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Adult Abuse


This could include people with learning disabilities, mental health problems, older people and people with a physical disabilities or impairments. This can include people who are vulnerable themselves as a consequence of their role as a carer for such a person. They may need additional support to protect themselves, for example, in situations such as domestic violence, physical frailty or chronic illness, sensory impairment, challenging behaviour, drug or alcohol problems.

Support provided should be appropriate to that person's physical and mental abilities, culture, religion, gender and sexual orientation and tailored to enable people to live lives that are free from violence, harassment, humiliation and degradation.

Adults may be permanently or temporarily resident within the boundaries of Lancashire and Cumbria, in all settings, including peoples own homes, care and nursing homes, day centres, places of work, colleges, hospitals and GP’s surgeries, for example.

Definition of Harm

'Harm' (regardless of whether the impact of this is significant or not) is defined as:

  • Ill treatment (including sexual abuse and forms of ill-treatment that are not physical);
  • The impairment of development and/or an avoidable deterioration in, physical or mental health; and
  • The impairment of physical, emotional, social or behavioural development or the impairment of health;
  • Conduct which appropriates or adversely affects property, rights or interests (theft or fraud, for example).

(Who Decides: Lord Chancellor's Department 1997; and the Law Commission Review of Adults Social Care Law consultation 2010).

The Care Act 2014 identifies a number of different types and patterns of Abuse and Neglect and the circumstances in which they may take place.

It is important to note that professionals should not limit their view on what constitutes abuse or neglect, as they can take many forms and the circumstances of the individual must always be considered.

Incidents of abuse may be one-off or multiple, and affect one person or more.

Professionals and others should look beyond single incidents or individuals to identify patterns of harm, just as the Care Quality Commission, as the regulator of service quality, does when it looks at the quality of care in health and care services. Repeated instances of poor care may be an indication of more serious problems and of what the Care Act now describes as organisational abuse. In order to see these patterns it is important that information is recorded and appropriately shared.

Patterns of Abuse

Patterns of abuse and abusing vary and reflect very different dynamics. These include:

  • Serial abuse in which the perpetrator seeks out and ‘grooms’ individuals. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse;
  • Long-term abuse in the context of an on-going family relationship such as domestic violence between spouses or generations or persistent psychological abuse; or
  • Opportunistic abuse such as theft occurring because money or jewellery has been left lying around.

Who Abuses and Neglects Adults?

Anyone can abuse or neglect adults including:

  • Spouses/partners;
  • Other family members;
  • Neighbours;
  • Friends;
  • Acquaintances;
  • Local residents;
  • People who deliberately exploit adults they perceive as vulnerable to abuse;
  • Paid staff or professionals; and
  • Volunteers and strangers.

Abuse can happen anywhere: for example, in someone’s own home, in a public place, in hospital, in a care home or in college. It can take place when an adult lives alone or lives with others.

While a lot of attention is paid, for example to targeted fraud or internet scams perpetrated by complete strangers, it is far more likely that the person responsible for abuse is known to the adult and is in a position of trust and power.

Physical Abuse

Physical Abuse is the non-accidental infliction of physical force that results (or could result) in bodily injury, pain or impairment.

Examples of physical abuse include:

  • Assault;
  • Hitting;
  • Slapping;
  • Pushing;
  • Kicking;
  • Pinching;
  • Shaking;
  • Scalding.

Physical abuse can also include:

  • Misuse of medication;
  • Prolonged exposure to heat or cold;
  • Force feeding;
  • Not giving/withholding adequate food or drink.

Potential indicators of physical abuse include:

  • Unexplained or inappropriately explained injuries;
  • Person exhibiting untypical self-harm;
  • Unexplained cuts or scratches to mouth, lips, gums, eyes or external genitalia;
  • Unexplained bruising to the face, torso, arms, back, buttocks, thighs, in various stages of healing. Collections of bruises that form regular patterns which correspond to the shape of an object or which appear on several areas of the body;
  • Unexplained burns on unlikely areas of the body (e.g. soles of the feet, palms of the hands, back), immersion burns (from scalding in hot water/liquid), rope burns, burns from an electrical appliance;
  • Unexplained or inappropriately explained fractures at various stages of healing to any part of the body;
  • Medical problems that go unattended;
  • Sudden and unexplained urinary and/or faecal incontinence;
  • Evidence of over/under medication;
  • Person flinches at physical contact;
  • Person appears frightened or subdued in the presence of particular people;
  • Person asks not to be hurt;
  • Sudden weight loss or weight gain;
  • Person may repeat what the alleged abuser has said (e.g. ‘Shut up or I’ll hit you’);
  • Reluctance to undress or uncover parts of the body.

Restraint

Unlawful or inappropriate use of restraint or physical interventions and/or Deprivation of Liberty is physical abuse.

