Types of Physical Abuse (also links to domestic abuse)

• Assault, hitting, slapping, punching, kicking, hair-pulling, biting, pushing.
• Rough handling.
• Scalding and burning.
• Physical punishments.
• Inappropriate or unlawful use of restraint.
• Making someone purposefully uncomfortable (e.g. opening a window and removing blankets).
• Involuntary isolation or confinement.
• Misuse of medication (e.g. over-sedation).
• Forcible feeding or withholding food.
• Unauthorised restraint, restricting movement (e.g. tying someone to a chair).

Warning Signs & Risk Indicators

Behavioural or Emotional Signs:

• The person appears withdrawn and isolated.
• Expressions of anger, frustration, fear or anxiety.
• Fear of specific people, or reluctance to be alone with them.
• Subdued or changed behaviour in the presence of a particular person.

Physical Signs:

• No explanation for injuries or inconsistency with the account of what happened.
• Injuries are inconsistent with the person’s lifestyle.
• Bruising, cuts, welts, burns and/or marks on the body or loss of hair in clumps.
• Frequent injuries.
• Unexplained falls.
• Signs of malnutrition.

Service/ System Signs:

• Failure to seek medical treatment or frequent changes of GP.

Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence, or abuse between two people aged 16 or over who are ‘personally connected’. This includes those who are, or have been, intimate partners, or relatives, regardless of gender or sexual orientation. This may include psychological, physical, sexual, financial, emotional abuse, and so-called honour-based violence. See the full definition here: Domestic Abuse Act 2021 - Statutory Guidance July 2022

LSAB Adult Safeguarding and Domestic Abuse 7 minute briefing 

Domestic Abuse and Older People – Information from Safe Lives

Free online training for Female Genital Mutilation and Forced Marriage: Virtual College

Raise awareness of the signs of Coercive Control by using Lewisham's - Can you see the signs of coercive control? - Poster

Also see this very useful Web Page: Lewisham Safeguarding Adults Board - Domestic Abuse

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.

Warning Signs & Risk Indicators

Behavioural or Emotional Signs:

• Low self-esteem.
• Feeling that the abuse is their fault when it is not.
• Isolation – not seeing friends and family.

Physical Signs:

• Physical evidence of violence such as bruising, cuts, broken bones.
• Unexplained injuries or weight loss.
• Verbal abuse and humiliation in front of others.

Financial Concerns:

• Limited access to own money.
• Changes to wills, or powers of attorney.
• Bills unpaid – including care bills for elderly relatives in care homes.
• Unexplained financial transactions or money going missing.
• Benefits being claimed fraudulently.

Environmental Signs:

• Damage to home or property.

Service System/ Signs:

• Fear of outside intervention.
• Fear of institutional care – being placed in a care home.

Types of Sexual Abuse (also links to Domestic Abuse)

• Rape, attempted rape or sexual assault.
• Inappropriate touch anywhere.
• Non- consensual masturbation of either or both persons.
• Non- consensual sexual penetration or attempted penetration of the vagina, anus or mouth.
• 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.

Warning Signs & Risk Indicators

Behavioural or Emotional Signs:

• The person appears withdrawn and isolated.
• Expressions of anger, frustration, fear or anxiety.
• Fear of specific people, or reluctance to be alone with them.
• Subdued or changed behaviour in the presence of a particular person.
• An air of silence when a particular person is present.
• Withdrawal or change in the psychological state of the person.
• Low self-esteem.
• Poor concentration, withdrawal, sleep disturbance.
• Excessive fear/apprehension of, or withdrawal from, relationships.
• Fear of receiving help with personal care.

Physical Signs:

• Bruising, particularly to the thighs, buttocks and upper arms and marks on the neck.
• Torn, stained or bloody underclothing.
• Bleeding, pain or itching in the genital area.
• Unusual difficulty in walking or sitting.
• Foreign bodies in genital or rectal openings.
• Infections, unexplained genital discharge, or sexually transmitted diseases.
• 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.

Sexual Exploitation

What is Adult Sexual Exploitation?

There is no national definition of Adult Sexual Exploitation (ASE) and this is often only seen as a form of sexual abuse, but there are differences, and this is a distinct and separate type of abuse.

Adult Sexual Exploitation occurs where a person or a group of people (including grooming gangs) take advantage of someone else, normally using an imbalance of power, to coerce, manipulate or deceive an adult into sexual activity: In exchange for something the adult needs or wants (food, drugs, money, cigarettes etc); and or for the financial advantage or increased status of the perpetrator.

