Abuse, What is and to whom

(Within this article I will be referencing to various organisations to evidence the comments contained in the article.  I have no other reason to be referencing to these organisation and in no way should it be held otherwise.)

Currently in the UK abuse is very much in the day to day coverage in the media, but I am not here to comment on the specific alleged incidents being reported on.

I feel it is important now, as it always is and should always be, that abuse or alleged abuse is always taken seriously.

But as a starting point what is abuse, who is an abuser and who can be abused?

What is abuse?  

A possible starting definition from the Department of Health guidance No Secrets is

“Abuse is a violation of an individual’s human and civil rights by any other person or persons”.

Abuse may consist of a single act or repeated acts. It may be physical, verbal or psychological, it may be an act of neglect or an omission to act, or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent. Abuse can occur in any relationship and may result in significant harm to, or exploitation of, the person subjected to it.

Who is an abuser?

Abusers come from all walks of life. They can come from any ethnic group, religion, class or neighbourhood. They may be older or younger. However, whilst they may also be any gender, the majority of perpetrators are men.

This definition is taken from the ‘Women’s Aid’ website and is referencing the relationship to Domestic Violence. But it is in the main still relevant as a definitions for abusers, what ever the form of abuse.  The meaning being anyone could be an abuser.

Who can be abused?

Anyone can be abused, but adults who are especially vulnerable include the elderly, those who are frail, those with a physical or sensory impairment, a learning disability or a mental health problem.

This definition from Staffordshire and Stoke-on-Trent Adult Safeguarding Board is to protect vulnerable adults, but it is still relevant with regards to children.

So anyone can be abused, but in most cases they will in some way be vulnerable.

As already stated anyone could be an abuser, but I feel mainly they will be persons who like to be in control, have a position of power or an assumed position of power.  They will most likely engineer a situation, where the abuse can take place, which is most likely to be in an area away from general view, but not always.  If the abuser is confident no one will report them or notice abuse is taking place, they may abuse a person or persons where they may be seen.

The forms of abuse can be many and various.

The ten types of abuse

Use the links below to navigate to the required area of the website where the types of abuse are detailed:

• Discriminatory
• Psychological
• Financial or material
• Organisational
• Neglect and acts of omission
• Physical
• Sexual
• Domestic
  
• Modern slavery
• Self-neglect

Physical abuse

May include a person being

• hit, punched, kicked, slapped, pushed, thrown, pinched, shaken, strangled or suffocated
• hit or beaten with an object
• stabbed, burnt or scalded

It may also include

• inappropriate restraint or imprisonment
• abuse of medication
• deprivation of use, or misuse, of physical aids and adaptations
• neglect of personal care, food, drink, and warmth

Signs that physical abuse is taking place include

• injuries that are consistent with physical abuse
• injuries that are the shape of objects
• presence of several injuries of a variety of ages
• injuries that have not received medical attention
• a person being taken to many different places to receive medical attention
• pressure sores and skin infections
• dehydration or unexplained weight changes
• medication being “lost”

It may include physical conditions that mean a person is restrained or imprisoned, such as

• locks that the person cannot use
• wheel chair tyres deflated

It may include behaviour that indicates that the person is afraid of the perpetrator, for example

• flinching at movements made by the perpetrator
• change of behaviour in presence of the perpetrator
• avoiding the perpetrator

Sexual abuse

may include

Any forced or coerced involvement in sexual activity.

It may involve physical contact such as

• rape(heteroexual, gay or lesbian) ,oral sex
• kissing and unwanted touching
• being coerced into physical activity such as masturbating the perpetrator or carrying out sexual acts for which others pay the perpetrator

        

Non-contact abuse can include

• being forced or coerced to be photographed or videoed, to allow others to look at their body or to watch them masturbate
• to look at photographs or DVDs
• being sexually harassed verbally or through the sending of unwanted gifts

Some sexual activity is defined as abuse because a person cannot legally consent to the activity.

This includes

• Incest
• sexual intercourse with a “defective” (defined as a woman with arrested or incomplete development of mind) and

sexual intercourse between male staff and female residents of a mental hospital or home

Sexual abuse may be heterosexual, gay or lesbian. Healthy approaches to sexuality assist people who may be at risk of abuse understand what they want and do not want to happen to them.

A good example of positive work is that carried out under the Learning Difficulty Services “Healthy Sexuality Policy“. Services should adopt a clear and open approach to the sexuality and sexual needs of the people they support or care for.

