Abuse is the violation of an individual’s human and civil rights by any other person or persons’. Abuse can be a single act, repeated acts, psychological, physical, verbal, inability to consent, no consent in transactions, and can occur in relationships. The outcome of abuse can lead to significant harm; physical or psychological, exploitation and/or denial of rights.
Types of Abuse
Physical abuse is non-accidental harm to the body caused by the use of force or violence that results in pain, injury or a change in the person’s physical estate. It includes assault, battery, and inappropriate restraint. Physical abuse may be carried out by care workers who lose their temper with a service user because they are being difficult or in retaliation. Examples of physical abuse include:
1. Punching – bruising to parts of the body.
2. Hitting – bruising, outlines of objects on skin.
3. Restraining – signs of pinching.
4. Slapping – hand prints on parts of the body.
5. Shaking – signs of hand grip marks to upper arms.
Sexual abuse is any kind of sexual activities or relationships directed towards a vulnerable adult without the person’s full knowledge and which they haven’t consented to and cannot consent to, or they can’t understand, or they are not able to consent to. Sexual abuse includes sexual assault, sexual harassment, and rape. Sexual abuse can happen to mentally capable adults by their spouse, partner, a family member or trusted people in their lives. It can also happen to mentally unable adults. Examples of sexual abuse include:
1. Enforced sexual contact – a service user is forced to take part in sexual activities that they do not want to take part in.
2. Sexual assault – any sexual behaviour that makes a person feel uncomfortable, frightened or threatened. It is sexual activity to which a person does not consent to.
Neglect is the failure to supply essential care, aid, guidance or attention that causes, or is reasonably expected to cause the person physical, mental or emotional harm or considerable damage to or loss of possessions. Recurring instances of poor care inside a care setting can be a sign of serious fundamental problems. For vulnerable adults, neglect may be self-imposed because of mental health problems. Examples of neglect include:
1. Failure to provide sufficient food, drink, heating, clothing – could result into malnutrition and hyperthermia
2. Failure to ensure access to health and social care services – not giving people access to care services.
3. Failure to ensure adequate hygiene and skin care – results in poor hygiene
4. Failure to administer medication – carers may not give medication to service users.
Financial or material abuse involves the use of a vulnerable person’s belongings, assets, income without their knowledgeable permission or making financial transactions that they do not understand to be of advantage to another person. Vulnerable adults are most at risk of financial abuse because they may be unaware of people taking their personal belongings and money. They may also be unaware of the consequences. Examples of financial/material abuse include:
1. Using pressure to obtain rights to a property – a carer may gain ownership of a service user’s asset.
2. Inappropriate use of financial ability or power of attorney – a carer may be given money by a service user to buy a gift for a relative, but the carer uses the money to buy something else for themselves.
3. Taking possessions – involves stealing service users belongings.
4. Stealing money as cash or from a bank – a carer may see some money on a service users table and just take it.
Psychological abuse is behaviour which has a harmful effect on a vulnerable adult’s emotional welfare and development. A person who is being abused may also be threatened to make them keep quiet. Examples of psychological abuse include:
1. Denial of choice – a care professional does not allow a service user to make choices for themselves.
2. Dignity, privacy and respect – a carer does not give a service user privacy, respect or dignity, this can leave the service user feeling uneasy.
3. Shouting and swearing – a carer constantly shouts and swears at a service user, which can lead to the service user feeling anxious.
4. Threats, insults and harassment – this can result in a service user feeling unwanted or useless.
Discriminatory abuse is behaviour that makes or sees a difference between people as a basis for prejudice and unfair treatment. It includes verbal abuse, harassment or other mistreatment based on a person’s ethnicity, race, gender, religion, age, culture, disability. Examples of discriminatory abuse include:
1. Racial or sexual harassment – a person may be abused because of their skin colour or sexuality.
2. Dislike towards a religious or cultural belief – an individual may be abused of their culture or religious beliefs.
3. Insults – a person may be insulted because of their ethnicity, race, gender, beliefs, age or disability.
Institutional abuse is a term used to describe a pattern of poor care within a care setting such as a hospital or care home. Individuals can be abused by the practices and procedures of the organisation that cares for them. Examples of institutional abuse include:
1. Service users are denied dignity and respect – this may occur throughout an organisation because of the procedures put in place.
2. Staff may be poorly trained and supervised – this can lead to care professionals abusing service users.
3. Abusive care carried out by a particular group of staff – there may be a group of staff within an organisation that abuse service users.
