The purpose of this guide is to provide guidance to agencies and managers who have to address concerns raised where one Adult at Risk abuses another. It aims to provide advice about:
- When it is appropriate to address the concerns within the organisation;
- The decision-making process regarding the actions to be taken to support and protect both the victim and the alleged perpetrator.
It is important to ensure that service users are aware of the danger of abuse, the warning signs and indicators, and how they can get advice and help when needed.
All abuse is serious and needs to be recognised as such, Abuse by one Adult at Risk of another within a service setting should be addressed as a Safeguarding Adults issue. This means addressing what may have become culturally acceptable behaviour; this could be an acceptance that Adults at Risk abuse each other, or come from settings where behaviour and/or attitudes that are now considered abusive, were accepted and condoned by staff and/or Adults at Risk. Such situations have traditionally been framed in terms of the perpetrator’s challenging behaviour and are often not identified as abusive acts. The trigger for reporting concerns is the abusive act. When Adults at Risk are subject to sections of the Mental Health Act 1983, the Mental Capacity Act 2005 or to the Criminal Justice System, they are still entitled to be both protected from abuse and prevented from abusing other Adults at Risk.
Research has shown that where this kind of abuse is ignored or not addressed appropriately, the victims may suffer mental health problems, low self-esteem and may also become perpetrators of abuse against others.
Agencies and services that provide support to adults who present a wide range of challenging behaviours have a responsibility to safeguard them from abuse as well as preventing them from abusing other Adults at Risk.
Many provider organisations have become accustomed to responding internally to incidents of vulnerable service users who abuse other service users. This has meant that regulatory, contract and commissioning agencies, for both the victim and the perpetrator, may not have been informed of the concerns, or been given an opportunity to engage in decision making around the issues. It has also resulted in Safeguarding Adults Procedures being ignored and abuse that may also constitute a criminal offence not being addressed.
When a person has been placed with a service, that service has an obligation to ensure that they are provided with the appropriate support to meet their needs. Organisations that aim to provide support to service users who have challenging behaviours need to have an understanding of the history and needs of the person to ensure that they are able to both safeguard them from abuse and prevent them from abusing other Adults at Risk within the service. The organisation must ensure that the appropriate assessments are carried out accordingly and that they are able to meet the needs of the service user and develop a care plan to meet those needs.
An acceptance by the service of low level abuse/bullying from whatever source will ultimately, if allowed to continue, lead to a culture that is damaging to all service users and staff in that service. It is important, therefore, that all instances of abuse are recognised and reported to the Local Authority’s Safeguarding Adults Team using the Safeguarding Adult Concern (SAC) online form on the Safeguarding Adults Portal, which clearly indicates the level of harm as assessed using the Safeguarding Adults Threshold Guidance Tool. This in itself is insufficient to safeguard, and measures taken by the service to safeguard the individual(s) should be clearly identified on the SAC form.
It is not always necessary for every instance where one service user abuses another to be investigated formally using the Safeguarding Adults Procedures. It is however, important that such instances are recognised and dealt with appropriately and efficiently by the organisation caring for the individuals and that the individual who has been abused (or their family/advocate where appropriate, if they lack capacity) is fully involved in any decision about what they want to happen next and what outcome they want. It is important that, even if the incident is dealt with internally, all actions have been taken to safeguard and that risks have been brought down to the lowest level possible and that the local authority are notified using the SAC form as soon as possible after the incident has occurred or concern has been raised. This will ensure that all incidents of abuse, including those perpetrated by Adults at Risk, are recorded in accordance with the Care Act 2014, and brought to the attention of the local authority so they can assess and manage their statutory duty to make enquiries. In some cases, it may be that the local authority decides to convene a strategy discussion/meeting or request additional action to be taken, for example if the alleged abuse also constitutes a criminal matter, or of the matter is particularly complex or requires further investigation. It may also be the case if there has been more than one incident involving the same perpetrator or victim (referred in the past). In other instances it may be considered appropriate that the situation can be dealt with by implementing internal procedures, reviewing care plans and/or arranging multidisciplinary meetings, requesting re-assessment or altering service provision.
If there are any doubts about the course of action to take in these particular matters, the Responsible Person or Safeguarding Adults Lead in the worker’s own organisation should be contacted for advice. Who these individuals are should be clearly stated in the organisation’s Individual Agency Guidance, or as part of their Safeguarding Adult policy and procedures.
- Supporting Adults at Risk who may be Victims or Perpetrators
Raising safeguarding adults concerns can result in a variety of actions that affect victim, alleged perpetrator, service or setting, families and/or carers. However, the safeguarding process is managed, if post-abuse issues are not considered much of the effectiveness of the work will be jeopardised. Any post-abuse care plan or Safeguarding Plan may have cost implications, and these need to be discussed and agreed by funding agencies. It is important that the appropriate/key people and agencies responsible for any part of the care plan or Safeguarding Plan are quickly identified and involved. It is equally important that care plans or safeguarding plans are robustly monitored and reviewed to make sure that all actions are completed. It is particularly important to ensure that the individual is involved in defining not only what they would want to happen next and what outcome they want but that any post-incident review is compliant with the principles of making safeguarding personal.
The following points might assist in considering a post-abuse care plan or safeguarding plan for actions or support work that may be required.
4.1 For the Victim
- What the person wants. Is it personalised, has the person been involved, and if not why not? Where an individual does not have capacity is an advocate involved?
- Practical: home/community support services, closer oversight/monitoring, alternative accommodations, day care, short breaks, residential/nursing care, adaptations or aids, advocacy, medical treatment;
- Emotional: victim support, psychology, counselling, therapy, psychiatric assessment/treatment, advocacy;
- Legal/financial: money advice, legal advice regarding criminal/civil injury compensation, preparation for court;
- Educational: training to cover key areas:
- Sexuality and relationships;
- Social skills;
- Understanding what abuse is and safeguarding measures for the future, to enable them to protect themselves;
- Understand the implications of making unfounded accusations/allegations
4.2 For the Perpetrator
- Practical: home/community support services, short breaks or day care, longer term residential care, additional/closer monitoring and/or supervision, alternative accommodation, adaptations/aids, help with housing;
- Emotional: group support, counselling, advocacy, psychiatric/psychological input;
- Legal/financial: legal advice, money advice/debt counselling;
- Educational: training to cover key areas:
- Sexuality and relationships;
- Understanding about issues of abuse;
- Support to develop social skills
- Learning from Addressing Allegations of Abuse between Service Users
As in any other aspect of work, it is important to consider whether lessons can be learnt from the decisions and actions that were taken in the handling of any concern.
It might be useful to ask:
- Could this incident have been avoided?
- Have management and practice been reviewed to protect Adults at risk/vulnerable children in the future?
- Were other service users who are Adults at Risk, vulnerable children or staff at risk of abuse or harm?
- Was the appropriate action taken at the right time?
- Was the right support received? If not, what could be done to ensure it is received in the future?
- Have the appropriate risk assessments or risk management plans been undertaken?
- Have the needs, rights, views and opinions of both victim and perpetrator been considered?
- Was/is action clearly reflective of the principles of making safeguarding personal?
- Have the actions taken been recorded appropriately?
- Have care plans been revised and reviews set?
- Has the Safeguarding Adults Threshold Guidance Tool been applied to guide decision making?
- Have the Safeguarding Adults Team been informed by completing the Safeguarding Adults Concern (SAC) form online?
- Have safeguarding measures/action taken been identified to safeguard the individual/s?
- What has been learnt and what would be done differently next time?