3: Recognising abuse in adults

Chapter 3: 
Recognising abuse in adults

Aim of the chapter

1. To describe forms of abuse and indicators of same
2. To provide specific cultural and faith-based considerations

Good safeguarding practice means that our denomination must ensure that all staff and volunteers understand how to recognise abuse, and how to pass on any safeguarding concerns to the relevant people.

This does not mean that Kirk Sessions, staff or volunteers are responsible for deciding whether or not abuse has occurred, but they do have a responsibility to be alert to the signs, actions and/or behaviour by adults that suggests something may be wrong.

 A broad look at abuse

Abuse may be defined as ‘any act, or failure to act, which results in a breach of a vulnerable person’s human rights, civil liberties, physical and mental integrity, dignity or general well-being, whether intended or through negligence, including sexual relationships or financial transactions to which the person does not or cannot validly consent, or which are deliberately exploitative. Abuse may take a variety of forms’. Health Information and Quality Authority (HIQA). The National Standards for Residential Services for Children and Adults with Disabilities. Dublin, 2013

‘This definition excludes self‐neglect which is an inability or unwillingness to provide for oneself. However, the HSE acknowledges that people may come into contact with individuals living in conditions of extreme self‐neglect. To address this issue the HSE has developed a specific policy to manage such situations.’ Safeguarding Vulnerable Persons at Risk of Abuse National Policy and Procedures

Abuse is the misuse of power and control that one person has over another. It can involve direct and indirect contact and can include online abuse.

Abuse is described in regional policies under the following terms:

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

Sexual abuse includes rape and sexual assault, or sexual acts to which the vulnerable person has not consented, or could not consent, or into which he or she was compelled to consent. 

Psychological abuse includes 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 includes theft, fraud, exploitation, pressure in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits. 

Neglect and acts of omission includes 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 includes ageism, racism, sexism, abuse that is based on a person’s disability, and other forms of harassment, slurs or similar treatment.

Institutional abuse may occur within residential care and acute settings including nursing homes, acute hospitals and any other in‐patient settings, and may involve poor standards of care, rigid routines and inadequate responses to complex needs.

Abuse can happen anywhere – for example, in someone’s own home, within day care, residential care, nursing care or other institutional settings, at work or in educational settings, in church property at church organisations, or in public. 

Anyone can be an abuser – Kirk Sessions, staff and volunteers must be aware that those who cause harm come from all sections of society, all professions and all races and can be male or female, of any age. 

As painful as it may be, we must remain open to the fact that people may join our congregations and become trusted parts of our church communities in order to get easier access to abuse people. In our situation, we must remain aware that abusers can also be, for example, those in positions of leadership and trust including Elders, Presbyterian Women (PW) leaders or any others. 

Familial abuse – Abuse of a vulnerable person by a family member.

Professional abuse – Misuse of power and trust by professionals and a failure to act on suspected abuse, poor care practice or neglect.

Peer abuse –  Abuse, for example, of one adult with a disability by another adult with a disability. 

Stranger abuse – Abuse by someone unfamiliar to the vulnerable person.

(Safeguarding Vulnerable Persons at Risk of Abuse National Policy and Procedures)

A focused look at definitions of abuse

Physical abuse

Physical abuse is physical force or mistreatment of one person by another that might or might not cause physical injury. This type of abuse includes:

• hitting
• pushing
• rough handling
• exposure to heat or cold
• force feeding
• improper administration of medication
• denial of treatment
• misuse or illegal use of restraint
• not being allowed to go where you wish, when you wish

Signs of physical abuse are:

• fractures
• bruising
• burns
• pain
• marks
• not wanting to be touched

Psychological (or emotional) abuse

Psychological or emotional abuse is harmful behaviour that can cause mental distress. It can involve both verbal and non-verbal abuse that can scare, humiliate and isolate a person.

