Forms and Signs of Abuse
Forms and Signs of Abuse
People with care and support needs, such as older people or people living with a disability, are more likely to be abused or neglected. They may be seen as an easy target and may be less likely to identify abuse themselves or to report it. People with communication difficulties can be particularly at risk because they may not be able to alert others. Sometimes people may not even be aware that they are being abused, and this is especially likely if they have a cognitive impairment. Abusers may try to prevent access to the person they abuse.
Whilst these particular adults are the specific focus of ‘Safeguarding Adults’ policy and procedures, this does not negate the public duty of those carrying out this work to protect the human rights of all citizens, including those who are the subject of concern but are not covered by these procedures, or those who are not the subject of the initial concern.
Such work is the responsibility of all agencies and cannot exist in isolation. It must be effectively linked to other initiatives, as part of a network of measures aimed at enabling all citizens to live lives that are free from violence, harassment, humiliation and degradation.
Types of abuse:
- Discriminatory abuse
- Domestic abuse (Including Coercive and Controlling Behaviour)
- Financial or material abuse
- Modern slavery
- Neglect or acts of omission
- Organisational or institutional abuse
- Physical abuse
- Psychological or emotional abuse
- Sexual abuse
- Sexual exploitation
Signs of abuse
Signs of abuse can often be difficult to detect. The information below aims to help people who come into contact with people with care and support needs to identify abuse and recognise possible indicators. Many types of abuse are also criminal offences and should be treated as such.
Evidence of any one indicator from the following lists should not be taken on its own as proof that abuse is occurring. However, it should alert professionals to make further assessments and to consider other associated factors. The lists of possible indicators and examples of behaviour are not exhaustive and people may be subject to a number of abuse types at the same time.
Types of discriminatory abuse
- Unequal treatment based on age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex or sexual orientation (known as ‘protected characteristics’ under the Equality Act 2010)
- Verbal abuse, derogatory remarks or inappropriate use of language related to a protected characteristic
- Denying access to communication aids, not allowing access to an interpreter, signer or lip-reader
- Harassment or deliberate exclusion on the grounds of a protected characteristic
- Denying basic rights to healthcare, education, employment and criminal justice relating to a protected characteristic
- Substandard service provision relating to a protected characteristic
Possible indicators of discriminatory abuse
- The person appears withdrawn and isolated
- Expressions of anger, frustration, fear or anxiety
- The support on offer does not take account of the person’s individual needs in terms of a protected characteristic
Hate crime is the targeting of individuals, groups and communities because of who they are.
It is any incident which is a criminal offence and which is thought, by you or someone else, to be motivated by a hostility or prejudice based on race, ethnicity, religious beliefs, gender, gender identity, disability, age, sexual orientation or any other actual or seeming difference.
This can include:
- Threats, bullying or intimidation
- Threatening or offensive mail, texts or emails
- Verbal abuse
- Damage to property
- Physical assaults
It is important to report all hate incidents, even if you think nothing can be done as it helps the police and other agencies identify areas of concern, patterns of behaviour and what is happening in our communities. Hate crimes are not only crimes against the targeted victim, but also against a particular group as a whole. Firm action will be taken against people who commit any acts of hatred.
We know that some victims may not wish to be identified, so we encourage victims to report crime anonymously to a third party reporting site to ensure that the police can do all they can to tackle hate crime in the community.
The police and the council will:
- Investigate all reported incidents of hate crime
- Take legal action if there is sufficient evidence to enable us to do this
- Keep in contact with you and let you know of our progress
- Support you during this process
Some organisations can offer support to help you decide if you want to make an official report or complaint. If you do, this will be forwarded to the police and the council to note or take action and for monitoring the numbers of incidents reported.
Below is a list of groups and local venues where you can make an anonymous report of hate crime.