“Sexual exploitation happens when a person is coerced, forced or manipulated into engaging in sexual activities”

The adult may have been sexually exploited even if the sexual activity appears consensual. It is important to note that those living with *mental ill health and/or a learning disability may appear to consent to sexual activity but may lack capacity to do so. Lewisham Safeguarding Adults Board - Mental Capacity, DoLS and Advocacy

* The Sexual Offences Act 2003 contains a number of offences in relation to those who have a mental disorder.

It is important to understand the difference between a capacitated adult consensually engaging in ‘sex work’ and an adult who takes part in sexual activity as a result of being exploited.

Many leading charities argue that more effort is needed to completely eliminate sex work or ‘survival sex’ which links in with the wider initiatives to end violence against women and girls.

UK charity working to end sexual exploitation | Beyond The Streets

Lewisham Safeguarding Adults Board - Sexual Abuse and Sexual Exploitation

Warning Signs & Risk Indicators

ASE does not always involve physical contact; it can also occur through the use of technology:

• Being forced to take part in or watch pornography.
• Being victim to revenge porn - when a previously taken video or photograph, which was taken with or without consent, is shared online.

Sextortion – which is a type of online blackmail where criminals threaten to share sexual pictures, videos, or information. Victims are often tricked into sharing sexual images or the abuser has hacked into a victim’s electronic device(s).

More broadly, the internet acts as an enabler of trafficking for sexual exploitation: 75% of victims of trafficking for sexual exploitation are advertised online. This is often in the form of Adult Service Websites (ASWs) - which are unregulated. These can allow traffickers to anonymously advertise victims of sexual exploitation. 

Sexual Exploitation can happen in lots of different ways, including:

• Sex for rent arrangements, where a landlord offers accommodation in exchange for sexual activity.
• Being forced to exchange sex for money, accommodation, food in order to survive – also known as ‘survival sex’.
• Being coerced into the sex industry by a third party – such as a partner or friend.
• Being coerced into unwanted sexual activities with third parties by a partner, family member or friend.
• Being trafficked for the purpose of performing sexual acts. Lewisham Safeguarding Adults Board - Modern Slavery & Human Trafficking

Types of Psychological or Emotional Abuse (also links to Domestic Abuse)

• Enforced social isolation – preventing someone accessing services, educational and social opportunities and seeing friends.
• Removing mobility or communication aids or intentionally leaving someone unattended when they need assistance.
• Preventing someone from meeting their religious and cultural needs.
• Preventing the expression of choice and opinion.
• Failure to respect privacy.
• Preventing stimulation, meaningful occupation or activities.
• Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse.
• Addressing a person in a patronising or infantilising way.
• Threats of harm or abandonment.
• Cyber bullying.

Warning Signs & Risk Indicators

Behavioural or Emotional Signs:

• The person appears withdrawn and isolated.
• Expressions of anger, frustration, fear or anxiety.
• Fear of specific people, or reluctance to be alone with them.
• Subdued or changed behaviour in the presence of a particular person.
• An air of silence when a particular person is present.
• Withdrawal or change in the psychological state of the person.
• Insomnia.
• Low self-esteem.
• Uncooperative and aggressive behaviour.
• A change of appetite, weight loss/gain.
• Signs of distress: tearfulness, anger.

Care Provider/ Relationship Signs:

• Apparent false claims, by someone involved with the person, to attract unnecessary treatment.

Types of Financial or Material Abuse (also links to Domestic Abuse)

• Theft of money or possessions.
• Fraud, scamming.
• Preventing a person from accessing their own money, benefits or assets.
• Employees taking a loan from a person using the service.
• Undue pressure, duress, threat or undue influence put on the person in connection with loans, wills, property, inheritance or financial transactions.
• Arranging less care than is needed to save money to maximise inheritance.
• Denying assistance to manage/monitor financial affairs.
• Denying assistance to access benefits.
• 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.
• False representation, using another person's bank account, cards or documents.
• 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.

For More Information, Please Refer To:

• Dedicated SCAMS training: Lewisham Safeguarding Adults Board - LSAB Learning Zone
• Lewisham Safeguarding Adults Board - SCAMS Information and Advice
• Biggest ever UK fraud sting busts phone number spoofing scammers who stole millions | Evening Standard
• About us Take Five

Warning Signs & Risk Indicators

Possible Indicators of Financial or Material Abuse

• 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.

