What is Abuse?

What Do We Mean by Abuse?

Abuse is when someone does something to another person, which damages their quality of life or puts them at risk of harm.  Abuse can be a criminal act when it is an offence against another person.  It can happen once or repeatedly.  It may be deliberate or caused by ignorance.

Abusers of adults can be anyone, but it is usually someone who is known to the victim.  Abuse can happen anywhere.  It may happen at home, in a care home, hospital, day centre or in a public place. 

Why Abuse Happens

Some abuse is deliberate but some occurs because of ignorance, lack of support or the stress of caring for someone.  Factors that lead to caring becoming abusive often occur in combination and while carers may be able to cope with a limited amount of stress, when factors occur together the strain of the situation may prove too much.

Forms of Abuse

Abuse can take many forms and may include:

• Physical Abuse - Being hit or injured on purpose. Restraining someone inappropriately.
• Emotional Abuse - Intimidation, threats, humiliation, extortion. Racial, verbal or psychological abuse.
• Sexual Abuse - Involvement in a sexual activity that is unwanted or not understood.  Unwanted sexual attention.
• Neglect / Deprivation Abuse - Not providing food clothing, attention or care.  Withholding of aids or equipment (continence, walking, hearing, glasses).  Putting someone at risk of infection.  Failure to provide access to appropriate health or social care.
• Imposed Isolation / Confinement Abuse - Being refused the company or others either at home or outside.  Sensory deprivation.
• Misuse of Medication Abuse - Inappropriately giving medication, overdosing or withholding it. 
• Financial / Material Abuse - The theft or misuse of money property or personal possessions.  Pressure in connection with wills, property or inheritance.
• Discriminatory Abuse - Threatening people differently or worse than you would want to be treated because they are older, more frail, confused or otherwise vulnerable.  Self inflicted injury may be a sign that abuse is taking place, e.g. because someone feels disturbed.
• Institutional Abuse - Repeated instances of poor care may be an indication of more serious problems. Neglect and poor professional practice may lead to other forms of abuse as defined above. This is sometimes referred to as institutional abuse.

Indicators of Abuse

These are some of the signs, which may indicate abuse particularly when a number of these signs are present:

• Seeking shelter or protection
• Unexplained reactions towards particular individuals
• Unexplained reactions towards particular settings
• Frequent or regular visits to the GP, or hospital casualty department, or hospital admissions
• Frequent or irrational refusal to accept investigations or treatments for routine difficulties
• Unexplained change in material circumstances
• Inconsistency of explanation or no explanation

Where the following 'trigger' behaviours are apparent in a client, these may be additional indicators that abuse is occurring:

• Destruction of physical environment
• Turning night into day/sleep disturbance
• Chronic incontinence
• Extreme physical and/or emotional dependence
• Verbal abuse and aggression towards the carer
• Changes in personality-caused by illness and/or medication
• Non-compliance with carers wishes
• Obsessive behaviour
• Wandering/absconding
• Self harm

The following problems exhibited by a carer may increase the risk and likelihood of an abusive situation:

• Alcoholism and / or drug dependency
• Mental illness
• Stress
• Chronic fatigue
• Conflicting demands of other family members
• Individual unmet needs

Organisational factors:

• Weak or oppressive management
• Inadequate staffing (numbers, competence)
• Inadequate staff supervision or support 
• Insufficient training
• Rigid routines
• Closed communication channels

Who may be an Abuser?

An abuser may be:

• a partner, child, relative, or other household member
• a friend or neighbour
• a volunteer worker
• a Health or Social Worker
• a member of staff in a care setting e.g. a residential or nursing home or supported living arrangement scheme
• another adult who may have separate safeguarding needs
• anyone else who has contact with the adult.