Afghanistan and Central Asian Association
Room 68b, the Albany, Deptford SE8 4AG
020 8469 0723
African Advocacy Foundation
76 Elmer Rd, London SE6 2ER
020 8698 4473
Catford and Bromley Synagogue
6 Crantock Road, London, SE6 2QT
020 8698 9496
Citizens Advice Lewisham
Leemore Community Information Hub
Bonfield Road, Lewisham SE13 5EU
0800 231 5453
Goldsmiths Students’ Union
Dixon Rd, London SE14 6NW
020 7717 2511
Goldsmiths, University of London
8 Lewisham Way, New Cross, London SE14 6NW
020 7919 7050
9 Holbeach Road, Catford, SE6 4TW
020 8314 7237
Lewisham Irish Community Centre
2A Davenport Road, Catford SE6 2AZ
020 8695 6264 email@example.com
Lewisham Islamic Centre
363–365 Lewisham High Street, Lewisham SE13 6NZ
020 8690 5090
199-201 Lewisham High St, London SE13 6LG
020 8314 8430
Lewisham Refugee and Migrant Network
341 Evelyn Street, SE8 5QX
020 8694 0323
Lewisham and Southwark College
Lewisham Way, London SE4 1UT
020 3757 3340
Lewisham Speaking Up
Deptford Albany, Douglas Way, SE8 4AG
020 8692 1862
1st Floor Equitable House, 7 General, Gordon Square, Woolwich SE18 6FH
020 8305 5000
Second Wave Youth Arts
1 Creek Rd, London SE8 3BT
020 8694 2444
More information on Hate Crime can be found on the Lewisham Council Website
Types of domestic abuse
Domestic abuse can be characterised by any of the indicators of abuse relating to:
- Financial or economic
Domestic abuse includes 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. (This definition will change once the Domestic Abuse Act 2021 comes into force).
Possible indicators of domestic abuse
- Low self-esteem
- Feeling that the abuse is their fault when it is not
- Physical evidence of violence such as bruising, cuts, broken bones
- Verbal abuse and humiliation in front of others
- Fear of outside intervention
- Damage to home or property
- Isolation – not seeing friends and family
- Limited access to money
Coercive or controlling behaviour is a core part of domestic violence
A pattern of controlling or coercive behaviour can be well established before a single incident is ever reported to support services. In many cases the conduct of the perpetrator might seem innocent - especially if considered in isolation of other incidents - and the victim may not be aware of, or be ready to acknowledge, abusive behaviour.
"In many relationships, there are occasions when one person makes a decision on behalf of another, or when one partner takes control of a situation and the other has to compromise. The difference in an abusive relationship is that decisions by a dominant partner can become rules that, when broken, lead to consequences for the victim."
Building on examples provided within the Statutory Guidance, relevant behaviours to be aware of can include:
- Isolating a person from their friends and family
- Depriving them of their basic needs
- Monitoring their time
- Monitoring a person via online communication tools or using spyware
- Taking control over aspects of their everyday life, such as where they can go, who they can see, what to wear and when they can sleep
- Depriving them access to support services, such as specialist support or medical services
- Repeatedly putting them down such as telling them they are worthless
- Enforcing rules and activity which humiliate, degrade or dehumanise the victim
- Forcing the victim to take part in criminal activity such as shoplifting, neglect or abuse of children to encourage self-blame and prevent disclosure to authorities
- Financial abuse including control of finances, such as only allowing a person a punitive allowance
- Control ability to go to school or place of study
- Taking wages, benefits or allowances
- Threats to hurt or kill
- Threats to harm a child
- Threats to reveal or publish private information (e.g. threatening to 'out' someone)
- Threats to hurt or physically harming a family pet
- Criminal damage (such as destruction of household goods)
- Preventing a person from having access to transport or from working
- Preventing a person from being able to attend school, college or University
- Family 'dishonour'
- Reputational damage
- Disclosure of sexual orientation
- Disclosure of HIV status or other medical condition without consent
- Limiting access to family, friends and finances
This is not an exhaustive list and you should be aware that a perpetrator will often tailor the conduct to the victim, and that this conduct can vary to a high degree from one person to the next.