There is a distinction to be drawn between restraint, restriction and deprivation of liberty. A judgement as to whether a person is being deprived of liberty will depend on the particular circumstances of the case, taking into account the degree of intensity, type of restriction, duration, the effect and the manner of the implementation of the measure in question.

In extreme circumstances, unlawful or inappropriate use of restraint may constitute a criminal offence. Someone is using restraint if they use force, or threaten to use force, to make someone do something they are resisting, or where a person’s freedom of movement is restricted, whether they are resisting or not.

Restraint covers a wide range of actions. It includes the use of active or passive means to ensure that the person concerned does something, or does not do something they want to do, for example, the use of key pads to prevent people from going where they want from a closed environment.

Appropriate use of restraint can be justified to prevent harm to a person who lacks capacity as long as it is a proportionate response to the likelihood and seriousness of the harm.

Sexual Abuse

Sexual abuse is the direct or indirect involvement in sexual activity without Consent. This could also be the inability to consent, pressure or induced to consent or take part. Sexual abuse includes rape, indecent assault, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts to which the adult has not consented or was pressured into consenting.

This also includes the involvement of an adult in sexual activity or relationships, which they cannot understand, or have been coerced into because the other person is in a position of trust, power or authority (e.g. day centre worker, residential worker/health worker etc.)

Denial of a sexual life to consenting adults is also considered abusive practice.

Potential Indicators of sexual abuse include:

  • Person has urinary tract infections, vaginal infections or sexually transmitted infections that are not otherwise explained;
  • Person appears unusually subdued, withdrawn or has poor concentration;
  • Person exhibits significant changes in sexual behaviour or outlook;
  • Person experiences pain, itching or bleeding in the genital/anal area;
  • Person’s underclothing is torn, stained or bloody;
  • A woman who lacks the mental capacity to consent to sexual intercourse becomes pregnant.

Psychological Abuse

Psychological abuse (sometimes called Emotional Abuse) is behaviour that has a harmful effect on the adult’s emotional health, well-being and development. It is the denial of a person’s human and civil rights including choice and opinion, privacy and dignity and being able to follow one’s own spiritual and cultural beliefs or sexual orientation.

Examples of Psychological Abuse include:

  • Threats of harm or abandonment;
  • Deprivation of contact;
  • Humiliation or blaming;
  • Controlling;
  • Intimidation;
  • Cyber bullying;
  • Coercion;
  • Indifference;
  • Harassment;
  • Verbal abuse (including shouting or swearing); and
  • Isolation or withdrawal from services or support networks.

Potential indicators of psychological abuse include:

  • Untypical ambivalence, deference, passivity, resignation;
  • Person appears anxious or withdrawn, especially in the presence of the alleged abuser;
  • Person exhibits low self-esteem;
  • Untypical changes in behaviour (e.g. continence problems, sleep disturbance);
  • Person is not allowed visitors/phone calls;
  • Person is locked in a room/in their home;
  • Person is denied access to aids or equipment, (e.g. glasses, dentures, hearing aid, crutches, etc.);
  • Person’s access to personal hygiene and toilet is restricted;
  • Person’s movement is restricted by use of furniture or other equipment;
  • Bullying via social networking internet sites and persistent texting.

Financial or Material Abuse

Financial abuse is the main form of abuse by the Office of the Public Guardian both amongst adults and children at risk. Financial recorded abuse can occur in isolation, but as research has shown, where there are other forms of abuse, there is likely to be financial abuse occurring. Whilst this is not always the case, staff and volunteers need to aware of and vigilant to this.

Examples of Financial/Material Abuse include:

  • Fraud;
  • Exploitation;
  • Pressure in connection with wills, property or inheritance or financial transactions; or
  • The misuse or misappropriation of property, possessions or benefits.

It also includes the withholding of money or the unauthorised or improper use of a person’s money or property, usually to the disadvantage of the person to whom it belongs.

Staff borrowing money or objects from a service user is also considered financial abuse.

Potential indicators of financial/material abuse include:

  • Lack of heating, clothing or food;
    • Inability to pay bills/unexplained shortage of money;
    • Change in living conditions.
  • Unexplained withdrawals from accounts;
    • Unexplained loss/misplacement of financial documents;
    • The recent addition of authorised signers on a client or donor’s signature card.
  • Disparity between assets/income and living conditions;
  • Power of attorney obtained when the person lacks the Capacity to make this decision;
  • Sudden or unexpected changes in a will or deeds/title of house or other financial documents;
  • Recent acquaintances expressing sudden or disproportionate interest in the person and their money;
  • Service user not in control of their direct payment or individualised budget;
  • Mis-selling/selling by door-to-door traders/cold calling;
  • Illegal money-lending.

Financial abuse has the potential to significantly threaten an adult’s health and well being.

Neglect and Acts of Omission

Neglect is the failure of any person who has responsibility for the charge, care or custody of an adult to provide the amount and type of care that a reasonable person would be expected to provide.

