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What is abuse

Safeguarding adults is about protecting those at risk of harm from suffering abuse or neglect.

photo senior man covering his face with his handsWe all have the right to live our lives free from abuse. It is recognised that certain groups of people may be more likely to experience abuse and less able to access services or support to keep themselves safe.

This may include people with:

  • a learning, physical or sensory disability
  • mental ill health or dementia
  • frailty due to age
  • an acquired brain injury
  • a drug or alcohol problem
  • certain types of physical illness.

Abuse or neglect can take many forms and the individual circumstances of each situation should be considered carefully when there are grounds for concern.

It is important to understand the circumstances of abuse, including the wider context such as: 

  • whether others may be at risk of abuse,
  • whether there is any emerging pattern of abuse,
  • whether others have witnessed abuse and
  • the role of family members and paid staff or professionals.

It is important to recognise that abuse or neglect may be unintentional and may arise because a carer is struggling to care for another person.

Abuse may consist of a single or repeated act. It may be physical, verbal or psychological, an act of neglect or an omission to act.

Where does abuse take place?

Abuse may occur in a public place; it may occur when an adult lives alone or with a relative; it may occur within care settings, in hospitals, custodial settings, support services in people’s own homes and other places we could assume are safe.

Who commits abuse?

Anyone can perpetrate abuse or neglect, including:

Other family members
Local residents
People who deliberately exploit adults they perceive as vulnerable to abuse
Paid staff or professionals and volunteers

Types of Abuse

Types of abuse or neglect include:

Physical abuse +

Physical abuse could include: 

  • hitting
  • being locked in a room
  • slapping
  • force-feeding
  • pushing
  • kicking
  • inappropriate methods of restraint
  • burning
  • misuse of medication
  • scalding
  • biting
  • unnecessary use of medical equipment
  • invasive procedures
  • inappropriate sanctions

Signs or indicators of physical abuse might include: 

  • unexplained/explained injuries
  • bruises in various stages of healing
  • bruises inconsistent with falls
  • moving between agencies e.g. GP & A&E
  • burns on unlikely areas of the body
  • unexplained cuts or scratches to mouth, lips, gums, eyes or external genitalia
  • untypical self harm
  • reluctance to undress
  • history of injury
  • sudden and unexplained urinary and/or faecal incontinence
  • evidence of over/under medication
  • person flinches at physical contact
  • person asks not to be hurt
  • person appears frightened or subdued in the presence of particular people

Domestic abuse +

Domestic Abuse is any incident or pattern of incidents of controlling, coercive, 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.

Domestic violence & abuse includes: 

  • psychological abuse
  • physical abuse
  • sexual abuse
  • financial abuse
  • emotional abuse.

Family members include; mother, father, son, daughter, brother, sister, and grandparents, whether directly related, in laws or step-family.

Controlling behaviour

Controlling behaviour is a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

Coercive behaviour

Coercive behaviour is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim

What are the signs of domestic abuse?

They’re not always as obvious as you might think. That’s because domestic abuse is about controlling someone’s mind and emotions as much as hurting their body. Being abused can leave victims scared and confused.

Signs someone is being abused

It is very difficult to create a definitive list of signs that domestic abuse is happening because abuse can occur on many levels and both victims and alleged or known perpetrators can behave and respond in a range of different ways. The following list of signs of behaviour for victims is not exhaustive, and should not be used as a definitive list but should be used as guidance.

Keep an eye out for things like:

  • May have unexplained bruises/injuries, and may give other reasons for the injuries which refer to them being accidental
  • Anxious about using video conferencing - may only use telephone/text
  • Personality changes, like low self-esteem in someone who was always confident/becoming unusually quiet or withdrawn
  • Constantly checking in with their partner/overly worried about pleasing their partner
  • Never having money on hand
  • Skipping out on social interaction for no clear reason
  • Wearing clothes that don’t fit the season, like long sleeves in summer to cover bruises
  • Has panic attacks
  • Has frequent absences from work or other commitments
  • Stops talking about her/his partner
  • May never be seen alone, and is always accompanied by their partner
  • May become more isolated, withdrawing from friends and family
  • Go along with everything their partner says and does
  • Check in often with their partner to report where they are and what they’re doing

Information and support:

Other resources

Information and support about domestic abuse on the BBC website

Visit the Refuge domestic abuse website

For more information go to the Domestic Abuse resources page.