See our Adult Safeguarding Pathway for Coercive Control Resources
Economic abuse involves behaviours that interfere with an individual’s ability to acquire, use and maintain economic resources such as money, transportation and utilities. It can be controlling or coercive. It can make the individual economically dependent on the abuser, thereby limiting their ability to escape and access safety.
Examples of economic abuse
Examples of economic abuse include:
- Having sole control of the family income
- Preventing a victim from claiming welfare benefits
- Interfering with a victim’s education, training, or employment
- Not allowing or controlling a victim’s access to mobile phone/transport/utilities/food
- damage to a victim’s property
Indicators of Economic Abuse
There are some common warning signs to look out for in victims of economic abuse.
- A person often not having enough money
- There being a conflict with joint finances, such as one person controlling a couple’s money;
- Shopping habits including always using cash or not being able to buy something without a partner’s permission.
- Changes in someone’s working life, such as leaving a job they enjoyed
- If they suddenly stop socialising and seeing friends
- Their appearance changes, or they become overly anxious
Financial or material abuse
Types of financial or material abuse
- Theft of money or possessions
- Fraud, scamming Age UK Avoiding Scams Guide
- Preventing a person from accessing their own money, benefits or assets
- Employees taking a loan from a person using the service
- Undue pressure, duress, threat or undue influence put on the person in connection with loans, wills, property, inheritance or financial transactions
- Arranging less care than is needed to save money to maximise inheritance
- Denying assistance to manage/monitor financial affairs
- Denying assistance to access benefits
- Misuse of personal allowance in a care home
- Misuse of benefits or direct payments in a family home
- Someone moving into a person’s home and living rent free without agreement or under duress
- False representation, using another person's bank account, cards or documents
- Exploitation of a person’s money or assets, e.g. unauthorised use of a car
- Misuse of a power of attorney, deputy, appointeeship or other legal authority
- Rogue trading – eg. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship
Possible indicators of financial or material abuse
- Missing personal possessions
- Unexplained lack of money or inability to maintain lifestyle
- Unexplained withdrawal of funds from accounts
- Power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity
- Failure to register an LPA after the person has ceased to have mental capacity to manage their finances, so that it appears that they are continuing to do so
- The person allocated to manage financial affairs is evasive or uncooperative
- The family or others show unusual interest in the assets of the person
- Signs of financial hardship in cases where the person’s financial affairs are being managed by a court appointed deputy, attorney or LPA
- Recent changes in deeds or title to property
- Rent arrears and eviction notices
- A lack of clear financial accounts held by a care home or service
- Failure to provide receipts for shopping or other financial transactions carried out on behalf of the person
- Disparity between the person’s living conditions and their financial resources, e.g. insufficient food in the house
- Unnecessary property repairs
Types of modern slavery
- Human trafficking
- Forced labour
- Domestic servitude
- Sexual exploitation, such as escort work, prostitution and pornography
- Debt bondage – being forced to work to pay off debts that realistically they never will be able to
Possible indicators of modern slavery
- Signs of physical or emotional abuse
- Appearing to be malnourished, unkempt or withdrawn
- Isolation from the community, seeming under the control or influence of others
- Living in dirty, cramped or overcrowded accommodation and or living and working at the same address
- Lack of personal effects or identification documents
- Always wearing the same clothes
- Avoidance of eye contact, appearing frightened or hesitant to talk to strangers
- Fear of law enforcers
Further Home Office information on identifying and reporting modern slavery
London Directory of Services
The Human Trafficking Foundation has created a Directory of Survivor Support Services in London, which is constantly updated.
Neglect and Acts of Omission
Types of neglect and acts of omission
- Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care
- Providing care in a way that the person dislikes
- Failure to administer medication as prescribed
- Refusal of access to visitors
- Not taking account of individuals’ cultural, religious or ethnic needs
- Not taking account of educational, social and recreational needs
- Ignoring or isolating the person
- Preventing the person from making their own decisions
- Preventing access to glasses, hearing aids, dentures, etc.