Behaviours that can lead to neglect include:

  • Ignoring medical, emotional or physical care needs;
  • Failure to provide access to appropriate health, care and support, or educational services;
  • The withholding of the necessities of life, such as medication, adequate nutrition and heating (this may also constitute physical abuse if the person’s physical health is adversely affected).

Neglect also includes a 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.

Neglect and poor professional practice may take the form of isolated incidents or pervasive ill treatment and gross misconduct. Repeated instances of poor care may be an indication of more serious problems.

Neglect can be intentional or unintentional.

Potential indicators of Neglect and Acts of Omission include:

  • Person has inadequate heating and/or lighting;
  • Person’s physical condition/appearance is poor (e.g. ulcers, pressure sores, soiled or wet clothing);
  • Person is malnourished, has sudden or continuous weight loss and/or is dehydrated;
  • Person cannot access appropriate medication or medical care;
  • Person is not afforded appropriate privacy or dignity;
  • Person and/or a carer has inconsistent or reluctant contact with health and/or care and support services;
  • Callers/visitors are refused access to the person;
  • Person is exposed to unacceptable risk.

Self-Neglect

This covers a wide range of behaviours including neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. Safeguarding partnerships can be a positive means of addressing issues of self-neglect. The Safeguarding Adults Board is a multi-agency group that is the appropriate forum where strategic discussions can take place on dealing with what are often complex and challenging situations for practitioners and managers as well as communities more broadly.

Organisational Abuse (previously known as Institutional Abuse)

Organisational Abuse includes neglect and poor care practice within an institution or specific care setting such as a hospital or care home or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment.

It may be a result of regimes, routines, practices and behaviours that occur in services that adults live in or use and which violate their human rights. This may be part of the culture of a service to which staff are accustomed and may pass by unremarked upon. They may be subtle, small and apparently insignificant, yet together may amount to a service culture that denies, restricts or curtails the dignity, privacy, choice, independence or fulfilment of individuals.

Organisational Abuse is most likely to occur when staff:

  • Receive little support from management;
  • Are inadequately trained;
  • Are poorly supervised and poorly supported in their work;
  • Receive inadequate guidance.

The risk of abuse is also greater in services:

  • With poor management;
  • With too few staff;
  • Which use rigid routines and inflexible practices;
  • Which do not use a person-centred approach;
  • Where there is a closed culture;
  • Where there are inadequate quality assurance and monitoring systems in place.

Potential indicators of Organisational Abuse include:

  • Unnecessary or inappropriate rules and regulations;
  • Lack of stimulation or the development of individual interests;
  • Inappropriate staff behaviour, such as the development of factions, misuse of drugs or alcohol, failure to respond to leadership;
  • Restriction of external contacts or opportunities to socialise;
  • Staff attitudes, where staff may view clients negatively, treating them like children, not involving them in making choices as they seem too confused or disabled. Staff may think that if clients do not appear to understand then they can talk in front of them as if they are not there.

Discriminatory Abuse

The principles of Discriminatory Abuse are embodied in legislation including the following:

  • Race Relations Act 1976 (Amendments) Regulations 2003;
  • Disability Discrimination Act 1995;
  • Human Rights Act 1998.

Discriminatory Abuse links into all other forms of abuse.

Discriminatory Abuse exists when values, beliefs or culture result in a misuse of power that denies mainstream opportunities to some groups or individuals.

It is the exploitation of a person's vulnerability, resulting in repeated or pervasive treatment of an individual, which excludes them from opportunities in society, for example, education, health, justice, civic status and protection. It includes where a person or group is treated less favourably than any other person or group based on their colour, sex, age, disability, sexual orientation, religion, status, etc.

Examples of Discriminatory Abuse:

  • Unequal treatment;
  • Verbal abuse;
  • Inappropriate use of language;
  • Slurs;
  • Harassment;
  • Deliberate exclusion.

Signs and Symptoms of Discriminatory Abuse:

  • Lack of respect shown to an individual;
  • Signs of a sub-standard service offered to an individual;
  • Repeated exclusion from rights afforded to citizens such as health, education, employment, criminal justice and civic status;
  • Failure to follow the agreed care plans can result in the Adult at Risk being placed at risk.

Hate crime or incidents means any incident that is perceived by the victim, or any other person, to be racist, homophobic, transphobic or due to a person’s religion, belief, gender identity or disability. It should be noted that this definition is based on the perception of the victim a third party witnessing the incident. Such incidents may constitute a criminal offence.

Anyone can be a victim of hate crime or incidents regardless of race, age, disability, sexuality or gender. Lesbian, gay, bisexual and transgender (LGBT) individuals could face additional concerns around homophobia and gender discrimination. Individuals may be concerned that they would not be recognised as victims or be believed and taken seriously. Abusers may also control their victims, threatening to ‘out’ them to friends, family or support agencies. Local authorities have a range of support services and advice for professionals in place.