Sexual abuse +

This can include adults being forced to engage in sexual activity against their will (or because they cannot consent). Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can children.

 Sexual Abuse Examples: 

  • rape
  • being made to perform a sexual act
  • assault by penetration (penetration with an object)
  • persuasion or coercion into sexual activity
  • un/wanted touching
  • exposed to pornographic material
  • verbal harassment
  • any sexual relationship that develops between adults where one is in a position of trust, power or authority

Indicators of sexual abuse can be: 

  • urinary tract infections
  • sexually transmitted infections
  • pain, itching, bleeding
  • unexplained problems with catheters
  • being subdued and withdrawn
  • having poor concentration
  • a disclosure is made
  • sexualised behaviour
  • significant changes in behaviour
  • clothing is torn, stained or bloody
  • a woman who lacks capacity to consent becomes pregnant
  • untypical use of sexual language


If you think you have been raped you can contact RASASC Specialist Sexual Violence Support for Cheshire and Merseyside between the hours Monday to Friday 9.00 until 4.00

Information and helpline: 0330 363 0063

Warrington: 01925 221546

Cheshire East: 01260 697900

Cheshire West & Chester: 01244 907710

Halton: 01928 477980

Knowsley: 0151 218 7960

St. Helens: 01744 877987 

If you need to speak to someone for emotional support/advice out of these hours here are a number of options: 

  • Rape & Sexual Abuse Support Centre (National Free Helpline for men/women/family members) open every day 12noon-2.30pm and 7pm-9.30pm on 0808 802 9999 or visit their website: www.rapecrisis.org.uk/
  • Samaritans (24hr emotional support line): 08457 90 90 90
  • National Association for People Abused in Childhood (helpline weekdays and evenings): 0808 801 0331
  • Survivors UK (Helpline for male survivors of rape/sexual abuse open 7pm-10pm Mon/Tue/Thu): 0845 122 1201

Psychological abuse +

Persistent emotional ill-treatment of a person. It may involve; conveying that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person, not giving them opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate  It may involve seeing or hearing the ill-treatment of another (domestic abuse).

Psychological Abuse Examples: 

  • threats of harm or abandonment
  • deprivation of contact
  • humiliation
  • rejection
  • blaming
  • controlling
  • verbal abuse (shouting or swearing)
  • coercion
  • indifference
  • harassment
  • isolation
  • removing choice
  • playing “mind games”
  • intimidation
  • withdrawal from services or support networks

Indicators of Psychological abuse include: 

  • untypical lack of interest, passivity or resignation
  • anxious or withdrawn (possibly in the presence of the abuser)
  • untypical changes in behaviour
  • person is not allowed visitors or phone calls
  • unexplained paranoia
  • confusion, agitation
  • coercion
  • possible violation of human and/or civil rights
  • distress caused by being locked in a home or car
  • isolation – no visitors or phone calls allowed
  • inappropriate clothing
  • sensory deprivation
  • person is locked in a room or their home
  • person is denied access to aids or equipment, e.g. glasses, hearing aid, crutches, health checks
  • they appear depressed or low in mood
  • they seem anxious
  • low self esteem
  • ambivalence about carer
  • fearfulness, avoiding eye contact, flinching on approach
  • deference
  • insomnia or the need for excessive sleep
  • change in appetite
  • unusual weight loss/gain
  • tearfulness
  • restricted access to hygiene facilities
  • lack of personal respect
  • lack of recognition of individual rights
  • carer does not offer personal hygiene, medical care or regular food or drinks
  • use of furniture to restrict movement.

Financial or material abuse +

Financial abuse could involve theft of money or possessions, fraud, scamming. Carers or friends/family or acquaintances preventing a person from accessing their own money/benefits, arranging less care than is needed to save money, or misusing direct payments. Someone moving into a persons home or living rent free without agreement or under duress. 