- Failure to ensure privacy and dignity
Possible indicators of neglect and acts of omission
- Poor environment – dirty or unhygienic
- Poor physical condition and/or personal hygiene
- Pressure sores or ulcers
- Malnutrition or unexplained weight loss
- Untreated injuries and medical problems
- Inconsistent or reluctant contact with medical and social care organisations
- Accumulation of untaken medication
- Uncharacteristic failure to engage in social interaction
- Inappropriate or inadequate clothing
Organisational or institutional abuse
Types of organisational or institutional abuse
- Discouraging visits or the involvement of relatives or friends
- Run-down or overcrowded establishment
- Authoritarian management or rigid regimes
- Lack of leadership and supervision
- Insufficient staff or high turnover resulting in poor quality care
- Abusive and disrespectful attitudes towards people using the service
- Inappropriate use of restraints
- Lack of respect for dignity and privacy
- Failure to manage residents with abusive behaviour
- Not providing adequate food and drink, or assistance with eating
- Not offering choice or promoting independence
- Misuse of medication
- Failure to provide care with dentures, spectacles or hearing aids
- Not taking account of individuals’ cultural, religious or ethnic needs
- Failure to respond to abuse appropriately
- Interference with personal correspondence or communication
- Failure to respond to complaints
Possible indicators of organisational or institutional abuse
- Lack of flexibility and choice for people using the service
- Inadequate staffing levels
- People being hungry or dehydrated
- Poor standards of care
- Lack of personal clothing and possessions and communal use of personal items
- Lack of adequate procedures
- Poor record-keeping and missing documents
- Absence of visitors
- Few social, recreational and educational activities
- Public discussion of personal matters
- Unnecessary exposure during bathing or using the toilet
- Absence of individual care plans
- Lack of management overview and support
Types of physical abuse
- Assault, hitting, slapping, punching, kicking, hair-pulling, biting, pushing
- Rough handling
- Scalding and burning
- Physical punishments
- Inappropriate or unlawful use of restraint
- Making someone purposefully uncomfortable (e.g. opening a window and removing blankets)
- Involuntary isolation or confinement
- Misuse of medication (e.g. over-sedation)
- Forcible feeding or withholding food
- Unauthorised restraint, restricting movement (e.g. tying someone to a chair)
Possible indicators of physical abuse
- No explanation for injuries or inconsistency with the account of what happened
- Injuries are inconsistent with the person’s lifestyle
- Bruising, cuts, welts, burns and/or marks on the body or loss of hair in clumps
- Frequent injuries
- Unexplained falls
- Subdued or changed behaviour in the presence of a particular person
- Signs of malnutrition
- Failure to seek medical treatment or frequent changes of GP
Psychological or emotional abuse
Types of psychological or emotional abuse
- Enforced social isolation – preventing someone accessing services, educational and social opportunities and seeing friends
- Removing mobility or communication aids or intentionally leaving someone unattended when they need assistance
- Preventing someone from meeting their religious and cultural needs
- Preventing the expression of choice and opinion
- Failure to respect privacy
- Preventing stimulation, meaningful occupation or activities
- Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse
- Addressing a person in a patronising or infantilising way
- Threats of harm or abandonment
- Cyber bullying
Possible indicators of psychological or emotional abuse
- An air of silence when a particular person is present
- Withdrawal or change in the psychological state of the person
- Low self-esteem
- Uncooperative and aggressive behaviour
- A change of appetite, weight loss/gain
- Signs of distress: tearfulness, anger
- Apparent false claims, by someone involved with the person, to attract unnecessary treatment
Types of self-neglect
- 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
- Inability to avoid self-harm
- Failure to seek help or access services to meet health and social care needs
- Inability or unwillingness to manage one’s personal affairs
Indicators of self-neglect
- Very poor personal hygiene
- Unkempt appearance
- Lack of essential food, clothing or shelter
- Malnutrition and/or dehydration
- Living in squalid or unsanitary conditions
- Neglecting household maintenance
- Collecting a large number of animals in inappropriate conditions
- Non-compliance with health or care services
- Inability or unwillingness to take medication or treat illness or injury
7 Minute Briefing - Self-Neglect and Alcohol and Substance Misuse - Teeswide Safeguarding Adults Board
Types of sexual abuse
- Rape, attempted rape or sexual assault
- Inappropriate touch anywhere