Exploitation means taking advantage of someone for your own selfish purposes. Vulnerable adults are open to exploitation in many ways. One of the main forms of exploitation relates to financial issues. Examples of exploitation include:
1. Forcing service users to change a will or sign over control of assets – this may occur because the service user may have a mental disability that makes them unaware of what they are doing.
2. Forcing a service user to sell or give away possessions or property – the service user may be unaware of the consequences as a result of their actions.
Indicators of Abuse
Real or suspected abuse may be revealed in a number of different ways. For example; a care professional may find that someone wants to tell you about it because they trust them, or it might be from someone who has observed the abuse taking place, or a doctor, when giving a service user with learning disabilities a health check, might come across unexplained injuries.
Unexplained injuries are mainly a result of physical abuse where a service user has been slapped, punched, hit or restrained. Unexplained injuries are usually confirmed by a doctor; however they may be found by any other care professional. Unexplained injuries are usually confirmed by a doctor because they need to identify when an injury is non-accidental. For example, an injury may result from a fall but it may not be clear whether the fall was a result of a push or an accidental trip. However, there are clear indicators of injuries that show signs of abuse. These indicators include, finger marks in bruises, cigarette burns, bruising around the mouth from force feeding, cuts and marks could also indicate self harm.
Poor hygiene is a result of neglect because this where a carer fails to provide adequate hygiene and skin care to a service user. Poor personal hygiene, particularly if someone is unable to care for themselves and relies on others for help, can indicate someone is suffering from depression. Indicators of poor hygiene include rashes on the skin, flaky skin where the skin is dry, acne: occurs when there is a build up of bacteria and uneven texture to the skin.
Behaviour changes are a result of emotional or psychological abuse because psychological abuse has an effect on a vulnerable adult’s emotional welfare and development. Changes in behaviour that appear to be out of character for a person should be investigated by care workers. Examples of changes in behaviour include, low self-esteem, sudden lack of motivation, mood swings and attention seeking behaviour. Indicators of changes in behaviour include differences to the way a person acts. For example, talking about suicide and having suicidal thoughts can reveal feelings of helplessness.
Financial difficulties are a result of financial or material abuse because this is where a person’s money or possessions have been stolen from them. Other indicators of abuse include unexplained withdrawals from bank accounts without any clear benefit to a person. This can lead to low amounts of food in an individual’s house and not wanting to turn the heating on even when it’s cold. Occasionally it can be difficult to decide whether money was given or taken by a family member. Indicators of financial difficulties include a service user is unable to buy essential necessities such as food and drink. Another indicator is that a service user may be reluctant to use their heating, even when it is cold because they have been financially abused.
Factors That May Lead to Abuse
There are many factors that may lead to abuse. These include, people who are at greatest risk of being abused, and environments they are likely to be in, situations in which abuse may occur and the people who might abuse.
Adults Most at Risk
Adults most at risk are often referred to as vulnerable adults. There are different groups of people who seem to be more at risk of abuse than others. These groups are often of people with physical or learning disabilities and mental health difficulties. They also include older people and those with dementia, as well as people who have been abused in the past. People in these groups often do as they are asked and agree with anything that happens to them. This could be due to the medication that they take. These individuals’ illness, condition or age is likely to make them feel isolated and lonely. As a result of this, they usually have low self-expectations and low self-esteem. They also become reliant on their abusers for help, services and communication. Being vulnerable increases the fear of reaction from the abuser.
Individuals, with learning or physical disabilities, may be inexperienced and have very little sexual knowledge, which leaves them exposed to being taken advantage of. People who have been previously abused may see abuse as a persistence in different situations than normally.
These groups of people may be seen as vulnerable because, if people are unable to communicate verbally, they may have difficulty letting people know about their abuse. For example, carers taking sexual advantage of patients who are unconscious.
Care professionals provide care in a variety of different environments, and each setting can have the potential for abuse to occur. In a patient’s own home sexual abuse can take place especially if someone is living on their own. Financial abuse can also take place by a carer stealing a patient’s possessions. In residential care, institutional abuse can occur where there is poor management with poor understanding of care standards, lack of training, and/or denial of privacy when providing care. In hospitals, neglect can occur where care professionals fail to provide adequate food or drink, or fail to administer medication.
People who are short of mental capacity to give consent are vulnerable to exploitation. They are likely to be unaware of the consequences of their actions, and therefore unable to give knowledgeable consent.
People who are dependent on others for personal care may find that their social contact with others is limited. They may find that their main social contact is with their carers. This dependency can increase the helplessness of a person who is confused, weak or has a learning disability.
Adults who feel fear of reporting abuse may allow abuse to continue because they feel ashamed of what is happening and they don’t want other people to know by reporting it.
