Safeguarding Adults at Risk

You may think that adult safeguarding requires professionals to take control whenever someone makes a risky choice. You may also assume that an adult who refuses help must be left entirely alone, or that mental capacity is determined by age, diagnosis or disability. Adult safeguarding must balance protection, autonomy, proportionality and the rights of other people who may be at risk.

Adult safeguarding protects safety and personal rights Adult safeguarding means protecting an adult's right to live safely and free from abuse and neglect while taking account of their wishes, feelings, beliefs and wellbeing. It should not automatically remove control from the person involved. Adult safeguarding aims to prevent harm, stop abuse or neglect, support the adult's choices, improve safety and quality of life, address the causes of harm, coordinate services, and protect other people where necessary. This person led approach is often described as Making Safeguarding Personal. The Care Act criteria in England Under the Care Act framework in England, statutory adult safeguarding duties apply when an adult has needs for care and support. They also apply when the adult is experiencing, or is at risk of, abuse or neglect, and is unable to protect themselves from that abuse or neglect because of those needs. The adult does not need to receive council funded care or have eligible care needs before these safeguarding duties can apply. Wales, Scotland and Northern Ireland use different statutory frameworks and terminology. Local procedures must be followed. Someone who does not meet a statutory adult safeguarding threshold may still require police help, domestic abuse support, healthcare, housing assistance or another protective response. Care and support needs do not define the person Care and support needs may arise from physical disability, learning disability, cognitive impairment, mental illness, sensory impairment, frailty, brain injury, long term illness, substance dependence, temporary serious illness, or a combination of factors. A diagnosis alone does not show whether someone can protect themselves. Assessment considers how the person's needs interact with the particular risk. Abuse can occur in any relationship or setting Abuse may be caused by a partner or former partner, a relative, a friend or neighbour, a paid or unpaid carer. Another person using a service, a professional, a volunteer, a stranger, an organised criminal group, or an institution or service. It may occur at home, in supported housing, in hospital, in a care home, at work, in the community, online, during transport, or within a family or intimate relationship. The adult may depend financially, emotionally or physically on the person causing harm. Forms of abuse and neglect Care Act statutory guidance in England describes several forms of abuse and states that services should not restrict safeguarding consideration to a fixed list. Physical abuse can include assault, hitting or pushing, inappropriate restraint, deliberate rough handling, misuse of medication, harmful physical punishment, withholding mobility equipment, or force feeding or unsafe physical control. Possible indicators include unexplained injury, repeated injury, fear during care or a sudden change in behaviour. No single injury proves abuse. Sexual abuse includes sexual activity to which the adult did not consent, could not consent or was pressured into accepting. It may also include sexual harassment, unwanted touching, sexualised intimidation, exposure to sexual content, sexual exploitation, image based abuse, or activity occurring while the person is sedated or unable to communicate. Urgent healthcare, forensic and police pathways may be appropriate. The adult should not be repeatedly questioned or forced to recount details to several people. Psychological or emotional abuse may include threats, humiliation, intimidation, persistent criticism, isolation, verbal abuse, controlling behaviour, withholding contact or support, threatening abandonment, or deliberately ignoring communication needs. Possible signs include fearfulness, withdrawal, sleep disturbance, loss of confidence or marked distress around a particular person. Financial or material abuse may involve: Theft, fraud, or pressure concerning money or property. Misuse of bank cards. Unauthorised use of benefits. Misuse of a power of attorney. Coercion to change a will. Unexplained transfers or withdrawals. Charging for care that was not provided. Preventing access to personal money. Financial abuse can occur gradually and may be presented as help with money. A previously trusted person can still misuse their position. Domestic abuse and coercive control Domestic abuse is not limited to physical violence. It can include threats and intimidation, emotional abuse, sexual abuse, economic abuse, technology facilitated monitoring, isolation, or coercive or controlling behaviour. It may involve a partner, former partner or adult family member. Anyone can experience domestic abuse. Coercive control is a repeated pattern that makes someone dependent, frightened or less able to act freely. An apparent decision to refuse help may therefore require careful consideration of whether the conversation was private, whether someone is monitoring communication. Whether threats have been made, whether the adult fears consequences, and whether money, medicines, documents or transport are controlled. Do not confront a suspected abusive person or leave visible information that may increase danger. Modern slavery and exploitation Modern slavery can include forced labour, domestic servitude, trafficking and criminal or sexual exploitation. Possible concerns include: A person who cannot freely leave work or accommodation. Has identification documents controlled by someone else. Appears frightened of an accompanying person. Is unable to speak privately. Works excessive hours without control over pay. Has unexplained debt. Is transported and supervised closely. Does not know their address. Has poor living conditions or untreated injuries. These signs are not proof. In an emergency, call 999. Suspected modern slavery can otherwise be reported to police or specialist routes. Discriminatory and organisational abuse Discriminatory abuse involves harassment, degrading treatment or unequal care linked to characteristics such as disability, race, religion, sex, gender identity, sexual orientation