Examples of financial abuse include: 

  • theft
  • fraud
  • exploitation
  • pressure in connection with Wills or property
  • withholding of money
  • misappropriation of property or benefits
  • bribery
  • unauthorised use of a person’s money or property
  • borrowing money from service users
  • use of utilities
  • accepting gifts
  • who keeps the “get one free” or the “points?”
  • doing your own shopping on the service users time 

Indicators of Financial Abuse include: 

  • Change in living conditions
  • Lack of heating, clothing or food
  • Inability to pay bills/unexplained shortage of money
  • Unexplained withdrawals from an account
  • Unexplained loss/misplacement of financial documents
  • The recent addition of authorised signers on a client or donor’s signature card
  • Sudden or unexpected changes in a will or other financial documents
  • lack of money, especially after benefit day
  • recent acquaintances expressing sudden or disproportionate interest in the person and their money
  • “red” bills or services disconnected
  • change in appearance (becoming dishevelled)
  • disparity between assets/income and living conditions
  • recent changes of deeds/title of house
  • items missing
  • Internet scams, postal scams and doorstep crime are, more often than not, targeted at adults at risk and all are forms of financial abuse.

Read more information on scams and mate crime.

Modern slavery +

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.

Examples of Modern Slavery include: 

  • Slavery
  • Unpaid work
  • No human rights
  • Human trafficking
  • Forced and compulsory labour
  • Poor living conditions, access to amenities
  • 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.

Indicators of Modern Slavery include: 

  • Forced to work - through mental or physical threat;
  • Owned or controlled by an 'employer', usually through mental or physical abuse or the threat of abuse;
  • Dehumanised, treated as a commodity or bought and sold as 'property';
  • Physically constrained or has restrictions placed on his/her freedom of movement.
  • Signs of physical or emotional abuse
  • Appear malnourished, unkempt or withdrawn
  • Poor or overcrowded home conditions
  • Working and living at the same address. 

If you think that someone is the victim of Modern Slavery you can ring the Modern Slavery National Helpline on 08000 121 700.

Watch the HM Gov You Tube clip Modern Slavery is closer than you think

For more information follow this link to our page on Modern Slavery.

Discriminatory abuse +

Discriminatory abuse exists when values, beliefs or culture result in a misuse of power that denies opportunity to some groups or individuals. It can be a feature of any form of abuse of an adult, but can also be motivated because of age, gender, sexuality, disability, religion, class, culture, language, race or ethnic origin.

Examples of Discriminatory abuse are: 

  • comments or jokes that are racist, sexist, homophobic, ageist or based on a person’s disability
  • any other form of abuse based on prejudice
  • not providing for an individual’s cultural or religious beliefs
  • not providing accessible services
  • ignoring sexual orientation of service users
  • intentional and/or unintentional withholding of information, e.g. information not being available in different formats/languages
  • name calling
  • belittling
  • no treatment because “they’ve had a good innings”
  • not providing for people's spiritual needs

Indicators of Discriminatory abuse are: 

  • observation of oppressive practice
  • person becomes isolated from others
  • person stops “practising” their beliefs
  • person stops asking for needs to be met
  • changes behaviour to fit in with group
  • physical health deteriorates
  • withdrawal

For more information on hate/mate crime follow this link

Organisational abuse +

Includes neglect and poor care practice within an institution or specific care setting such as a hospital or care home, or where care is provided within an adults own home.

Organisational abuse occurs when the routines, systems and regimes of an institution result in poor or inadequate standards of care and poor practice which affect the whole setting and deny, restrict or curtail the dignity, privacy, choice, independence or fulfilment of adults with care and support needs.

This may range from one off incidents to on-going ill-treatment.

Potential indicators of organisational abuse.
It is important not to jump to the wrong conclusions too quickly but the following list may be possible indicators of organisational abuse:

  • no flexibility in bedtime routine and/or deliberate waking
  • people left on a commode or toilet for long periods of time
  • inappropriate care of possessions, clothing and living area
  • lack of personal clothes and belongings
  • un-homely or stark living environments
  • deprived environmental conditions and lack of stimulation
  • inappropriate use of medical procedures such as enemas, catheterisation
  • batch care – lack of individual care programmes
  • illegal confinement or restrictions
  • inappropriate use of power or control
  • people referred to, or spoken to, with disrespect
  • inflexible services based on convenience for the provider rather than the person receiving services
  • inappropriate physical intervention
  • service user removed from the home or establishment, without discussion with other appropriate people or agencies because staff are unable to manage the behaviour 

If you work or volunteer with adults and are concerned about organisational abuse please follow the link here to People in a Position of Trust (PiPot) for advice on what to do.

