Guidance Three - Defining vulnerable adults and abuse

page updated: 01/05/2010  

Introduction

This Nottingham and Nottinghamshire multi agency Policy, Procedure and Guidance, whilst working towards a preventive strategy, acknowledges that abuse may take place as a result of:

• A direct act by one or more individuals;
• A failure to act or provide proper care;
• Preventing others from providing proper care;
• Failure to refer alerts/disclosures/suspicions.  

Vulnerable Adult

A ‘Vulnerable Adult’ as defined by No Secrets (DH 2000) is:

‘A person aged 18 years or over who is or maybe in need of community care services by reason of mental or other disability, age or illness;

AND

Who is or maybe unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation.’Significant harm refers to: ‘ill treatment (including sexual abuse and forms of ill treatment that are not physical); the impairment of or an avoidable deterioration in physical or mental health; and the impairment of physical, emotional, social or behavioural development.’ ("Who decides?" Law Commission 1997).

It should also be noted that when the death of a vulnerable adult is caused by suspected abuse or neglect, this multi agency policy, procedure and guidance should still be considered along with any other actions that may be necessary.

The term adult abuse is subject to wide interpretation. ‘No Secrets’ provides the following definition as a starting point: Abuse is a violation of an individual’s human and civil rights by any other person or persons.

For the purposes of this document community care services are taken to include all care services provided in any setting or context. The term describes care in its widest sense.

Those in need of community care services may include:

- People with a Learning Disability

- People with a Physical Disability

- People with Mental Ill Health

- People who are Profoundly Deaf

- People who are Visually Impaired

- People who are Deaf/Blind

- People over 65

- People with HIV/AIDS

Carers of people in need of community care services may also be vulnerable adults and subject to abuse from the people they care for. (Note: the term ‘carer’ does not include those paid to provide care or acting as volunteers).

Of course not all individuals from these groups would see themselves, or be seen by others, as ‘vulnerable adults’. And, an individual may be both a vulnerable adult and a carer. Assessment of the environment and context should be taken into account when determining if an individual is vulnerable, as well as the person’s capacity.

Others Factors for Consideration

Safeguarding Children

The safety of others should also be considered. If a child or young person is thought to be at risk or you have concerns, you should contact the relevant Children’s Duty Team for where the child lives.

Where the allegation relates to historical abuse that happened when the vulnerable adult was a child, it should also be dealt with under Child Protection Procedures in the same way as a contemporary concern and a referral should be made to Children’s Social Care.

Domestic Violence

At times, there is a clear interface between domestic violence and safeguarding adults. If a vulnerable adult is subject to domestic violence then this Policy and Procedure should be followed. If the alleged victim is not a ‘vulnerable adult’ as described in this document, you should follow your own agencies policy and procedures relating to Domestic Violence.

Violence to Staff

Consideration should be given to staff safety when carrying out an investigation as part of the Safeguarding Assessment. The relevant organisations’ Violence to Staff policy and procedure should be followed where it is felt this may be a concern. This should also be followed where there is an allegation of abuse towards a member of staff.

Supporting People Services

At times, there is a clear interface between adults receiving a Supporting People Service and Safeguarding Adults. If abuse is alleged or suspected in relation to a Supporting People service user then this Policy and Procedure should be followed and a referral made to Adult Social Care and Health. Alongside this referral, the provider should consider any other action, as outlined in this guidance, to ensure the service user is safe. The Adult Social Care Team will decide what actions are required in relation to Safeguarding Adults and other interventions as appropriate. If Adult Social Care does not consider a Safeguarding Adults Assessment is required, the Supporting People service provider will need to consider whether any further support, advice and information is required or available to the individual.

Individuals should not be left without advice and guidance if they are or may be in need of safeguarding regardless of whether they are perceived as vulnerable or not. Every effort should be made to refer to appropriate support services e.g. the police, legal assistance, advice services.

Adult abuse is a social problem, but it is often also a serious crime e.g. rape, theft, assault. The term "abuse" should not be allowed to mask the reality and naming of a crime.