or age. It may be direct, verbal, physical or built into repeated service practices. A discriminatory environment can also make other forms of abuse less likely to be reported or believed. Organisational abuse occurs when a service's culture, staffing, processes or routines produce neglectful, degrading or unsafe care. Examples may include: Rigid routines that disregard personal needs. Repeated missed medicines. Unsafe staffing. Inadequate nutrition or hydration. Unnecessary restraint. Poor moving and handling. Failure to respond to pain. Lack of privacy. Retaliation against complaints. Repeated failure to provide accessible communication. It may involve one serious event or a pattern of poor practice. Neglect and self neglect Neglect may involve failure to provide food or fluid, medicines, heating, personal care, pressure area care, medical attention, mobility assistance, communication support, safe supervision, or access to social care. Neglect may be deliberate or result from inadequate knowledge, exhausted carers, poor staffing or failed services. Self neglect describes a broad pattern in which a person does not adequately care for their health, hygiene or environment. It can include severe hoarding. Not every unusual lifestyle, untidy home or refusal of help is a safeguarding matter. Assessment considers the seriousness of harm, fire or environmental risk, nutrition and hydration, medical needs, the person's ability to understand and manage the risk, capacity for relevant decisions, coercion or exploitation, and risks to neighbours, children or other adults. Care Act guidance states that self neglect is assessed case by case and does not automatically lead to a formal safeguarding enquiry. Mental capacity is specific to a decision Mental capacity is not determined solely by age, disability, mental illness, dementia, appearance, communication difficulty, or agreement with professionals. An adult should be presumed to have capacity unless there is a reason to assess it. Capacity relates to a particular decision at a particular time. Someone may have capacity for one decision but not another. Communication support, accessible information and adequate time should be provided before concluding that someone cannot decide. An unwise decision is not the same as lack of capacity An adult with capacity may choose an option that others consider risky or unwise. Safeguarding should not automatically become a way to force agreement. Professionals should explore whether the person understands the main risks, what outcome matters to them, whether less restrictive options exist. Whether they are being coerced, whether the decision puts other people at risk, whether capacity is fluctuating, and whether harm reduction support is possible. Care Act guidance recognises that a capacitous adult may decline assistance, while professionals may still need to act to protect others or respond to coercion. Speak with the adult privately where safe A private conversation may help identify fear, coercion or control. You should not create danger by visibly excluding a suspected person without planning. In healthcare settings, routine opportunities to speak privately may be safer. Use an independent interpreter or communication professional when needed. Do not rely on the possibly abusive person to interpret. Ask what the adult wants to happen. Avoid implying that only one answer will be accepted. Respond without interrogating If an adult tells you about harm: listen calmly, acknowledge what they have said, establish immediate safety and medical needs, avoid leading or repeated questions. Explain confidentiality limits, ask what outcome they would like, record their words and your observations, and follow the local safeguarding route. Seek advice when wishes and risk appear to conflict. Your role is not to obtain a confession, determine criminal guilt or search private belongings. Consent and confidentiality require judgement Where possible, the adult should know what information is being shared and why. However, confidentiality is not the same as secrecy. Information may need to be shared without consent when someone is in immediate danger, other adults or children may be at risk, a serious crime may have occurred. Coercion or intimidation may be influencing the decision, the adult lacks capacity for the relevant decision, a legal or professional duty applies, or a service wide risk requires action. Information sharing should remain proportionate and limited to those who need it. Raising an adult safeguarding concern When there is no immediate emergency, concerns are usually passed to the local authority adult safeguarding service where the adult lives. You should provide the adult's identifying and contact details where known, the nature of the concern, immediate risks, what the adult has said. Whether they know about the referral, their wishes, relevant care and support needs, other people at risk, actions already taken, and safe communication arrangements. A concern involving a crime may also require police contact. The response should be proportionate and person led Adult safeguarding in England is underpinned by six principles: empowerment, prevention, proportionality, protection, partnership and accountability. These principles support informed choice, early action, proportionate intervention, coordinated work and transparent responsibility. The response may include a safety plan, advocacy, healthcare, domestic abuse support, police action, changes to care, financial protection, housing support, a capacity assessment, a formal safeguarding enquiry, or monitoring or harm reduction. The adult should be involved as fully as possible. Local procedures and professional judgement still apply This lesson does not replace local Safeguarding Adults Board procedures, employer policy, Mental Capacity Act assessment, domestic abuse risk assessment, police investigation, social care assessment, legal advice, or professional judgement. The legal criteria and terminology differ across UK nations. Immediate danger always takes priority over routine procedure.

Adult safeguarding is person led but not passive. A safe response considers what harm or risk is present, whether the adult has care and support needs affecting their ability to protect themselves, the adult's wishes, mental capacity for the specific decision, coercion or undue influence, risks to other people, and the least restrictive effective response.