Hate crime or incidents that involve an adult covered by the adult safeguarding procedures should be raised as a safeguarding concern and action co-ordinated under these procedures. The police and other organisations should work together to ensure a robust, co-ordinated and timely response to these situations. Co-ordinated action will aim to ensure that the person is offered support and protection, and action is taken to identify and, where appropriate, prosecute those responsible.

Domestic Violence and Abuse/MARAC

Introduction

The official Government definition of domestic violence and abuse is:

“Any incident or pattern of incidents of controlling, coercive or 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. This can encompass but is not limited to the following types of abuse:

  • Psychological;
  • Physical;
  • Sexual;
  • Financial;
  • Emotional.

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 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.”

This definition includes honour based violence, female genital mutilation (FGM) and forced marriage (see Adult(s) at Risk Procedure), and is clear that victims are not confined to one gender or ethnic group.

The majority of domestic abuse is committed by men towards women. It can also involve men being abused by their female partners, abuse in same sex relationships, and by young people towards other family members, as well as the abuse of older people in families. Domestic abuse occurs irrespective of social class, racial, ethnic, cultural, religious or sexual relationships or identity.

No one agency can address all the needs of people affected by, or perpetrating, domestic violence and abuse. For intervention to be effective agencies and partner organisations need to work together, and be prepared to take on the challenges that domestic violence and abuse creates.

Roles of Agencies

Professionals, carers or volunteers may be alerted to the possibility of domestic violence and abuse involving adults in a number of different ways. The most important thing to do is not to ignore your concerns. Consult with your manager / Designated or Named Professional. All professionals should undertake a Safe Lives DASH Risk Indicator Checklist with the individual when domestic violence and abuse is an issue. This should also be completed for 16 - 17 year old and vulnerable adult victims and referred to MARAC if necessary. Adults who may be vulnerable and at risk of domestic abuse should also be referred to the local authority Safeguarding Adults Team.

Adult Social Care

Adult Social Care has a responsibility to assist those who experience abuse through the provision of appropriate information, offering advice and support and signpost to other avenues of support. They have a statutory responsibility in respect of ensuring that adults at risk are protected from harm.  Where there is domestic violence and abuse within a family where children are present, consideration should always be given to an assessment of the child's needs being undertaken.

Education Services

All colleges of further and higher education should create and maintain a safe environment for young people and adults and have sound policies and procedures for managing situations where there are child welfare concerns. Staff who have day-to-day contact with adults have a crucial role to play in noticing indicators of possible abuse or neglect, including the possibility of domestic violence and abuse. Education department staff and schools have a duty to assist Children's and Adults Social Care by providing information where there are concerns about a safety or well-being.

Police

The police are often the first point of contact with families in which domestic violence and abuse takes place. Officers attending incidents where children are present in the household are aware of the need to ensure the safety and well-being of both the adult victim and any children and, in extreme cases, to take immediate protection measures and refer to Children's Social Care immediately.

When no children are identified in the household the police will take positive action as far as possible.

Specialist Domestic Violence and Abuse officers work together, within a Police Public Protection Unit. All incidents of domestic violence and abuse, reported to the Police are referred to the Unit, where a database is maintained, enabling links to be identified and case referrals to other agencies and support groups, to be made. 

Incidents involving serious domestic violence and abuse, repeat victims and persistent offenders, are dealt with by the Unit and, where appropriate, cases involving children are investigated by both domestic violence and abuse and child protection officers. Where children are, or are normally, present in households where such incidents have occurred, these cases will be referred to Children's Social Care by the Unit.

Health Service

All health care professionals must recognise that their response to individuals experiencing domestic violence and abuse is of great importance. It is essential that there is an understanding of the inter-relationship which frequently exists, between domestic violence and abuse and the abuse and neglect of vulnerable adults and children.

Where professionals believe that adults and children are at risk they must follow their safeguarding procedures and refer accordingly.

Probation Service

The Probation Service is often asked to complete pre-sentence reports on offenders whose index offence is one of domestic violence and abuse or whose history contains a pattern of domestic violence and abuse. Such assessments often lead to supervision within the community on community based orders or, in some cases, on prison licence after release from custodial sentences. Nationally accredited programmes are currently being developed in addition to individual one to one packages. Such cases are routinely subject to multi-agency oversight and liaison with the police, social services and other key voluntary and statutory agencies is critical to our role.

Safety of Professionals Working with Domestic Violence and Abuse

Care must be taken to assess any potential risks to professionals, carers or other staff who are involved in providing services to a family where domestic violence and abuse is, or has occurred.

A risk assessment should be undertaken. Professionals should speak with their manager and follow their own agency’s guidance for staff safety.

Managing Risk and Levels of Intervention

The Domestic Abuse, Harassment and Honour Based Violence (DASH) Identification and Risk Assessment Model

See Safe Lives Website.