Neglect and acts of omission +

Neglect is the persistent failure to meet a person’s basic physical and or psychological needs, likely to result in the serious impairment of the health or development.

Examples of neglect include: 

  • failure to provide access to appropriate health, social care or educational services
  • failure to intervene in situations that are dangerous to the person concerned or to others, particularly when the person lacks the mental capacity to assess risk for themselves.
  • withholding of the necessities of life such as medication, adequate nutrition, heating and social contact
  • not providing enough staff to meet the needs of the client group.
  • taking “shortcuts” that result in harm, e.g. when moving and handling, bathing
  • ignoring medical / personal care needs
  • inappropriate use of continence aids
  • leaving someone in soiled clothes, beds, pads
  • missing calls and appointments

Indicators of Neglect include: 

  • person has inadequate heating and/or lighting
  • physical condition deteriorates
  • confusion due to dehydration, infection, hypothermia
  • person is exposed to unacceptable risk
  • callers/visitors are refused access to the person
  • pressure areas developing or not healing
  • weight loss
  • no access to appropriate medication or medical care
  • no privacy or dignity
  • change in appearance, poor skin and hair
  • smell of urine
  • dried faeces in pubic hair or under fingernails

Self-Neglect +

Self-Neglect covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.

Self-Neglect differs from other forms of abuse because it does not involve a perpetrator.

It is seen in all ages but is more common in older people. It covers a wide range of behaviour neglecting to care for ones personal hygiene, health or surroundings and includes behaviour such as hoarding.

Adults may present with a variety of conditions such as substance misuse, self harm, depression, history of trauma or bereavement.

Examples of Self Neglect include: 

  • Refusal of personal care
  • Refusal of medication
  • Refusal of other interventions
  • Inability (intentional or non-intentional) to maintain a socially and culturally accepted standard of self-care
  • Hoarding

Signs of Self Neglect include: 

  • Poor self-care leading to a decline in personal hygiene
  • Poor nutrition
  • Poor healing/sores
  • Poorly maintained clothing
  • Long toenails
  • Isolation
  • Failure to take medication
  • Hoarding large numbers of pets

For more information about Hoarding click here

Is self-neglect a safeguarding issue?

"Cases of self-neglect are complex and pose ethical dilemmas between promoting individual autonomy and fulfilling a duty of care……..” The University of Sussex, 2014

Self-neglect can be a difficult issue for friends, family, professionals and volunteers to address.  There is a need to find the right balance between respecting a person’s autonomy, their rights and choices with a duty to protect health and wellbeing. 

In some circumstances, where there is a serious risk to the health and wellbeing of an individual, it may be appropriate to raise self-neglect as a safeguarding concern.

It is important to determine whether the person has capacity to make decisions about their own wellbeing, and whether or not they are able or willing to care for themselves. An adult who is able to make choices may make decisions that others think of as self-neglect.

If the person does not want any safeguarding action to be taken, it may be reasonable not to intervene further, as long as: 

  • no-one else is at risk
  • their ‘vital interests’ are not compromised – that is, there is no immediate risk of death or major harm
  • all decisions are fully explained and recorded
  • other agencies have been informed and involved as necessary. 

Everyone should know what to do and where to go for help and advice when abuse or neglect is suspected. In order to manage risks effectively, respect people’s dignity and achieve satisfactory safeguarding outcomes in terms of empowering and protecting adults at risk in our community, everyone should:

  • Know about the different types of abuse and their signs
  • Support adults at risk to keep safe
  • Know who to tell about suspected abuse or neglect.
  • Support adults at risk to exercise informed choice and receive the support they need to achieve Improved wellbeing

To report an adult at risk click here