People who suffer from social isolation have little communication with others. This may happen in a care home because a person has an aggressive personality and other residents keep away from them. People who suffer from social isolation often don’t have someone they can talk to if they are being abused.
People Who Might Abuse
Abuse may be taken place by care professionals, other people using services, relatives, friends, volunteers and strangers. The potential for abuse is found in the interaction and powerlessness of an individual. The individual’s need for help with personal care increases the opportunity for abuse to occur. Abuse is a personal relationship that takes place behind closed doors therefore it is difficult to monitor.
Effects of two types of abuse
Abuse can affect every part of people’s lives. How a victim is affected by abuse depends on the victim’s age, how long they have been abused, who abused them and the type of abuse used. For example, a female who has been abused for a year may have different effects than a female who has been abused once or twice.
The short-term effects of sexual abuse are in the form of actions, feelings, thinking and physical. Effects of victims’ actions include showing aggression, having tantrums, isolating away from others, have little confidence in other people and themselves, and self-respect for their own body may change. These actions are a change in a person’s normal behaviour; if someone is normally quiet it doesn’t necessarily mean that they have been abused. So when looking for possible signs of abuse people often look for changes in behaviour.
Effects of a victims feelings include, fear, anxiety, panic attacks and anger. These feelings victims of abuse feel are different from their normal feelings. For example, if someone is usually fearful it doesn’t always mean that they have been abused.
Effects on a victims thinking includes, when a victim of sexual abuse is not sure what is right or wrong, not sure of boundaries, and asks themselves questions about why the abuse happened to them. For example a victim may ask what they did wrong or what they did to deserve what happened to them.
Physical effects of a victim include cuts, bruising, bleeding, abdominal pain, nausea and back pain. Physical effects are short term because it is assumed that a victim of abuse will heal from the physical harm of abuse.
Financial abuse can have a bad effect on victims’ health and welfare. Many adults who experience financial abuse also come across emotional abuse. Financial abuse can lead to continuing discomfort and financial strain in a victim’s life. It can leave a victim without money to purchase vital necessities including food, medications and transportation. Financial abuse may involve loss of personal possessions and assets. When abusers steal or control individual’s money or possessions, these individuals may have fewer means to take care of their own health, housing, good nutrition and activities.
A victim of financial abuse may feel hurt by their abuser’s behaviour, but they may not ask for the money back or talk about the situation. The situation could then become worse over time and could lead to physical abuse.
Long-Term Effects of Abuse
There are many long-term effects of abuse that can be broken down into categories including psychological, physical and social.
Social effects of abuse victims include the inability to trust themselves and other people around them. They have low self-esteem where they constantly doubt themselves. Effect on self-esteem has many effects in itself these include, self-imposed isolation, feelings of rejection and unimportance, over-reaction to criticism, and it can sometimes lead to thoughts about suicide (Wiki, Self-Esteem, 2012).
Social effects also include, victims can have a fear of being alone and become defensive where they are suspicious of what other people are doing. Abuse can also have an effect on their faith, employment, and sexuality. For example, a victim of abuse may not want to go to work because they are afraid of what other people may think or they are over-sensitive to power struggles or frequent job changes due to avoidance of conflict. (Long-Term Effects, 2012, pp. 10,11)
Psychological effects of victims of abuse include post-traumatic stress disorder (PTSD). The effects of PTSD include frequent nightmares, flashbacks: acting or feeling like the event is happening again, feelings of intense distress when reminded of the trauma, avoiding activities, places, thoughts or feelings that remind victims of the abuse, feeling separated from others, difficulty concentrating and feeling jumpy and easily surprised (PTSD, 2012).
Other psychological effects include increased sensitivity to touch: over-reaction to physical touch of any kind, even from trusted friends. Memory problems: inability to concentrate and memory blockages. Depression: feelings of hopelessness and thoughts of suicide.
Long-term physical effects of victims of abuse include, disability resulting from abuse. These disabilities can be physical and/or psychological. Physical disabilities resulting from abuse include deafness resulting from the abuser constantly shouting in a victim’s ear. Psychological effects include depression to the point of being disabling. Other physical effects include, infertility caused by sexual abuse, intentional obesity: someone may consider layers of to be layers of protection. Addictive behaviours including alcohol and other drugs, food, smoking as a way of coping with behaviour is also a physical effect.
From looking at the longer-term effects of abuse we can see that the long-term effects of abuse have an on-going impact on the quality of life and daily working of abuse victims. Abuse effects everyone differently, one person who has been abused, can go on to be an abuser, whereas others can focus on knowing what is right from wrong and doing what they can to change their lives.