Types of Abuse and Neglect

This includes being hit, slapped, kicked, pinched, inappropriate restraint, being force-fed or knowingly giving a person too much or not enough medication.

Possible signs and indicators of physical abuse include:

• Unexplained injuries
• Explanations not consistent with injury
• Clusters of injuries forming regular patterns
• Finger marks / slap marks
• Emotional distress / fear
• Multiple fractures
• Inappropriate use of physical restraint
• Medication misuse
• Injuries at different stages of healing

This involves a person being made to take part in sexual activity when they do not, or cannot, agree to this.

It includes rape, indecent exposure, inappropriate looking or touching, or sexual activity where the other person is in a position of power or authority.

Possible signs and indicators of sexual abuse include:

• Changes in behaviour or attitude, such as poor concentration, depression, withdrawal, sleep disturbance, self-harming.
• Bruising, particularly to the thighs, buttocks and upper arms and marks on the neck
• Pregnancy in women unable to consent to sexual intercourse
• Bleeding, pain or itching in the genital area
• Unusual difficulty in walking or sitting
• Infections, such as unexplained genital discharge or sexually transmitted diseases
• Incontinence note related to any medical diagnosis
• Torn, stained or bloody underclothing
• Excessive fear or apprehension of relationships
• Fear of receiving help with personal care
• Reluctance to be alone with a particular person.

This includes psychological, physical, sexual, financial or emotional abuse, by someone who is a family member or is, or has been, in a close relationship with the person being abused.

This may be a one-off incident or a pattern of incidents or threats, violence, controlling or coercive behaviour. It also includes so called ‘honour’ based violence, being forced to marry, or undergo genital mutilation.

Coercive or controlling behaviour is a core part of domestic violence. Coercive behaviour can include:

• Acts of assault, threats, humiliation and intimidation
• Harming, punishing, or frightening the person
• Isolating the person from sources of support
• Exploitation of resources or money
• Preventing the person from escaping abuse
• Regulating everyday behaviour

Possible signs and indicators of domestic violence and abuse include:

• Low self-esteem
• Feeling that the abuse is their fault when it is not
• Physical evidence of violence such as bruising, cuts, broken bones
• Verbal abuse and humiliation in front of others
• Fear of outside intervention
• Damage to home or property
• Isolation – not seeing friends and family
• Limited access to money

This includes misusing or stealing a person’s money or belongings, fraud, postal or internet scams tricking people out of money, or pressuring a person into making decisions about their financial affairs, including decisions involving wills and property.

Possible signs and indicators of financial abuse include:

• Missing personal possessions
• Unexplained lack of money or inability to maintain lifestyle
• Unexplained withdrawal of funds from accounts
• Power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity
• Failure to register an LPA after the person has ceased to have mental capacity to manage their finances, so that it appears that they are continuing to do so
• The person allocated to manage financial affairs is evasive or uncooperative
• The family or others show unusual interest in the assets of the person
• Signs of financial hardship in cases where the person’s financial affairs are being managed by a court appointed deputy, attorney or LPA
• Recent changes in deeds or title to property
• Rent arrears and eviction notices
• A lack of clear financial accounts held by a care home or service
• Failure to provide receipts for shopping or other financial transactions carried out on behalf of the person
• Disparity between the person’s living conditions and their financial resources, e.g. insufficient food in the house
• Unnecessary property repairs

This involves not meeting a person’s physical, medical or emotional needs, either deliberately, or by failing to understand these. It includes ignoring a person’s needs, or not providing the person with essential needs, such as medication, food, water, shelter and warmth.

Possible signs and indicators of neglect include:

• Poor environment, such as being 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

This involves a person being unable, or unwilling, to care for their own essential needs, including their health or surroundings (for example, their home is very unclean, refusal of necessary support, obsessive hoarding).

Possible signs and indicators of self-neglect include:

• 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
• Lack of engagement with health or social care services
• Inability or unwillingness to take medication or treat illness or injury

This includes being shouted at, ridiculed or bullied, threatened, humiliated, blamed or controlled by intimidation or fear.

It includes harassment, verbal abuse, online or mobile phone bullying and isolation.

Possible signs and indicators of neglect include:

• A change in behaviour when a particular person is presented
• Change in appetite
• Low self esteem / deference / passivity / resignation
• Fear / defensiveness / ambivalence
• Emotionally withdrawn
• Sleep disturbance
• Uncooperative or aggressive behaviour
• Signs of distress, such as tearfulness or anger

This includes forms of harassment, ill-treatment, threats or insults because of a person’s race, age, culture, gender, gender identity, religion, sexuality, physical or learning disability, or mental-health needs.

Possible signs and indicators of discriminatory abuse include:

• The person appearing withdrawn and isolated
• Expressions of anger, frustration, fear or anxiety
• Lack of respect shown to an individual
• Signs of a sub-standard service being offered to a person
• Repeated exclusion from rights afforded to citizens such as health, education, employment

Discriminatory abuse can also be called ‘hate crime’.  Hate crime is the targeting of individuals, groups and communities because of who they are.  It is any incident which is a criminal offence and which is thought, by you or someone else, to be motivated by a hostility or prejudice based on race, ethnicity, religious beliefs, gender, gender identity, disability, age, sexual orientation or any other actual or seeming difference.

This can include:

• Threats, bullying or intimidation
• Threatening or offensive mail, texts or emails
• Verbal abuse
• Damage to property
• Physical assaults

It is important to report all hate incidents, even if you think nothing can be done as it helps the police and other agencies identify areas of concern, patterns of behaviour and what is happening in our communities. Hate crimes are not only crimes against the targeted victim, but also against a particular group as a whole.

This includes human trafficking, slavery, domestic servitude, a person being forced to work for little or no pay (including in the sex trade), being held against their will, tortured, abused or treated badly by others.

Possible signs and indicators of modern slavery include:

• 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

The Home Office have produced a range of modern slavery guidance documents.

More information about modern slavery and how to combat it is available on the following webpages / websites:

• Sussex Police Modern Slavery
• Safe in East Sussex
• Anti-Slavery
• Stop the Traffik
• Office of the Independent Anti-Slavery Commissioner

This includes neglect and providing poor care in a care setting such as a hospital or care home, or in a person’s own home. This may be a one-off incident, repeated incidents or on-going ill-treatment.

It could be due to neglect or poor care because of the arrangements, processes and practices in an organisation.

Possible signs and indicators of organisational abuse include:

• 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
• Misuse of medication
• Inappropriate restraint methods
• Sensory deprivation, for example not providing hearing aids or spectacles
• Regimented routines, for example around mealtimes and bed times
• Poor record-keeping and missing documents, including an absence of individual care plans
• Denial to or absence of visitors
• Few social, recreational and educational activities
• Inappropriate staffing levels / lack of supervision and training
• Lack of management overview and support