It is helpful to have an understanding of the alleged victims attitude and orientation to sexual matters when assessing risk and harm done.

Signs that sexual abuse may be taking place

The signs that a person is experiencing psychological abuse and that they are experiencing sexual abuse are often similar. This is due to the emotional impact of sexual abuse on a person’s sense of identity and boundaries and to the emotional manipulation that a perpetrator may carry out in “grooming” a person they plan to abuse sexually.

The signs may include

• signs of sexual activity such as sexually transmitted diseases or pregnancy
• pain, soreness, itchiness, tears or bruises in genital or anal areas, breasts, or inner thighs
• unusual difficulty in walking and sitting
• signs that someone is trying to take control of their body or body image, such as head banging, self-harm, putting on or losing a lot of weight, anorexia or bulimia
• sexualised behaviour by the person experiencing the abuse towards the perpetrator and/or towards other people
• behaviour that indicates that the person is afraid of the perpetrator, or a change of behaviour in presence of the perpetrator or avoiding the perpetrator.
• It may be that the perpetrator is observed to have an overly familiar or sexualised relationship with the person experiencing abuse

Psychological Abuse

May include

• intimidation and threats
• humiliation
• racial, sexual or homophobic abuse
• harassment, coercion and extortion
• being isolated from people other than the abuser and from other sources of information
• being made to say or do things, or think in ways prescribed by the abuser
• being deprived of sleep
• being kept exhausted and debilitated
• having one’s sense of reality distorted by misinformation and lies, or misuse of medication

It may also include

• denying choice
• deprivation of privacy and other human rights
• lack of access to activities
• an abusive institutional “regime”

Signs that psychological abuse is taking place include

• difficulty gaining access to the person on their own, or the adult gaining opportunities to contact you
• the person not getting access to medical care, or appointments with other agencies
• low self-esteem
• anxiety and lack of confidence.
• increased levels of confusion
• increased urinary or faecal incontinence
• sleep disturbance
• the person feeling or acting as if they are being watched all of the time
• decreased ability to communicate
• communication that sounds like things that the perpetrator would say
• deference or submission to the perpetrator
• behaviours that show resistance to the perpetrator

Financial abuse

May include

• any act of theft of money or property, or use of money or property, without the person’s consent, or without the appropriate legal authority
• the misuse of money intended for, or belonging to, an adult by someone who has been trusted to handle their finances, or who has assumed control of their finances by default.
• The use of CHIP & PIN cards has caused increased concern that people at risk may be pressured into giving their Debit (Credit) Cards and PIN numbers to potential abusers. There is a close link to such activities as Doorstep Crime.

Signs that financial abuse may be occurring include

• sudden loss of assets
• unusual or inappropriate financial transactions
• change to, or pressure to change, signatories to bank accounts or house deeds
• visitors whose visits always coincide with the day a person’s pension or benefits are cashed
• the person not receiving material goods such as clothes or food
• bills not being paid
• household repairs not being carried out even though the person has an income that could cover these items
• the person having no choice in how their money is spent on their behalf
• the person who is managing the adult’s financial affairs is evasive or uncooperative, and only asks workers about financial aspects of the adult’s care

Neglect and acts of omission

may include

• Failure to provide the elements necessary for life or to avoid harm
• To treat carelessly
• To pass by without notice
• To fail to give due care

Signs that neglect is occurring include

• malnutrition
• rapid or continuous weight loss
• complaints of hunger
• dehydration
• lack of personal care
• pressure sores
• sensory deprivation / isolation (such as the lights or the television being left on constantly)
• inadequate or inappropriate clothing
• inadequate or excessive heating
• dirty clothing or bedding
• person being left wet or soiled
• untreated medical problems
• too much or too little exercise or social activity
• signs of medication over or under use
• not having access to necessary physical aids and adaptations

Neglect

Self Neglect – often services find themselves dealing with individuals who neglect their own well-being and perversely do not co-operate with services attempting to improve their health and welfare. Signs of self-neglect may be the same as neglect by others.

Concern may be expressed about the mental capacity of the individual and the guide to assessing capacity in this policy should be followed. If the individual is established to have capacity services there is the need to record all that has been done to assist the individual to maintain their health and safety. Clear recording should be made of concerns put to the individual with capacity and if necessary they may be asked to identify the services (legal advice must be sought) The Adult Safeguarding framework may be used to share information and record what actions services have taken and what concerns have been put to the individual.