- Non- consensual masturbation of either or both persons
- Non- consensual sexual penetration or attempted penetration of the vagina, anus or mouth
- Any sexual activity that the person lacks the capacity to consent to
- Inappropriate looking, sexual teasing or innuendo or sexual harassment
- Sexual photography or forced use of pornography or witnessing of sexual acts
- Indecent exposure
Possible indicators of sexual abuse
- Bruising, particularly to the thighs, buttocks and upper arms and marks on the neck
- Torn, stained or bloody underclothing
- Bleeding, pain or itching in the genital area
- Unusual difficulty in walking or sitting
- Foreign bodies in genital or rectal openings
- Infections, unexplained genital discharge, or sexually transmitted diseases
- Pregnancy in a woman who is unable to consent to sexual intercourse
- The uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude
- Incontinence not related to any medical diagnosis
- Poor concentration, withdrawal, sleep disturbance
- Excessive fear/apprehension of, or withdrawal from, relationships
- Fear of receiving help with personal care
- Reluctance to be alone with a particular person
Sexual violence includes any form of sexual activity (involving physical contact, words, or photographs) that takes place without the other person's full and informed consent. Rape and sexual assault are mostly carried out by someone known to the victim: a husband, boyfriend, friend, colleague or other family member.
Sexual violence can happen to anyone regardless of age, gender, race, sexual orientation, religion, class, or background.
Research shows that the majority of sexual violence is experienced by women and girls, but men and boys can also be victims. If you are a man who has experienced sexual violence, Refuge provide help and information and links to further resources to Support Men.
Sexual violence can include:
- Pressuring or forcing someone to do something sexual
- Touching someone sexually without their permission
- Unwanted sexting — sending sexually explicit texts and images to someone without their consent
- Unwanted sexual attention — for example 'wolf-whistling' and making sexualised comments about women's bodies
- Watching a sexual act take place without permission
- Engaging in sexual acts with someone who is too drunk, or too intoxicated, to give consent
- Engaging in a sexual act with someone who is asleep or unconscious
- Having sex with someone who cannot legally consent — for example, a boy or girl under the age of 16, or someone with a disability who does not have the capacity to understand the situation
- Making someone watch or appear in pornography against their will
- Preventing someone from using contraception
When you're having sex, or doing something intimate with another person, it's important to be sure that they want to be doing it too — that they have consented. Even if you're in a relationship with someone it's important to make sure your partner agrees to any sexual act every time.
- Consent is showing or verbally communicating a clear 'yes' to your partner. If you're not sure if someone is consenting, ask
- To be able to consent, a person must have both the capacity to say yes and must understand what is happening and what they are agreeing to do
- The absence of "no" doesn't mean yes. Someone might have been pressured or frightened into doing something they don't want to — this means they haven't consented. If you are not sure if your partner is consenting, ask
- Everyone has the right to say no to any kind of sexual activity, or to change their mind at any time before or during sex
- It's also important to remember that there are some groups of people who cannot consent under law. If someone is not physically or mentally capable of making a decision to have sex — or they can't understand what they're agreeing to — they cannot give consent. For example, if someone is very drunk or intoxicated when they agree to sex, the law recognises that they don't have the capacity to give `true' consent
- The age of consent in the UK is 16
If you have been sexually assaulted or raped
If you have just been raped or sexually assaulted, try to remember that you are not alone and you are not to blame for what has happened. Here are some simple steps you can take to help ensure your safety:
- Find somewhere you feel safe
- You might be in shock, so wrap up warm
- Consider telling someone you trust about what happened. If you don't feel comfortable telling anyone yet, you can call the 24 hour National Domestic Abuse Helpline for support on 0808 2000 247
- Call 999 if you require urgent medical attention
You might want to consider contacting a Sexual Assault Referral Centre (SARC). SARCs provide support to victims of rape or sexual assault — including providing a confidential space for interviews, examinations and collecting evidence. Some may also offer counselling services. These services are available regardless of whether you feel you want to report to the police.