Types of Modern Slavery

• Human trafficking.
• Forced labour.
• Domestic servitude (links to Domestic Abuse).
• Sexual exploitation, such as escort work, prostitution and pornography.
• Debt bondage – being forced to work to pay off debts that realistically they never will be able to.

Warning Signs & Risk Indicators

General Signs:

• Distrustful of authorities.
• Expression of fear or anxiety.
• Signs of psychological trauma (including PTSD).
• Acts as if instructed by another.
• Belief that they must work against their will.
• Evidence of control over movement, either as an individual or as a group.
• Found in or connected to a type of location likely to be used for exploitation.
• Restriction of movement and confinement to the workplace or to a limited area.
• Passport or documents held by someone else.
• Fear of law enforcers.

Physical Signs:

• Signs of physical or emotional abuse.
• Appearing to be malnourished, unkempt or withdrawn.
• 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.

Financial Signs:

• No or limited access to earnings or labour contract.
• Excessive wage reductions, withholding wages, or financial penalties.
• Evidence workers are required to pay for tools, food or accommodation via deductions from their pay.
• Imposed place of accommodation.

Further Home Office information on identifying and reporting modern slavery

LSAB Modern Slavery & Human Trafficking Web Page

Lewisham Modern Slavery Victim Care Pathway

Types of Discriminatory Abuse

• Unequal treatment based on age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex or sexual orientation - known as protected characteristics’ under the Equality Act 2010
• Verbal abuse, derogatory remarks or inappropriate use of language related to a protected characteristic.
• Denying access to communication aids, not allowing access to an interpreter, signer or lip-reader.
• Harassment or deliberate exclusion on the grounds of a protected characteristic.
• Denying basic rights to healthcare, education, employment and criminal justice relating to a protected characteristic.
• Substandard service provision relating to a protected characteristic.

Discriminatory Abuse Webinar

Discriminatory abuse self-assessment tool: safeguarding adults | Local Government Association

Stop Hate UK

Metro Charity

Lewisham Speaking Up

Steven Hoskin

Tricky Friends

Warning Signs & Risk Indicators

Behavioural or Emotional Signs:

• The person appears withdrawn and isolated.
• Expressions of anger, frustration, fear or anxiety.
• Fear of specific people, or reluctance to be alone with them.

Financial Concerns:

• Unusual interest from new friends or strangers (potential mate crime).

Service/ System Signs:

• The support on offer does not take account of the person’s individual needs in terms of a protected characteristic.
• Rigid routines that do not take into account individual needs.

Care Provider/ Relationship Signs:

• Lack of knowledge or awareness of issues such as neurodiversity, autism, ageism, ableism, sexism, racism and a lack of leadership to prevent this from occurring.  
• Lack of reporting discriminatory abuse as a Safeguarding Concern – which remains one of the most under-reported.

Environmental Signs:

• An absence of adaptations to the home or institutional setting where it might be expected in relation to age or disability.

Types of Organisational or Institutional Abuse

• Discouraging visits or the involvement of relatives or friends.
• Run-down or overcrowded establishment.
• Authoritarian management or rigid regimes.
• Lack of leadership and supervision.
• Insufficient staff or high turnover resulting in poor quality care.
• Abusive and disrespectful attitudes towards people using the service.
• Inappropriate use of restraints.
• Lack of respect for dignity and privacy.
• Failure to manage residents with abusive behaviour.
• Not providing adequate food and drink, or assistance with eating.
• Not offering choice or promoting independence.
• Misuse of medication.
• Failure to provide care with dentures, spectacles or hearing aids.
• Not taking account of individuals’ cultural, religious or ethnic needs.
• Failure to respond to abuse appropriately.
• Interference with personal correspondence or communication.
• Failure to respond to complaints.

Warning Signs & Risk Indicators

Behavioural or Emotional Signs:

• The person appears withdrawn and isolated.
• Expressions of anger, frustration, fear or anxiety.
• Fear of specific people, or reluctance to be alone with them.

Physical Signs:

• Poor environment – dirty or unhygienic.
• People being hungry or dehydrated.
• Poor standards of care.
• Lack of personal clothing and possessions and communal use of personal items.
• Absence of visitors.
• Unnecessary exposure during bathing or using the toilet.

Service/ System Signs:

• Lack of flexibility and choice for people using the service.
• Inadequate staffing levels.
• Lack of adequate procedures.
• Poor record-keeping and missing documents.
• Lack of management overview and support including neglect and poor care practice within and institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home.
• Absence of individual care plans.

Care Provider/ Relationship Signs:

• Few social, recreational and educational activities.
• Public discussion of personal matters.