Any agency identifying or receiving a disclosure of domestic abuse should complete an assessment of the risk of harm for the person experiencing this.

The DASH Risk Indicator Checklist is the preferred tool for assessing risk of harm in domestic abuse, stalking and ‘honour’-based violence cases. Staff conducting risk assessments using the DASH Risk Indicator Checklist should be trained in its use.

Where the risk of harm is assessed as high, or where there is evidence of escalation in the frequency or severity of abuse, a referral should be made to the local Multi-Agency Risk Assessment Conference (MARAC).

If a safeguarding adults concern indicates that the issue involves domestic abuse, stalking or ‘honour’-based violence, a decision must be taken at a safeguarding meeting, or earlier, regarding a referral to the MARAC and who should make that referral.

Whatever form it takes, domestic abuse is rarely a one-off incident and therefore the agencies should be aware that there may be a pattern of abusive and controlling behaviour through which the abuser seeks power over the victim. Domestic abuse occurs across society, regardless of age, gender, race, sexuality, wealth and geography. Children are also affected both directly and indirectly and there is also a strong correlation between domestic abuse and child abuse.

Given the prevalence of domestic homicides of a parent that are committed by a son or daughter, it is important that all agencies are robust in their interventions with interfamilial domestic abuse. Appropriate support services should be sought to meet the needs of the adult who is experiencing domestic abuse.

There are local procedures in place regarding the need to conduct a multi-agency review when a homicide relates to domestic violence. Domestic Homicide Reviews (DHR) are led by the police. Where the death of an adult covered by the Safeguarding Adults Procedures has involved domestic violence, the criteria for undertaking a Domestic Homicide review and a Safeguarding Adults Review (SAR) may both be met. In these situations there will be local arrangements in place for agreeing how this will be managed.

Referral to the Multi Agency Risk Assessment Conference

A MARAC is a local information-sharing meeting where the focus is domestic abuse cases of the highest risk. The meeting involves representatives of the local police, probation, health, children and adults safeguarding, housing practitioners, substance misuse services, Independent Domestic Violence Advisers (IDVAs) and other specialists from the statutory and voluntary sector.

The four aims of a MARAC are:

  • To safeguard any adults who are at high risk of domestic abuse;
  • To make links with other protection arrangements in relation to children, people causing harm and adults with care and support needs;
  • To safeguard staff;
  • To work towards addressing and managing the behaviour of the person causing harm.

Where the person experiencing domestic abuse is an adult covered by the safeguarding criteria, a concern should always be raised under the adult safeguarding procedures. A referral to the MARAC should be made on the basis of risk. The organisation that becomes aware of the domestic abuse should make the referral to the MARAC.

After sharing all relevant information that they have in relation to an adult experiencing domestic abuse, attendees discuss options for increasing the safety of that person and form a co-ordinated action plan. The MARAC will also discuss the risks posed to children and how to manage the person alleged to be causing the harm.

MARACs are based on a working assumption that no single agency or individual can see the complete picture of the life of a person at risk, but all may have insights that are crucial to their safety, as part of a co-ordinated community response to domestic abuse. The person at risk does not attend the meeting although their views are fed into the meeting by representatives who have been in contact with them. The MARAC will seek protection for those who disclose domestic abuse and are at highest risk of being injured or killed.

Each local authority has arrangements in place for making referrals to the MARAC, and to support people experiencing domestic abuse who are referred to these.

Any agency receiving a disclosure of domestic abuse is able to refer the case to the local MARAC once they have completed the safe Lives DASH risk identification checklist , and identify it as a high-risk case.

Relevant forms, agency toolkits and further information about the MARAC can be obtained through the Safe Lives website and on the relevant local authority’s website.

Action Plans and 3rd Party Information

After the meeting the MARAC administrator sends an action plan.

The representative will communicate the agreed actions to the social worker involved, ask for confirmation of when the actions are complete and update the administrator accordingly.

Minutes of the meeting will be shared with the allocated worker and saved in the client’s record in the safeguarding adults section.

Staff should be aware that these will contain sensitive third-party information which should not be routinely shared or disclosed outside formal protocols and only with due regard to data protection guidance.

Interface between the Safeguarding Adults Procedure and the MARAC

Where domestic abuse is being experienced by an individual who is also considered to be an adult covered by the safeguarding adults procedures, a safeguarding concern and a Safe Lives DASH risk assessment and referral should both be completed as soon as practicable.

The Pan Lancashire and Cumbria Adults Policy and Procedures provides the overarching process for ensuring the co-ordination of multi-agency involvement where an adult covered by the safeguarding procedures.

Domestic Violence Disclosure Scheme (‘Clare’s Law’)

The Domestic Violence Disclosure Scheme (DVDS) (also known as ‘Clare’s Law’)  commenced in England and Wales on 8 March 2014. The DVDS gives members of the public a formal mechanism to make enquires about an individual who they are in a relationship with, or who is in a relationship with someone they know, where there is a concern that the individual may be violent towards their partner. This scheme adds a further dimension to the information sharing about children where there are concerns that domestic violence and abuse is impacting on the care and welfare of the children in the family.