If you are considering reporting what happened, or simply want more information about your options, see Support Services in London.
Find out about the specialist services Refuge Athena Lewisham provides to victims of sexual violence.
Information for Professionals
Space for Self: The therapeutic model of the Rape and Sexual Abuse Support Centre (RASASC). The report evaluates the outcomes of using the RASASC therapeutic empowerment model for children and young people aged up to 25.
Perpetrators of Abuse
The person alleged to have caused harm
Abuse can occur anywhere and be perpetrated by anyone. Adults at risk are sometimes abused by strangers, but more often, they are abused by someone known to them or in a position of trust. This may include:
- A partner, relative, friend or child
- A neighbour or someone from the community network
- A paid carer or volunteer
- A health, social care worker or other professional
- Another vulnerable adult
- A non-carer or stranger
Abuse can occur in any relationship. It often occurs where the person who is abusing is in a more powerful position than the person who is being abused.
Abuse occurs when the abuser misuses such power either intentionally, or unintentionally or for their own benefit or gain.
The person who is abusing may have more power because they are more able than the person they are abusing.
They may also have more power because the adult at risk may be dependent on them in some way.
In some instances the abuser themselves may also be an adult at risk, for example another service user, or an adult with learning disabilities caring for a frail older parent.
In any formal caring situation, the person providing the care is held in a position of trust.
There can often be a power imbalance between a member of staff, paid carer or a volunteer and an adult at risk.
It must be noted that some abusers deliberately seek out adults who appear to be vulnerable, with the intention of abusing, harming, exploiting or manipulating that person.
What happens after you report your concerns
Once a report of suspected adult abuse or neglect is made, the organisation you reported your concerns to will take steps to ensure the immediate safety of the person and anyone else who may be affected. You can be assured that all reports of suspected abuse or neglect are taken seriously and are confidential.
When a report of suspected adult abuse is received further information will be gathered. If the adult at risk is unable to speak for themselves they can choose someone to act on their behalf such as a friend or family member. If this isn’t possible Adult Social Care can arrange for an independent person to do this, they are known as an Advocate.
They will talk to the person, or a suitable representative on their behalf, to find out what is happening and then work together to plan what can be done to help keep them safe and as independent as possible.
Where necessary Adult Social Care will investigate allegations of abuse with partner organisations and take appropriate action.
Sometimes a meeting is needed. The individual, or the person who acts on their behalf, may be invited to a meeting called a safeguarding planning meeting. During this meeting concerns will be discussed and the Chairperson will ensure that everybody has their say.
The Chairperson will ensure that everything that was agreed to be done is being done, and decide if any further action is needed. A safeguarding plan may be agreed to continue to keep the person safe.
Sometimes they will need to arrange further meetings to review the safeguarding plan and make changes if necessary to ensure the person continues to remain safe.
What if you don’t want anything to happen?
If the abuse is happening to you, you have a right to say what you want to be done about it. You will always be asked what you want and who you want to be involved.
Sometimes there are other people who may also be in danger and the abuse is too serious for people to do nothing. Professionals have a duty of care to you and other people and may have to act against your wishes. If this has to happen you will always be told why.
What if you’re not happy?
If you’re not happy about the safeguarding adults process Lewisham Adult Social Care would like to know why. You can speak to the Chairperson who was involved in your meetings, or you can contact the Lewisham Safeguarding Adults Manager.
