Types of abuse

What is it?

Deliberately hurting an adult, causing injuries such as bruises, broken bones, burns or cuts, or otherwise causing harm.  It could also be when a carer fabricates the symptoms of, or deliberately induces illness, or misuses medication.

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 signs

• Multiple bruising
• Fractures
• Injuries in places not normally exposed to falls or rough games
• Burns
• Bed sores
• Fear
• Depression
• Unexplained weight loss
• Assault (can be intentional or reckless)
• Failure to seek medical treatment, or a pattern of visiting different hospitals or doctors over a short period of time.

Domestic abuse is any type of violence - or other abuse - that is present in close relationships. For example it could be between husband and wife; mother/father and their son/daughter; siblings; boyfriend and girlfriend; partner or ex-partner.

It can emerge through many other types of abuse: physical, sexual, emotional or financial, and can include undermining of self-confidence and the threat of violence.

Possible signs of domestic abuse:

• Low self-esteem
• Physical evidence of violence such as bruising, cuts, broken bones
• Verbal abuse and humiliation in front of others
• Fear of outside help and support
• Damage to home or property
• Isolation – not seeing friends and family
• Limited access to money

Sexual abuse is any sexual activity where a person has been forced or persuaded to take part, or doesn't understand.

Types

• Rape, attempted rape or sexual assault
• Inappropriate touching anywhere on the body
• 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
• Repeated urine infections or unexplained stomach pains, soreness or bruising around the genitals, sexually transmitted infections, unplanned, concealed or
  denied pregnancies
• Uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude
• Self-harming
• 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

Emotional maltreatment. It is sometimes called psychological abuse and can cause serious harm. It may involve:

• Isolation from services, social opportunities or friends
• Removing mobility of communication aids
• Intentionally leaving someone unattended when they need assistance
• Preventing expression of choice or opinion
• Failure to respect privacy
• Preventing stimulation, meaningful occupation or activities
• Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse
• Being patronising or infantilising towards an individual
• Cyber bullying
• Preventing access to services or support.

Possible signs:

• An air of silence when a particular person is present
• Withdrawal or noticeable changes mood or behaviour
• Depression, aggression, extreme anxiety
• Signs of distress, tearfulness, anger
• Obsessions, fears or phobias
• Sleep disorders, changes in appetite
• Going missing, stealing and lying
• Low self-esteem

Disciminatory abuse is where an individual is treated differently because of ethnicity, culture, sexuality, gender, age or disability.

Types

• 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 signs

• 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

Organisational abuse is where poor working practices in care homes or hospitals cause mistreatment by repeated poor or inadequate care, which violates a person's dignity and human rights.

Types

• Discouraging visits or the involvement of relatives or friends
• Run-down or overcrowded establishment
• 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
• 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 signs

• 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

Neglect is the ongoing failure to meet basic needs. The individual may be left hungry or dirty, without adequate clothing, shelter, supervision, medical/health care, and access to aids or equipment. They may not get the love, care and attention they need from their family or carers.

Types

• 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

Self-neglect is the lack of self-care; lack of care for one's environment; and/or the refusal of services, to an extent that it threatens personal health and safety.

Types of Self-Neglect:

• Lack of self-care
• 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

Possible signs to look out for:

• 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
• Hoarding
• 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

Modern Slavery is where an individual is exploited, forced to work, or sold.  It involves the recruitment and movement of individuals using threats, deception and coercion for the purpose of exploitation. Modern Slavery can take many forms:

Types

• Forced labour
• Domestic servitude
• Sexual exploitation, such as escort work, prostitution and pornography
• Human trafficking
• 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

Modern Slavery isn't confined to history or other countries, it is a global problem and is happening right now, here in Lancashire.  It's a problem that affects all ages, genders and ethnicities, and affects people from Britain and aboard.