This may include:

• threats
• humiliation or ridicule
• provoking fear of violence
• shouting, yelling and swearing
• blaming
• controlling
• intimidation
• coercion

Signs of psychological abuse are:

• being withdrawn
• being too eager to do everything they are asked
• showing compulsive behaviour
• not being able to do things they used to
• not being able to concentrate or focus

Financial abuse

Financial abuse happens if someone tries to steal, steals or defrauds you of your money, goods or property. This includes:

• exploitation
• embezzlement
• withholding pension or benefits
• exerting pressure around wills, property or inheritance

Signs of financial abuse are:

• having unusual difficulty with finances
• not having enough money
• being too protective of money and things they own
• not paying bills
• not having normal home comforts

Institutional abuse

Institutional abuse is the mistreatment or neglect of an adult at risk by a regime or individuals. It takes place within settings and services that adults at risk live in or use, including any organisation, in or outside the health and social care sector.

Institutional abuse may occur:

• when routines, systems and regimes result in poor standards of care
• when poor practice and behaviours are in place
• within strict regimes and rigid routines that violate the dignity and human rights of the adults and place them at risk of harm
• within a culture that denies, restricts or curtails privacy, dignity, choice and independence

Possible signs are:

• the person has no personal clothing or belongings
• there is no care plan for them
• they are admitted often to hospital
• professionals having treated them badly or unsatisfactorily or acting in a way that causes harm to the person

Neglect

Neglect occurs when a person deliberately withholds, or fails to provide, suitable and adequate care and support needed by another adult. It may be through a lack of knowledge or awareness, or through a decision not to act when they know the adult in their care needs help. It may impair the health or well-being of an adult.

Possible signs are:

• having pain or discomfort
• being very hungry, thirsty or untidy
• failing health

Exploitation

Exploitation is the deliberate maltreatment, manipulation or abuse of power and control over another person. It is taking advantage of another person or situation usually, but not always, for personal gain.

Exploitation comes in many forms, including:

• slavery
• being controlled by a person or a group
• forced labour
• domestic violence and abuse
• sexual violence and abuse
• human trafficking

Recognising signs of harm or abuse

You might become aware that an adult is at risk of harm when:

• you see or hear something
• they tell you about abuse, exploitation or neglect happening to them
• a friend, family member or somebody tells you something that causes you concern
• you notice injuries or physical signs that cause you concern
• you notice the victim or abuser behaving in a way that alerts something may be wrong

Sexual Abuse

Sexual abuse is unwanted sexual activity or sexual behaviour that happens without consent or understanding.

Sexual violence and abuse can be physical contact or non-contact sexual activities, such as:

• indecent exposure
• stalking
• grooming
• being forced to look at or be involved in producing sexually abusive material
• being forced to watch sexual activities

Possible signs are:

• genital itching, soreness or having a sexually transmitted disease
• using bad language
• not wanting to be touched
• behaving in a sexually inappropriate way
• changes in appearance

Domestic abuse

Domestic abuse isn’t always physical. Coercive control is at the heart of domestic abuse. It is a pattern of controlling behaviours and acts that may include threats, humiliation and intimidation, assaults or other abuse, which is used to harm, punish or frighten the victim (Women’s Aid). This controlling behaviour is designed to make a person dependent on their abuser by isolating them from family, friends and support services, exploiting them, humiliating and degrading them and regulating their everyday behaviour. It can be a gradual process that over time can lead to a total loss of confidence and sense of self.

Examples of coercive behaviour include:

• Love bombing, e.g. being showered with gifts and compliments, wanting the person’s undivided attention, calling and texting frequently, or getting upset when boundaries and limits are put up. Abusers lavish the person with attention or affection, in order to influence or manipulate them
• Gaslighting, e.g. lying to the person, discrediting them, minimising their thoughts and feelings, shifting the blame or an abuser retelling stories/events in ways that are in their favour
• Isolating from friends and family
• Depriving the person of basic needs
• Monitoring the person’s time
• Monitoring the person via online communication tools or spyware
• Taking control over aspects of everyday life, such as where the person can go, who they can see, what they can wear and when they can sleep
• Depriving the person of access to support services
• Repeated put downs, humiliating, degrading or dehumanising the person
• Controlling the person’s finances
• Threats and intimidation

Hate Crime

Any incident that constitutes a criminal offence perceived by the victim or any other person as being motivated by prejudice, discrimination or hate towards a person’s actual or perceived race, religious belief, sexual orientation, disability, political opinion or gender identity.