Including neglect and poor care practice within and institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home.

NICE Guidelines: Safeguarding in Care Homes

Guidance for Reporting Falls Events as Adult Safeguarding Concerns May 2024

If there any concerns about the behaviour and conduct of a professional working with an adult at risk of abuse and neglect, then this should be reported as a Safeguarding Concern under the 'Public Interest Duty', and if this work is a regulated activity, then a referral to the Disclosure and Barring Service (DBS) should also be considered: DBS Briefing

Types of Neglect and Acts of Omission

• Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care.
• Providing care in a way that the person dislikes.
• Failure to administer medication as prescribed.
• Refusal of access to visitors.
• Not taking account of individuals’ cultural, religious or ethnic needs.
• Not taking account of educational, social and recreational needs.
• Ignoring or isolating the person.
• Preventing the person from making their own decisions.
• Preventing access to glasses, hearing aids, dentures, etc.
• Failure to ensure privacy and dignity.

Warning Signs & Risk Indicators

Behavioural or Emotional Signs:

• The person appears withdrawn and isolated.
• Expressions of anger, frustration, fear or anxiety.
• Fear of specific people, or reluctance to be alone with them.

Physical Signs:

• Poor environment – dirty or unhygienic.
• Poor physical condition and/or personal hygiene.
• Pressure sores or ulcers.
• Malnutrition or unexplained weight loss.
• Dehydration.
• Inappropriate or inadequate clothing.

Care Provider/ Relationship Signs:

• Untreated medical conditions.
• Untreated injuries.
• Inconsistent or reluctant contact with medical and social care organisations.
• Patients who need assistance not being taken to medical, or other important appointments. 
• Accumulation of untaken medication.
• Medication not being provided, or in the wrong dose, or administered in the wrong way.
• Uncharacteristic failure to engage in social interaction.
• Failure to arrange access to lifesaving services or medical care.
• Failure to intervene in dangerous situations where the adult lacks the capacity to assess risk.
• Missed home care visits.
• Poor hospital discharge leading to harm occurring.

Safeguarding adults protocol: pressure ulcers and raising a safeguarding concern - GOV.UK

Stop the Pressure: NHS Improvement

Pressure Ulcer Panel Process - University Hospital Lewisham Dec 2020

Pressure Ulcer Panel Process - In the Community Sep 2022

Guidance for Reporting Falls Events as Adult Safeguarding Concerns May 2024

Types of Self-Neglect

• Lack of self-care to an extent that it threatens personal health and safety.
• Neglecting to care for one’s personal hygiene, health or surroundings.
• Inability to avoid self-harm (including suicidal ideation).
• Failure to seek help or access services to meet health and social care needs.
• Inability or unwillingness to manage one’s personal affairs.

Warning Signs & Risk Indicators

Behavioural or Emotional Signs:

• The person appears withdrawn and isolated.
• Expressions of anger, frustration, fear or anxiety.
• Fear of specific people, or reluctance to be alone with them.

Physical Signs:

• Very poor personal hygiene.
• Unkempt appearance.
• Lack of essential food, clothing or shelter.
• Malnutrition and/or dehydration.
• Non-compliance with health or care services.
• Inability or unwillingness to take medication or treat illness or injury.

Environmental Signs:

• Living in squalid or unsanitary conditions.
• Neglecting household maintenance.
• Hoarding.
• Collecting a large number of animals in inappropriate conditions.

Financial Signs:

Poor management of finances leading to risks to health, wellbeing or property.

Self-harm and Suicide 

The very serious concerns for a person who carries out an act of self-harm or attempts suicide may not constitute a Safeguarding Concern in isolation.

Agencies must consider the individuals whole circumstances, as they may be displaying other characteristics which also constitute self-neglect, as well as the self-harm or suicidal ideation.

Agencies should consider an individual’s physical and emotional ability to self-care. If a person is suffering from mental instability, it is likely this will have an overall impact on their wellbeing, which could include characterises of self-neglect detailed above.

The local self-neglect practice guidance (link below) does not include issues of risk associated with deliberate self-harm and suicidal ideation, although more information can be found here on this subject: Get Help with Mental Health

LSAB Hoarding & Self-Neglect Web Page

Self-Neglect High Risk Panel - Risk Assessment & Action Plan Template

London Fire Brigade: Help for Hoarders - Fire Safety Tips

Read our Homelessness and Safeguarding Information page for guidance, tools and advice

Lewisham Suicide Prevention Strategy 2022-25