This video Safeguarding Adults- An Independent Life After Abuse produced by the Social Care Institute for Excellence shows the positive outcomes the safeguarding process can have on a person who has been abused.
Mental Capacity, DoLS and Advocacy
Mental Capacity Act Deprivation of Liberty Safeguards
The Mental Capacity Act (MCA) 2005 came into force during 2007. A number of government departments sponsored its implementation. The MCA is designed to protect and restore power to those vulnerable people who lack capacity. The MCA also supports those, over the age of 18, who have capacity and choose to plan for their future. It applies to everyone working in health and social care who is involved in the care, treatment and support of people aged 16.
At the heart of the MCA in terms of concepts and values are the five ‘statutory principles’. Consider the five principles as the benchmark. They should be used to underpin all acts done and decisions taken in relation to those who lack capacity.
Using the Mental Capacity Act
This new film below from Social Care Institute for Excellence explains the MCA and how it can protect the right to make choices. It's an introduction to the Act for people who need it, staff, carers and others.
SCIE free online Mental Capacity Act e-learning
This course explores the Mental Capacity Act 2005, including best interests decision-making,and how to support people to make their own decisions.
The course is for everyone who looks after or cares for someone, for example, doctors, nurses, care assistants, social workers, and family members.
Deprivation of Liberty Safeguards
The Deprivation of Liberty Safeguards (DoLS) provide additional protection for the most vulnerable people living in residential homes, nursing homes, hospital environments and supported housing through the use of a rigorous, standardised assessment and authorisation process. They aim to protect those who lack capacity to consent to arrangements made in relation to their care and/or treatment, but who need to be deprived of their liberty in their own best interest to protect them from harm. They also offer the person concerned the rights:
- To challenge the decision to deprive them of their liberty;
- For a representative to act for them and protect their interests; and
- The right to have their status reviewed and monitored on a regular basis.
DoLS help ensure that an institution only restricts liberty safely and correctly and only when all other less restrictive options have been explored. The Local Authority manages this process and reports to the local Safeguarding Adults Board. In March 2014 the Supreme Court judgement in the case of “P v Cheshire West and Chester Council and another” and “P and Q v Surrey County Council” lowered the threshold for a deprivation and significantly widened the scope of the Mental Capacity Act Deprivation of Liberty Safeguards themselves.
Lewisham Council's Adult Social Care has a dedicated Deprivation of Liberty Safeguards web page that provides general information, links to other sources of information and contact details for the Deprivation of Liberty Safeguards Team.
Independent advocacy under the Care Act 2014
Advocacy and the duty to involve
Local authorities must involve people in decisions made about them and their care and support. No matter how complex a person’s needs, local authorities are required to help people express their wishes and feelings, support them in weighing up their options, and assist them in making their own decisions.
When does the advocacy duty apply?
The advocacy duty will apply from the point of first contact with the local authority and at any subsequent stage of the assessment, planning, care review, safeguarding enquiry or safeguarding adult review. If it appears to the authority that a person has care and support needs, then a judgement must be made as to whether that person has substantial difficulty in being involved and if there is an appropriate individual to support them. An independent advocate must be appointed to support and represent the person for the purpose of assisting their involvement if these two conditions are met and if the individual is required to take part in one or more of the following processes described in the Care Act:
- A needs assessment
- A carer’s assessment
- The preparation of a care and support or support plan
- A review of a care and support or support plan
- A child’s needs assessment
- A child’s carer’s assessment
- A young carer’s assessment
- A safeguarding enquiry
- A safeguarding adult review
- An appeal against a local authority decision under Part 1 of the Care Act (subject to further consultation)
Judging ‘substantial difficulty’
Local authorities must consider, for each person, whether they are likely to have substantial difficulty in engaging with the care and support process. The Care Act defines four areas where people may experience substantial difficulty. These are:
- Understanding relevant information
- Retaining information
- Using or weighing information
- Communicating views, wishes and feelings
Who is an ‘appropriate individual’ to assist a person’s involvement?