 Types of Abuse

There are many different kinds of abuse and, whilst short comprehensive definitions are difficult, the important features are outlined here, taken from No Secrets and recommended in the interests of achieving a "common language" when discussing abuse:

Physical abuse including; hitting, slapping, pushing, kicking, misuse of medication, restraint, or inappropriate sanctions.

Sexual abuse including; rape and sexual assault or sexual acts to which the vulnerable adult has not consented, or is incapable of giving informed consent or was pressured into consenting; this may involve contact or non-contact abuse (e.g. touch, masturbation, being photographed, teasing, inappropriate touching).

Psychological abuse including; emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks.

Financial or material abuse including; theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or the 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, the withholding of the necessities of life, such as medication, adequate nutrition and heating.

Discriminatory abuse including; racist, sexist, that based on a person’s disability, culture and discrimination and other forms of harassment, slurs or similar treatment.

Abusive activity may be of an organised kind – the work of a number of people victimising others.

Institutional abuse where neglect and poor professional practice in care settings also need to be taken into account. It may take the form of isolated incidents of poor practice at one end of the spectrum, through to pervasive ill treatment or gross misconduct at the other. It can occur when the routines, systems, communications and norms of an institution compel individuals to sacrifice their preferred life style and cultural diversity to the needs of that institution. Repeated instances of poor care may be an indication of more serious problems.

In reality, abusive situations are rarely as tidily or straightforwardly described as these categories suggest, so remember to listen carefully when being told something and where there is any doubt about defining a situation of adult abuse, discuss it with your Line Manager.

Self Harm and Neglect

The remit of the Nottingham(shire) Safeguarding Adults Policy does not include self-harm. However, it is acknowledged that this is a serious challenge to all care providers and should be addressed by organisations’ own internal procedures.

What is Self Harm?

The National Institute for Clinical Excellence’s (NICE) clinical Guideline on Self Harm (2004) states that;

"People who have self-harmed should be treated with the same care, respect and privacy as any patient. In addition, professionals should take full account of the likely distress associated with self-harm".

Self-harm, as defined in the NICE guideline, is:

"An expression of personal distress, usually made in private, by an individual who hurts him or herself. The nature and meaning of self-harm however, vary greatly from person to person. In addition, the reason a person harms him or herself may be different on each occasion, and should not be presumed to be the same.

People who harm themselves may feel that they are alone, but self-harm is more common than many people realise. The methods of self-harm can be divided into two broad groups: self-injury and self-poisoning. The most common method of self-injury is by cutting oneself. Less common methods include swallowing objects, putting objects inside the body, burning, hanging, stabbing, shooting and jumping from heights or in front of vehicles.

Self-poisoning involves overdosing with a medicine or medicines, or swallowing a poisonous substance. The majority of people who attend emergency departments after self-poisoning have taken over-the-counter medication. Other people take medicines that have been prescribed by their doctor. A small number of people take a large amount of an illegal drug or poison themselves with another substance. Alcohol may also play a part.

Self-injury is more common than self-poisoning as an act of self-harm, although people who self-poison are more likely to seek professional help. During acts of self-harm, it is common for people to feel separate or disconnected from their feelings and their pain".

What is self-neglect?

Self-neglect is any failure of an adult to take care of himself or herself that causes, or is reasonably likely to cause within a short period of time, serious physical, mental or emotional harm or substantial damage to or loss of assets.

Self-neglect can happen as a result of an individual's choice of lifestyle, or the person may:

• be depressed;
• have poor health;
• have cognitive (memory or decision making) problems, or;
• be physically unable to care for self.

  Self-neglect includes:

  • Living in unsanitary conditions;
  • Suffering from an untreated illness, disease or injury;
  • Suffering from malnutrition to such an extent that, without an intervention, the adult's physical or mental health is likely to be severely impaired;
  • Creating a hazardous situation that will likely cause serious physical harm to the adult or others or cause substantial damage to or loss of assets, and;
  • Suffering from an illness, disease or injury that results in the adult dealing with his or her assets in a manner that is likely to cause substantial damage to or loss of the assets.

If you suspect that someone in your care is self-harming you should follow your own procedures relating to self harm and neglect.

There are a number of documents available from NICE, for use by staff and information for the public. These can be ordered or downloaded at www.nice.org.uk or by telephoning 0870 1555 455.