 'physical, sexual, psychological, or financial violence that takes place within an intimate or family-type relationship and forms a pattern of cohesive and controlling behaviour.  This can include forced marriage and so-called 'honour crimes', domestic violence and abuse may include a range of abusive behaviours that may not include physical violence.

Domestic violence and abuse should only need to be addressed under Safeguarding procedures and guidance if;
  • The person has care and support needs and as a result of these needs is unable to protect himself or herself from abuse;
  • and where it is likely to be best for the person involved, taking into account their wishes.

The main categories of abuse

Below are the main types of abuse. It is important not to jump to the wrong conclusion; the following may be indicators of many different problems.

Physical abuse

This is non-accidental harm to the body.  It can include hitting, pushing, punching, kicking, pulling hair, rough handling, spitting, misuse of medication or inappropriate use of restraint.

Physical abuse can present as:
  • Cuts, lacerations, puncture wounds, open wounds, bruises, welts, discolouration, black eyes, burns, bone fractures, broken bones, and skull fractures
  • Untreated injuries in various stages of recovery, or not properly treated
  • Poor skin condition or poor skin hygiene
  • Dehydration and/or malnourishment without illness-related cause
  • Loss of weight
  • Soiled clothing or bed
  • Broken eyeglasses/frames, physical signs of being subjected to punishment, or signs or being restrained
  • Inappropriate use of medication: over dosing or under dosing
  • A person telling you that they have been hit, slapped kicked or mistreated.

Sexual abuse includes rape or attempted rape, sexual assault or sexual acts to which the adult at risk has not consented, could not consent or was pressured into consenting.  Sexual abuse also includes acts of sexual harassment or non-contact abuse such as pornography.

Signs of sexual abuse include:
  • Change in behaviour
  • Fear, withdrawal, depression, flinching from physical contact
  • Difficulty in walking/sitting
  • Injuries or bruising to genital and intimate areas
  • Pregnancy in a person unable to consent

Psychological and emotional abuse

This can include threats of harm or abandonment, intimidation, deprivation of contact or cultural needs, humiliation, blame or verbal. Signs of psychological abuse include:
  • Withdrawal, depression
  • Cowering and fearfulness
  • Change in sleep patterns
  • Agitation
  • Confusion
  • Change in behaviour
  • Change in appetite/weight

Financial or Material Abuse

Finance or material abuse includes property theft, fraud, exploitation, internet-scamming, pressure in connection with wills, property, inheritance or financial transactions; or the misuse or misappropriation of property, possessions or benefits.

Modern slavery

Modern slavery encompasses; slavery, human trafficking, forced labour and domestic servitude. 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.

Radicalisation is defined as the process by which an individual comes to support any form of extremism or terrorism.  It has the potential to cause significant harm to the individuals and to others and is therefore aligned to safeguarding principles.

PREVENT is part of the UK's counter termism strategy, aimed at reducing the risk of people (including patients and/or staff) becoming involved and know who to discuss our concerns with.  Familiarise yourself with your organisations policy and procedure on escalating a concern.

Discriminatory abuse

Discriminatory and oppressive attitudes towards race, gender, cultural background, religion, physical and/or sensory impairment, sexual orientation and age.
Signs of discriminatory behaviour include;
  • Low self-esteem
  • Withdrawal
  • Depression
  • Fear or anger

Mate crime and hate crime

Hate crime can be defined as, "any hate incident, which constitutes a criminal offence, perceived by the victim or any other person, as being motivated by prejudice or hate". Adults may, therefore, be victims of mate/hate crime due to age, disability, gender, gender identity, sexual orientation, socio-economics, race/ethnicity, religion/beliefs or lifestyle choice.

Mate crime is usually used to refer to abuse of an adult with care and support needs where the victim is being abused or exploited by one or more people who the victim wanted to be their friend, particularly in situations where the victim was otherwise isolated and lonely.

Organisational abuse

Organisational abuse of people with care needs can occur in any service provided to people with care needs, including;
  • Home-based or domiciliary care services
  • Care Homes
  • Hospital or other inpatient settings
  • any primary, community or secondary health services
  • Social or supported housing
  • Any universal public service(e.g. Police)
  • Organisational abuse can involve 
  • abuse where there is a culture of abusive behaviour, tolerance of abusive behaviour, repeated failure to prevent abuse or neglect within a service; including incorrect use of restraint, isolation or unauthorised deprivations of liberty.
  • Repeated lower level or initially unsubstantiated concerns about a service may indicate possible organisational abuse or neglect.
  • Safeguarding concerns within a service relating solely to the behaviour of an individual staff member would not on their own usually be seen as organisational abuse but where there are wider concerns about the culture, practice or supervision within an organisation this can indicate organisational abuse.

Neglect and acts of omission

Including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational needs or services, inadequate nutrition or heating, failure to protect privacy or dignity, poor environmental conditions.

Self-neglect

Self-neglect is now a category of abuse under the Care Act Statutory Guidance 2014. The Care Act includes duties on health and care services and service commissioners to promote well-being.  There are many types of self-neglect and many factors that can contribute to people neglecting themselves and putting themselves at risk. People who neglect themselves can often be at risk of other forms of abuse and exploitation.

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