Members of the public can make an application for a disclosure, known as the ‘right to ask’. Anybody can make an enquiry, but information will only be given to someone at risk or a person in a position to safeguard the victim. The scheme is for anyone in an intimate relationship regardless of gender.

Partner agencies can also request disclosure is made of an offender’s past history where it is believed someone is at risk of harm. This is known as ‘right to know’.

If a potentially violent individual is identified as having convictions for violent offences, or information is held about their behaviour which reasonably leads the police and other agencies to believe they pose a risk of harm to their partner, the police will consider disclosing the information. A disclosure can be made if it is legal, proportionate and necessary to do so.

For further information, see Domestic Violence Disclosure Scheme (GOV.UK website).

Forced Marriage

Forced marriage is a form of child/domestic abuse and should be treated as such. Forced marriage affects people from many communities and cultures. Cases should be tackled using existing structures, policies and procedures designed to safeguard children, adults with support needs and victims of domestic abuse.

Forced marriage cannot be justified on religious grounds, every major faith condemns it and freely given consent to marriage is a pre-requisite of Christian, Jewish, Hindu, Muslim and Sikh marriages. 'Forced marriages' is an abuse of human rights. It can happen to both men and women although most cases involve young women and girls aged between 13 and 30. There is no “typical” victim of forced marriage. Some may be under 18 years old, some may be over 18 years old, some may have a disability, some may have young children and some may be spouses from overseas.

The joint Foreign and Commonwealth Office and the Home Office Forced Marriage Unit is the United Kingdom’s ‘one stop shop’ for developing government policy on forced marriage, coordinating outreach projects and providing support and information to professionals and those at risk.

Forced marriage has many parallels with domestic abuse and child abuse. A clear distinction must be made between a forced marriage and an arranged marriage. In arranged marriages, the families of both spouses take a leading role in arranging the marriage but the choice whether or not to accept the arrangements remains with the adult or young person. In forced marriage one or both spouses do not consent to the marriage and some element or duress is involved. Duress may include physical and or emotional abuse. In some cases people may be taken abroad without knowingly that they are to be married. When they arrive in the country their passports may be taken by their family to try and stop them from returning home.

Legal Position

Anyone threatened with forced marriage or forced to marry against their will can apply for a Forced Marriage Protection Order. Third parties, such as relatives, friends, voluntary workers and police officers, can also apply for a protection order with the leave of the court. Local authorities can seek a protection order for Adults at Risk and children without leave of the court. Guidance published by the Ministry of Justice explains how local authorities can apply for protection orders and provides information for other agencies. (This is available at the GOV.UK website).

The Anti-social Behaviour, Crime and Policing Act 2014 made it a criminal offence, with effect from 16 June 2014, to force someone to marry. This includes:

  • Taking someone overseas to force them to marry (whether or not the forced marriage takes place);
  • Marrying someone who lacks the mental Capacity to consent to the marriage (whether they’re pressured to or not).

Breaching a Forced Marriage Protection Order is also now a criminal offence. The civil remedy of obtaining a Forced Marriage Protection Order through the family courts, as set out above, continues to exist alongside the criminal offence, so victims can choose how they wish to be assisted.

Forcing someone to marry can result in a sentence of up to 7 years in prison.

Disobeying a Forced Marriage Protection Order can result in a sentence of up to 5 years in prison.

Honour Based Abuse

The terms honour crime, honour-based abuse or izzat (an Urdu work which means protecting family honour) embrace a variety of crimes of violence (mainly but not exclusively against women), including assault, imprisonment and murder, where the person is being punished by their family or their community.

They are being punished for actually, or allegedly, undermining what the family or community believes to be the correct code of behaviour. In transgressing this correct code of behaviour, the person shows that they have not been properly controlled to conform by their family and this is to the “shame” or “dishonour” of the family.

Welchman and Hossain state “The term crimes of honour encompasses a variety of manifestations of violence against women; including murder termed “honour killings”, assault, confinement or imprisonment and interference with choice in marriage where the publicly articulated justification is attributed to a social order claimed to require the preservation of a concept of honour vested in male family and or conjugal control over women and specifically women’s sexual conduct – actual, suspected or potential.”

Multi-Agency Guidelines: Actions to be Taken in all Cases

Cases of forced marriage can involve complex and sensitive issues that should be handled by a child protection or Safeguarding Adults specialist with expertise in forced marriage. The statutory guidance on forced marriage states that all organisations should have “a lead person with overall responsibility for safeguarding children, protecting Adults at Risk or victims of domestic abuse. Although front line staff should contact specialists as soon as possible, there may be occasions when they will need to gather some information from the person to establish the facts and assist the referral.