Human trafficking

Human trafficking involves the acquisition and movement of people by improper means, such as force, threat or deception, for the purposes of exploiting them. It can take many forms, such as domestic servitude, forced criminality, forced labour, sexual exploitation and organ harvesting. Victims of human trafficking can come from all walks of life; they can be male or female, children or adults, and they may come from migrant or indigenous communities.

Related definitions

Female genital mutilation (FGM) involves procedures that include the partial or total removal of the external female genital organs for cultural or other non-therapeutic reasons. The practice is medically unnecessary, extremely painful and has serious health consequences, both at the time when the mutilation is carried out and in later life. FGM is a criminal offence in the Republic of Ireland. 

Forced marriage is marriage conducted without the valid consent of one or both parties and where duress is a factor. Forced marriage is a criminal offence in Northern Ireland.

Honour based violence (HBV) is the term used to refer to a range of violent practices used to control behaviour within families or other social groups to sustain or promote perceived cultural and religious beliefs and/or honour. Such violence can occur when perpetrators perceive that a relative or another has shamed, or may shame, the family and/or community by breaking their ‘honour code’. The punishment can include assault, abduction, restrictions of liberty, confinement, threats and murder.

Online abuse can happen on any device connected to the web. Adults, like children, often use text messaging, email, apps, online chats and gaming sites regularly to communicate, and abuse can occur via any of these means. It can include adults being persuaded or forced to send sexually explicit images of themselves or to take part in sexual activities or conversations. It also includes exposing or showing pornography to another person.

Cultural and faith-based considerations

There are a number of additional risk factors that must be considered in recognising abuse in a faith context, like ours.

These risks can cause barriers to disclosure or reporting and include but are not limited to:

• strong beliefs can prevent adults from reporting concerns
• a sense of honour or shame can prevent adults from seeking help or reporting concerns
• strong cultural or religious belief in the sanctity of marriage may dissuade adults from reporting concerns
• opinions expressed by faith communities around young adults especially, regarding sex outside marriage, can cause a barrier for people to speak up about abuse
• social isolation can occur if an individual or family are seen to have acted outside of the community of faith in some manner
• religion or faith can be used as an explanation for abusive behaviours or can be used as a distraction, for example, used to accuse professionals of discrimination
• some professionals lack knowledge about specific cultures and religions and do not feel confident in challenging harmful practices
• Professionals want to be respectful of families’ cultural and religious practices but the desire to be culturally sensitive can result in professionals accepting lower standards of care (Culture and faith: learning from case reviews, June 2014, NSPCC)
• some extreme cases mean people who are seen as ‘disobedient’ or ‘different’ are believed to be possessed by a spirit controlling their behaviour. Individuals can be physically and emotionally abused in an effort to ‘exorcise’ the spirit
• harmful or unhealthy cultures or ministry practices can be created around the character and personality of a charismatic leader, giving opportunity to abuse a position of trust
• individuals can believe that the reputation of the Church is the most significant risk so do not respond appropriately to knowledge of abuse

Vulnerable Persons – Special Considerations 

(as per safeguarding vulnerable persons at risk of abuse national policy and procedures) 

Abuse of a vulnerable person may be a single act or repeated over a period of time. It may comprise one form or multiple forms of abuse. The lack of appropriate action can also be a form of abuse. Abuse may occur in a relationship where there is an expectation of trust and can be perpetrated by a person who acts in breach of that trust. Abuse can also be perpetrated by people who have influence over the lives of vulnerable persons, whether they are formal or informal carers or family members or others. It may also occur outside such relationships.

Abuse of vulnerable persons may take somewhat different forms and therefore physical abuse may, for example, include inappropriate restraint or use of medication. Vulnerable persons may also be subject to additional forms of abuse such as financial or material abuse and discriminatory abuse. 

It is critical that the rights of vulnerable persons to lead as normal a life as possible is recognised; in particular, deprivation of the following rights may constitute abuse:

• Liberty
• Privacy
• Respect and dignity
• Freedom to choose
• Opportunities to fulfil personal aspirations and realise potential in their daily lives
• Opportunity to live safely without fear of abuse in any form
• Respect for possessions

People with disabilities and older people may be particularly vulnerable due to:

• diminished social skills
• dependence on others for personal and intimate care
• capacity to report
• sensory difficulties
• isolation
• power differentials

CHAPTER END