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Lewisham Safeguarding Adults Board

Adult Safeguarding and Domestic Abuse

Adult safeguarding and domestic abuse – a guide to support practitioners and managers

Carers can perpetrate domestic abuse towards people they care for. Sometimes domestic abuse referrals are judged to be a result of carer stress – in these situations adult social care has a duty to assess the needs of the adult and the carer. The situation may benefit from the provision of extra support by social services and may not require domestic abuse action.

An ADASS report (2011) draws a distinction between intentional harm and unintentional harm. It says that some actions by carers or their impacts may be unintentional and arise from lack of coping skills or unmet needs. Others may be intentional. The report proposes that the issue is always one of impact on the individual affected by the carer’s actions or lack of action. The outcomes of intervention should be person centred and not process driven. Careful assessment of the impact of abuse, and the risks of further abuse; risk enablement; consistency and competence in safeguarding functions; and in working with carers, are all considered essential skills to assess whether harm is intentional or unintentional.

Where abuse is intentional, the crime of wilful neglect covers the deliberate neglect by a carer of a mentally incapacitated adult. The Domestic Violence Crime and Victims Act (2004) includes the crime of causing or allowing the death of a child or vulnerable adult, and this may be relevant to carers who do not ensure that a person in their household gets help to prevent serious harm. Perpetrators of domestic abuse towards people with care and support needs may have the same motivations for control as in other domestic abuse situations. Effective interventions with them to stop their abusive behaviour will therefore be the same as those described above.

London: ADASS suggests that the risk of harmful behaviour, whether intended or not, tends to be greater where the carer’s well-being is at risk because they:

  • Have unmet or unrecognised needs of their own
  • Are themselves vulnerable
  • Have little insight or understanding of the person’s care and support needs
  • Have unwillingly had to change lifestyle
  • Are not receiving practical and/or emotional support from other family members
  • Are feeling emotionally and socially isolated, undervalued or stigmatised
  • Have other responsibilities such as family or work
  • Have no personal or private space outside the caring environment
  • Have frequently requested help but problems have not been solved
  • Are being abused by the person they are caring for
  • Feel unappreciated by the person they are caring for or that they are being exploited by relatives or services.

Potential indicators of situations where abuse of carers is more likely include situations where relationships are unsatisfactory, communication is difficult, and the person being cared for:

  • Has health and care needs that exceed the carer’s ability to meet them (especially where of some duration)
  • Does not consider the needs of the carer or family members
  • Treats the carer with a lack of respect or courtesy
  • Rejects help and support from outside (including breaks)
  • Refuses to be left alone by day or by night
  • Has control over financial resources, property and living arrangements engages in abusive, aggressive or frightening behaviours
  • Has a history of substance misuse, unusual or offensive behaviours
  • Does not understand their actions and their impact on the carer
  • Is angry about their situation and seeks to punish others for it
  • Has sought help or support but did not meet thresholds for this
  • The caring situation is compounded by the impact of the nature and extent of emotional and/or social isolation of the carer or supported person

In general, families and carers make an invaluable contribution to society and the support of carers is integral to the Care Act (2014). However, practitioners should be aware of and vigilant against the potential of ‘the rule of optimism’, when professionals may place undue confidence in the capacity of families to care effectively and safely, affecting professional perceptions and recognition of risk of harm, abuse or neglect.

This may arise from:

  • Generalised assumptions about ‘carers’
  • Uncritical efforts to see the best
  • Concerns about consequences of intervention
  • Minimising concerns
  • Not seeing emerging patterns
  • Not ensuring a consistent focus on the person at risk

If the ‘rule of optimism’ prevails, situations where there is harmful intent on the part of the carer or where unintentional harm is having a serious impact on the person’s well-being may not be recognised. Agencies that could protect the victim may then not be involved and serious harm can result. Such cases are the exception, but they exist, and have been identified through Serious Case Reviews. If deliberate or reckless acts of harm, or acts of omission leading to neglect, are suspected, safeguarding procedures and police referral must always follow.

Resources for identifying the risk victims face

When someone is suffering domestic abuse, it’s vital to make an accurate and fast assessment of the danger they're in, so they can get the right help as quickly as possible.

Here you can access resources to assist you www.caada.org.uk

New Domestic Homicide Review (DHR) Case Analysis Report

A new case analysis report has been published by Standing Together Against Domestic Violence (STADV).

Nicole Jacobs the CEO of STADV states in her opening statement:

“The sisters, mothers, daughters, sons and brothers who have been murdered at the hands of their current/former partners or family members are at the heart of this report. It is in their memory that we feel compelled to learn as much as we can from their tragic experience….

This report is our contribution to fully highlight the learning from Domestic Homicide Reviews as most of us recognise the need for national, regional and local work required to embed a true coordinated community response (CCR) to domestic abuse.

Broadly, much of these findings fall into two categories. There are findings which could be characterised as implementation gaps. They are failures or missed opportunities where we understand the best practice but fail to implement it. In other areas such as mental health, adult child to family abuse, adult safeguarding practice and issues such as support for carers, more work is required to establish better, safer and more appropriate ways of working. And much of these findings are underpinned by a lack of fundamental understanding of coercive control, a lack of focus on the perpetrator and the need for more professional curiosity in thinking beyond basic policy and procedure…..”

New Guidance from Department of Health - Responding to Domestic Abuse

This new resource looks at how health professionals can support adults and young people over 16 who are experiencing domestic abuse, and dependent children in their households.

It will help health staff to identify potential victims, initiate sensitive routine enquiry and respond effectively to disclosures of abuse.

Commissioners will gain insight into services to support people experiencing domestic violence and abuse, and the importance of joined-up local strategic planning.

The resource draws on the National Institute for Health and Care Excellence multi-agency guidelines on domestic violence and abuse.

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