First Steps in all Cases:
  • See them immediately in a secure and private place where the conversation cannot be overheard;
  • See them on their own – even if they attend with others;
  • Explain all the options to them;
  • Recognise and respect their wishes;
  • Perform a risk assessment;
  • Contact, as soon as possible, a trained specialist who has responsibility for forced marriage;
  • If the young person is under 18 years of age, refer them to the designated person with responsibility for safeguarding children and activate local safeguarding procedures;
  • If the person is an adult with support needs, refer them to the person with responsibility for safeguarding Adults at Risk;
  • Reassure them about confidentiality i.e. practitioners will not inform their family;
  • Establish a way of contacting them discreetly in the future;
  • Obtain full details to pass on to the trained specialist;
  • Consider the need for immediate protection and placement away from the family.
Do Not:
  • Send them away;
  • Approach members of their family or the community unless they expressly ask you to do so;
  • Share information with anyone without their express consent;
  • Breach confidentiality (see confidentially and sharing information safely);
  • Attempt to be a mediator.
Additional Steps:
  • Give them, where possible, the choice of the ethnicity and gender of the specialist who deals with their case;
  • Inform them of their right to seek legal advice and representation;
  • If necessary, record any injuries and arrange a medical examination;
  • Give them personal safety advice;
  • Develop a safety plan in case they are seen i.e. prepare another reason why you are meeting;
  • Establish if there is a family history of forced marriage, e.g. siblings forced to marry. Other indicators may include domestic violence, self-harm, family disputes, unreasonable restrictions (e.g. withdrawal from education or “house arrest”) or missing persons within the family;
  • Advise them not to travel overseas. Discuss the difficulties they may face;
  • Identify any potential criminal offences and refer to the police if appropriate;
  • Give them advice on what service or support they should expect and from whom;
  • Ensure that they have the contact details for the trained specialist;
  • Maintain a full record of the decisions made and the reason for those decisions;
  • Information from case files and database files should be kept strictly confidential and preferably be restricted to named members of staff only;
  • Refer them, with their consent, to appropriate local and national support groups, counselling services and women’s groups that have a history of working with survivors of domestic abuse and forced marriage.
Remember:

When referring a case of forced marriage to other organisations, ensure they are capable of handling the case appropriately. If in doubt, approach established women’s groups who have a history of working with survivors of domestic abuse and forced marriage and ask these groups to refer the person to reputable agencies. Circumstances may be more complex if the person is lesbian, gay, bisexual or transgender. British Embassies and High Commissions can only help British nationals or, in certain circumstances EU or Commonwealth nationals. This means that if a non-British national leaves the UK to be forced into marriage overseas, the British Embassy or High Commission will not be able to assist them.

Confidentiality and Sharing Information Safely

A dilemma may occur because someone facing forced marriage may be concerned that if confidentiality is breached and their family finds out that they have sought help they will be in serious danger. On the other hand, those facing forced marriage are often already facing serious danger because of domestic abuse, “honour-based” violence, rape, imprisonment etc. Therefore, in order to protect them, it may be necessary to share information with other agencies such as the police.

Consequently, confidentiality and information sharing are going to be extremely important for anyone threatened with, or already in, a forced marriage. Practitioners need to be clear about when confidentiality can be promised and when information may need to be shared.

Circumstances sometimes arise where a child, or more probably a young person, explicitly asks a practitioner not to give information to their parents/guardians or others with some authority over them. Their request for confidentiality should be upheld.

If a decision is made to disclose confidential information to another person, (usually another practitioner) the practitioner should seek the consent of the person before the disclosure. Most people will consent to the disclosure if they receive a careful explanation of why the disclosure is to be made and are assured about their safety (e.g. information will not be passed to their family) and what will happen following such a disclosure. Whether or not the person agrees to the disclosure, they must be told if there is to be disclosure of confidential information.

Female Genital Mutilation

Female genital mutilation (FGM) is a collective term for procedures which include the removal of part or all of the external female genitalia 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. The procedure is typically performed on girls aged between 4 and 13, but in some cases it is performed on young women before marriage or pregnancy.

FGM has been a criminal offence in the U.K. since the Prohibition of Female Circumcision Act 1985 was passed. The Female Genital Mutilation Act 2003 replaced the 1985 Act and makes it an offence for the first time for UK nationals or permanent UK residents to carry out FGM abroad, or to aid, abet, counsel or procure the carrying out of FGM abroad, even in countries where the practice is legal.

It is increasingly found in Western Europe and other developed countries primarily among immigrant and refugee communities.

For further information, see Female Genital Mutilation: Multi-Agency Practice Guidelines (Department of Health, 2011).

Cultural Sensitivity

Investigating agencies need to be sensitive to the cultural beliefs surrounding FGM and should consult with cultural community groups (see Useful Organisations). However, professionals should not let fears of being branded 'racist' or 'discriminatory' weaken the protection required by vulnerable girls and women.