If the person being supported doesn’t want that person to support them, that’s not an appropriate adult. You can’t force an advocate on someone.
Co-production workshop participant
Local authorities must consider whether there is an appropriate individual who can facilitate a person’s involvement in the assessment, planning or review process, and this includes four specific considerations. The appropriate individual cannot be:
- Already providing care or treatment to the person in a professional capacity or on a paid basis
- Someone the person does not want to support them
- Someone who is unlikely to be able to, or available to, adequately support the person’s involvement
- Someone implicated in an enquiry into abuse or neglect or who has been judged by a safeguarding adult review to have failed to prevent abuse or neglect
The role of an ‘appropriate individual’ under the Care Act is potentially fuller and more demanding than that of an individual with whom it is ‘appropriate to consult’ under the Mental Capacity Act (MCA). Under the Care Act the appropriate individual’s role is to facilitate the person’s involvement, not merely to consult them and make decisions on their behalf.
Information and advice
The Care Act places a duty on local authorities to ensure that all adults in their area have access to information and advice on care and support, and to keep them safe from abuse and neglect. Prior to making contact with the local authority, there may be some people who require independent advocacy to access information and advice.
Continuing health care
The advocacy duty in the Care Act applies equally to those people whose needs are being jointly accessed by the NHS and the local authority, or where a package of support is planned, commissioned or funded by both a local authority and a clinical commissioning group (CCG), known as a ‘joint package’ of care.
The independence of the service is an important consideration for all commissioners. For services to be meaningful and acceptable to those they are designed to support they must have the confidence of individuals, carers and the public.
From April 2015 local authorities will also be responsible for assessing and meeting the social care needs of adult prisoners (not just on discharge from prison but also while in custody). All prisoners will be treated as if they are resident in that area for the purposes of the Care Act and for as long as they reside in that prison. Prisoners will be entitled to the support of an independent advocate in the same circumstances as people in the community.
Social Care and Health have produced this video in British Sign Language on the provision of Independent Advocacy under the Care Act 2014.
This video Safeguarding Adults - Helping People To Protect Themselves From Crime which has been produced by the Social Care Institute for Excellence, shows what care workers and others who are in contact with a vulnerable adult can do to help them protect themselves from crime.
This video Safeguarding Adults - Looking Out For Each Other To Prevent Abuse which has been produced by the Social Care Institute for Excellence, can be helpful to highlight what the local community can do to protect themselves and those they care about.
Feeling lonely or isolated? - Age UK telephone friendship
As we get older, we may find we spend more time on our own. This can sometimes feel lonely, boring or make us miss friends or family.
If you or someone you know is missing the joy of regular conversation, Age UK and our partner charity The Silver Line can help. Age UK offer free telephone friendship services so you can enjoy chatting with someone over the phone, all from the comfort of your own home.
Whether you’d like to speak to someone every week, or just want to talk when the need strikes, we’re here to help.
London Fire Brigade - Home fire safety Visits
The London Fire Brigade’s Lewisham Borough Officers can visit you, a loved one, or someone you care for at home to provide personalised advice about fire safety. It's totally free, available 24/7, and they will even fit free smoke alarms during the visit if you need them.
Free home fire safety visits from London Fire Brigade | London Fire Brigade (london-fire.gov.uk)
London Fire Brigade - Fire Risk Checklist
The London Fire Brigade has created a checklist to help you identify fire risks for the people you work with or care for.
This form has been designed for carers, support workers, housing officers and social workers, but if you care for a family member or friend you can also use it.
Home Fire Safety Risk Checklist
Metropolitan Police- Lewisham - Cash Point Safety Advice
Independent Age - Advice and support for older age
Independent Age have some great advice on what can cause falls, what you can do if you do fall and where to find out further information.
Staying steady on your feet
Lewisham and Greenwich NHS Trust offer a falls rehabilitation service which you can access via referral from your GP.
How much do you really know about identity fraud? Action Fraud has produced the infographic below which gives tips on how to keep your identity safe.