An individual lacking capacity may need decisions to be taken on their behalf; this should be explained to them and they should be enabled to retain as much control over their lives as possible. Consideration may be necessary to using the Mental Health Act 1983 or Section 47 of the National Assistance Act.

Mental Capacity Act 2005

This Act has identified the new criminal offence of ill treatment or wilful neglect which applies to the following individuals:

• A person who has the care of a person who lacks or is reasonably believed by that person to lack capacity; or
• A person who is the attorney appointed under a Lasting Power of Attorney (LPA), or an existing Enduring Power of Attorney; or
• A person who is a deputy appointed by the Court of Protection
• That person is guilty of an offence if he /she ill-treats or wilfully neglects the person they have care of. The penalty for such an offence is a fine or imprisonment of up to 5 years.

Discriminatory abuse

May include

• harassment
• slurs
• treatment which is based upon an individuals gender, race, disability, faith, culture or sexual orientation

Signs that discriminatory abuse may be taking place include

• low self esteem
• anxiety and lack of confidence
• deference or submission to the perpetrator

Institutional/Organisaional abuse

This may take the form of isolated incidents of poor or unprofessional practice at one end of the spectrum, through to pervasive ill treatment or gross misconduct at the other.

Neglect and poor professional practice can often develop into institutional abuse.

Signs that institutional abuse is occurring include

• poor care standards
• lack of positive responses to complex needs
• rigid routines
• inadequate staffing and an insufficient knowledge base within the service
• Failure of agencies to ensure staff receive appropriate guidance on

Abuse reporting

Who may report abuse, this can be anybody who is aware of abuse taking place.  Be it the person who has been abused or another person who has seen the abuse taking place or is aware of it happening by other means. This could include chit chat by the abused person, counselling of the abused person or in some instances of over hearing others conversations.  I feel it is the duty of anyone in position of the knowledge that abuse as taken place for them to reported it.  This not only safeguards the persons already abused, but will stop others being abused, assuming the abuse allegations are investigated.

Many people say when the abused person eventually tells or reports being abused, why did it take them so long to do so. This may be days, weeks, months and in many cases years.  What many people who have never been abused can not understand or visualise is the feelings an abused person may experience.

While it will never be the fault of the person being abused, many abused persons feel deeply ashamed and guilty that an act of abuse has been inflicted upon them.  This is often used by the abuser to further intimidate the abused person from reporting the act or acts.

Report to whom

This is not always as easy as it may seem.  For an abused person to report they have been abused means they have to over come their strong feeling of guilt and being ashamed.

When an abused person is ready to disclose they have been abused, they will generally do this to someone they feel they can trust. This may be someone who is seen to be in an official position, like the Police or Social Worker. But this will not always be so, it may be a family friend or in some cases, as it the may be with some charities,  public corporations, local government and central government , a person who has been designated by the organisation to be the responsible person to whom abuse allegations are reported to.  Whether the person to whom the abuse allegation is being made to is there in some official capacity or a friend, they should ensure they are taking the information they are receiving in a serious manner. They should  endeavour not to make any comments showing, shock, surprise, doubt or anything which may cause the abused person to feel they should not be reporting the abuse.  When the person is aware they are being told of an abuse allegation, they should advise the person making the allegation, that if they continue to provide information, that you will have to report it to someone who can proceed further and investigate the allegation.

In addition to the above, the person to whom the abuse allegation is be made to, should not question any of the information being given.  They should, as quickly as possible, make a written record of the abuse allegation with details of the abused person and then forward this record to the person within the organisation who has been designated and trained in dealing with abuse allegations.  It is then up to this person, or persons, who will decide how to proceed further.  This may be to investigate, advise Police or Social Services, but this will be in accordance with that organisations Protection Procedures.

Unless anyone receiving details of any abuse allegations is trained in counselling, they should not do anything more than record the details as they have been given to them.  It may be that the abused person and the person to whom the details have been given will be in need of counselling and should this be the case, then this should be arranged separately from providing the abuse allegation details.

It is, therefore extremely important that all acts of abuse are reported and when doing so, that they are treated seriously.  If an act of abuse goes unreported, then this is allowing the abuser to be free to enact more acts of abuse, either on the original victim or others.