FGM is much more common than is generally realised both worldwide and in the U.K. It is deeply embedded in the culture of the practicing community who may resent what they perceive as the imposition of liberal western values on them, but it is not a matter which can be left to personal preference or culture and custom. FGM is an extremely harmful practice that violates the most basic human rights. However, any community education should be sensitive to cultural norms and pressures.

It may be most useful to try to engage community groups and elders or religious leaders in community education programmes. It is extremely important that those running programmes are not seen as alien to the practice. This may create animosity and paranoia within the practicing communities and make it harder to safeguard Adults at Risk from FGM.

For many families English may not be their preferred language, the assistance of an independent interpreter needs to be considered. Any interpreter should be appropriately trained in relation to FGM and should not be a family member, not be known to the individual, and not be an individual with influence in the individual's community. This is because girls or women may feel embarrassed to discuss sensitive issues in front of such people and there is a risk that personal information may be passed on to others in their community and place them in danger

The guidance recommends that a female professional be available to speak to if the girl or woman would prefer this.

Raising an Alert

If any agency becomes aware of an Adult at Risk who may have been subjected to or is at risk of FGM they must raise an Alert using the Stage One: Raising an Alert/Duty to Enquire Procedure.

Suspicions may arise in a number of ways that an Adult at Risk is being prepared for FGM to take place abroad.

All professionals need to consider whether any other indicators exist that FGM may have or has already taken place, for example:

  • Preparations are being made to take a long holiday;
  • The Adult at Risk has changed in behaviour after a prolonged absence from home; or
  • The Adult at Risk has health problems, particularly bladder or menstrual problems.

There may be older women in the family who have already had the procedure and this may prompt concern as to the potential risk of harm to other females in the same family.

It should be remembered that this is a one-off act of abuse to a child, although it will have lifelong consequences, and can be highly dangerous at the time of the procedure and directly afterwards.

Assessment and Case Management

Once an Alert has been raised, the case may progress though the safeguarding process as outlined in Part 2, Procedures (including how to make an alert).

Family and carers may genuinely believe that it is in the adult’s best interest to conform to their prevailing custom. The preferred outcome may be that the family agree to halt the process. Therefore the main emphasis of work in cases of actual or threatened FGM should be through education and persuasion.

Where an Adult at Risk appears to be in immediate danger of mutilation, legal advice should be sought, making it clear to the family that they will be breaking the law if they arrange for the adult to have the procedure.

Useful Organisations

Foundation for Women's Health, Research & Development (FORWARD)
Tel: 020 8960 4000

Black Women's Health and Family Support
Tel: 020 890 3503

Modern Slavery

Modern Slavery encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.

Human trafficking is the movement of a person from one place to another, using methods of deception, coercion, the abuse of power or of someone’s vulnerability and for the purposes of exploitation. It is possible to be a victim of trafficking even if their consent has been given to being moved. Human trafficking may occur across international borders or take place within one country.

According to the National Crime agency, there are three main elements:

  1. The movement: recruitment, transportation, transfer, harbouring or receipt of people;
  2. The control: threat, use of force, coercion, abduction, fraud, deception, abuse of power or vulnerability, or the giving of payments or benefits to a person in control of the victim;
  3. The purpose: exploitation of a person, which includes prostitution and other sexual exploitation, forced labour, slavery or similar practices, and the removal of organs.

If professionals believe a person is a victim of modern slavery they must follow safeguarding procedures for referral.

ICT Abuse

E-safety can be described as safeguarding all users of fixed and mobile devices that allow access to content and communications that could pose risks to personal safety and wellbeing. Examples are PCs, laptops, mobile phones and gaming consoles such as Xbox, Playstation and Wii. Examples of risks associated with information and communication technology are:

  • Content (vulnerable person as recipient);
  • Commercial (adverts, spam, sponsorship, personal information);
  • Aggressive (violent/hateful content);
  • Sexual (pornographic or unwelcome sexual content);
  • Values (bias, racism, misleading info or advice);
  • Contact (vulnerable person as participant);
  • Commercial (tracking, harvesting personal information;
  • Aggressive (being bullied, harassed or stalked);
  • Sexual (meeting strangers, being groomed);
  • Values (self-harm, unwelcome persuasions);
  • Conduct (vulnerable person as actor);
  • Commercial (illegal downloading, hacking, gambling, financial scams, terrorism);
  • Aggressive (bullying or harassing another);
  • Sexual (creating and uploading inappropriate material);
  • Values (providing misleading info or advice).

Signs and symptoms of ICT Abuse include:

  • Spending extended amounts of time online;
  • Secrecy over mobile phone and computer;
  • Withdrawal from social contact;
  • Depression;
  • Mood Swings;
  • Unexplained gifts;
  • Sleep disturbances;
  • Self-harming.

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