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Safeguarding Vulnerable Adults Matthew Croughton RMN MSc

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Safeguarding

Vulnerable

Adults Matthew Croughton

RMN MSc

Aims of Presentation

! What can cause and/or influence vulnerability

! Types of abuse

! The 6 Safeguarding Principles

! Assessing vulnerability & Mental Capacity

! Raising concerns

What can cause and/or influence

vulnerability?

The Department of Health defines a vulnerable

adult as a person aged 18 years or over who is

or may be in need of community care services

by reason of mental or other disability, age or

illness, and who is or may be unable to take

care of him or herself, or unable to protect him

or herself against significant harm or

exploitation.

Boland et al. (2013)

What can cause and/or influence

vulnerability?

!  Lack of mental capacity.

!  Increasing age.

!  Being physically dependent on others.

!  Low self-esteem.

!  Previous history of abuse.

!  Negative experiences of disclosing abuse.

!  Social isolation.

!  Lack of access to health and social services or high-quality information.

Boland et al. (2013)

Types of abuse – Physical Abuse

! Assault

! Hitting

! Slapping

! punching

! kicking

! hair-pulling

! Biting

! pushing

! scalding and burning

!  inappropriate or

unlawful use of

restraint

! misuse of medication

(e.g. over-sedation)

Social Care Institute for Excellence

Recognising Physical Abuse

!  no explanation for

injuries or

inconsistency with the

account of what

happened

!  injuries are

inconsistent with the

person’s lifestyle

!  frequent injuries

!  subdued or changed

behaviour in the

presence of a

particular person

!  failure to seek medical

treatment or frequent

changes of GP

!  signs of malnutrition

Social Care Institute for Excellence

Types of abuse – Sexual Abuse

!  Rape, attempted rape or sexual assault

!  Any sexual activity that the person lacks the capacity to consent to

!  inappropriate looking, sexual teasing or

!  innuendo or sexual harassment

! sexual photography

or forced use of

pornography or

witnessing of sexual

acts

!  indecent exposure.

Social Care Institute for Excellence

Recognising Sexual Abuse !  bruising, particularly to

the thighs, buttocks and upper arms and marks on the neck

!  pregnancy in a woman who is unable to consent to sexual intercourse

!  the uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude

!  incontinence not

related to any medical

diagnosis

!  self-harming

!  poor concentration,

withdrawal, sleep

disturbance

!  fear of receiving help

with personal care

Social Care Institute for Excellence

Types of abuse – Psychological

Abuse

!  enforced social isolation – preventing someone accessing services, educational and social opportunities and seeing friends

!  preventing the expression of choice and opinion

!  cyber bullying

!  threats of harm or abandonment

!  intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse

!  removing mobility or communication aids or intentionally leaving someone unattended when they need assistance

!  preventing someone from meeting their religious and cultural needs

Social Care Institute for Excellence

Recognising Psychological

Abuse

!  withdrawal or change in the psychological state of the person

!  Insomnia

!  Low self-esteem

!  uncooperative and/or aggressive behaviour

!  a change of appetite, weight loss/gain

! signs of distress:

tearfulness, anger

! apparent false

claims, by someone

involved with the

person, to attract

unnecessary

treatment

Social Care Institute for Excellence

Types of Abuse – Financial/

Material Abuse !  theft of money or

possessions

!  denying assistance to access benefits

!  denying assistance to manage/monitor financial affairs

!  misuse of personal allowance in a care home

!  misuse of benefits or direct payments in a family home

!  someone moving into a person’s home and living rent free without agreement or under duress

!  exploitation of a person’s money or assets, e.g. unauthorised use of a car

!  misuse of a power of attorney, deputy, appointeeship or other legal authority

!  rogue trading – e.g. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship.

Social Care Institute for Excellence

Recognising Financial/Material

Abuse

!  Unexplained deficit of money

!  Unusual interest in assets by family or others

!  Financial debts or arrears inconsistent with perceived income

!  unnecessary property repairs

!  the person allocated to manage financial affairs is evasive or uncooperative

!  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

Social Care Institute for Excellence

Other categories of abuse

! Domestic violence

! Modern Slavery

! Discriminatory

! Organisational/institutional

! Neglect

The 6 Safeguarding Principles

! Empowerment - People being supported and

encouraged to make their own decisions and

informed consent.

! Prevention – It is better to take action before

harm occurs.

! Proportionality – The least intrusive

response appropriate to the risk presented.

The 6 Safeguarding Principles

! Protection – Support and representation for

those in greatest need.

! Partnership – Local solutions through

services working with their communities.

! Accountability – Accountability and

transparency in delivering safeguarding.

In England and Wales, statutory requirements for

safeguarding adults are set out in the

Department of Health document No Secrets. This

establishes the principles of multi-agency

working and sets out how this should be

achieved locally.

Assessing Vulnerability !  Assessing the potential vulnerability or

safeguarding concerns requires the same skills as any other assessment, and is based on the same principles of a person-centred approach

!  People with complex needs may require more time to be spent with them in order to promote disclosure.

!  Key point: Does the individual have the ability or capacity to protect themselves or promote their interests?

Mental Capacity Five Principles Which Underpin The Mental Capacity Act:

!  You must always assume a person has capacity unless it is proved otherwise

!  You must take all practicable steps to enable people to make their own decisions

!  You must not assume incapacity simply because someone makes an unwise decision

!  Always act, or decide, for a person without capacity in their best interests

!  Carefully consider actions to ensure the least restrictive option is taken

Assessing Capacity - Brief Follow the 2 stage test for capacity:

!  Stage 1: Does the person have an impairment of the mind or brain (temporary or permanent)?

If Yes:

!  Stage 2: Is the person able to:

!  Understand the decision they need to make and why they need to make it?

!  Understand, retain, use and weigh information relevant to the decision?

!  Understand the consequences of making, or not making, this decision?

!  Communicate their decision by any means (i.e. speech, sign language)?

Failure on one point will determine lack of capacity

When to raise a concern Key concept: Significant harm

Other factors include:

!  the vulnerability of the individual

!  the nature and extent of the abuse

!  the length of time it has been occurring

!  the effect of the abuse on the individual

!  the risk of repeated or increasingly serious abuse

!  the likelihood that other vulnerable individuals may also be put at risk

!  whether criminal offences are involved.

BMA GP Toolkit

How to raise a concern

!  Safeguarding referrals should be directed towards your Local Authority – Social Services.

!  Local Authorities have responsibilities to co-ordinate multi-agency responses to safeguarding concerns.

!  Your Local Authority will have a Safeguarding referral document – these usually vary depending on whether it is a child or an adult being referred.

!  If unsure: Refer.

Further Information

! Social Care Institute for Excellence

! Safeguarding Vulnerable Adults – a General

Practitioner’s Toolkit

!  “No Secrets” – Department of Health

! Office of the Public Guardian safeguarding

Policy

! The Care Act 2015

! The Mental Capacity Act

References !  Patient.info – Vulnerable Adults

!  Boland B, Burnage J, Chowhan H; Safeguarding adults at risk of harm. BMJ. 2013 May 14;346:f2716. doi: 10.1136/bmj.f2716.

!  No Secrets: guidance on protecting vulnerable patients in care; Dept of Health, March 2000

!  Vulnerable adults and confidentiality; BMA

!  Social Care Institute for Excellence

!  Safeguarding Vulnerable Adults – a General Practitioner’s Toolkit

!  “No Secrets” – Department of Health

!  Office of the Public Guardian safeguarding Policy

!  The Care Act 2015

!  The Mental Capacity Act