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Lewisham Safeguarding Adults Board

Forms and Signs of Abuse

Forms and Signs of Abuse

People with care and support needs, such as older people or people living with a disability, are more likely to be abused or neglected. They may be seen as an easy target and may be less likely to identify abuse themselves or to report it. People with communication difficulties can be particularly at risk because they may not be able to alert others. Sometimes people may not even be aware that they are being abused, and this is especially likely if they have a cognitive impairment. Abusers may try to prevent access to the person they abuse.

Whilst these particular adults are the specific focus of ‘Safeguarding Adults’ policy and procedures, this does not negate the public duty of those carrying out this work to protect the human rights of all citizens, including those who are the subject of concern but are not covered by these procedures, or those who are not the subject of the initial concern.

Such work is the responsibility of all agencies and cannot exist in isolation. It must be effectively linked to other initiatives, as part of a network of measures aimed at enabling all citizens to live lives that are free from violence, harassment, humiliation and degradation.

Signs of abuse

Signs of abuse can often be difficult to detect. The information below aims to help people who come into contact with people with care and support needs to identify abuse and recognise possible indicators. Many types of abuse are also criminal offences and should be treated as such.

Evidence of any one indicator from the following lists should not be taken on its own as proof that abuse is occurring. However, it should alert professionals to make further assessments and to consider other associated factors. The lists of possible indicators and examples of behaviour are not exhaustive and people may be subject to a number of abuse types at the same time.

Types of abuse:

Discriminatory abuse +

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

Possible indicators of discriminatory abuse

  • The person appears withdrawn and isolated
  • Expressions of anger, frustration, fear or anxiety
  • The support on offer does not take account of the person’s individual needs in terms of a protected characteristic

Hate Crime +

Hate crime is the targeting of individuals, groups and communities because of who they are.

It is any incident which is a criminal offence and which is thought, by you or someone else, to be motivated by a hostility or prejudice based on race, ethnicity, religious beliefs, gender, gender identity, disability, age, sexual orientation or any other actual or seeming difference.

This can include:

  • Threats, bullying or intimidation
  • Threatening or offensive mail, texts or emails
  • Verbal abuse
  • Damage to property
  • Physical assaults

It is important to report all hate incidents, even if you think nothing can be done as it helps the police and other agencies identify areas of concern, patterns of behaviour and what is happening in our communities. Hate crimes are not only crimes against the targeted victim, but also against a particular group as a whole. Firm action will be taken against people who commit any acts of hatred.

We know that some victims may not wish to be identified, so we encourage victims to report crime anonymously to a third party reporting site to ensure that the police can do all they can to tackle hate crime in the community.

The police and the council will:

  • Investigate all reported incidents of hate crime
  • Take legal action if there is sufficient evidence to enable us to do this
  • Keep in contact with you and let you know of our progress
  • Support you during this process

Some organisations can offer support to help you decide if you want to make an official report or complaint. If you do, this will be forwarded to the police and the council to note or take action and for monitoring the numbers of incidents reported.

Below is a list of groups and local venues where you can make an anonymous report of hate crime.

Afghanistan and Central Asian Association

Room 68b, the Albany, Deptford SE8 4AG


020 8469 0723

African Advocacy Foundation

76 Elmer Rd, London SE6 2ER

020 8698 4473


Catford and Bromley Synagogue

6 Crantock Road, London, SE6 2QT


020 8698 9496

Citizens Advice Lewisham

Leemore Community Information Hub

Bonfield Road, Lewisham SE13 5EU

0800 231 5453

Goldsmiths Students’ Union

Dixon Rd, London SE14 6NW

020 7717 2511


Goldsmiths, University of London

8 Lewisham Way, New Cross, London SE14 6NW

020 7919 7050


Lewisham Council

9 Holbeach Road, Catford, SE6 4TW

020 8314 7237


Lewisham Irish Community Centre

2A Davenport Road, Catford SE6 2AZ

020 8695 6264 manager@lewishamirish.org.uk

Lewisham Islamic Centre

363–365 Lewisham High Street, Lewisham SE13 6NZ

020 8690 5090


Lewisham Library

199-201 Lewisham High St, London SE13 6LG

020 8314 8430


Lewisham Refugee and Migrant Network

341 Evelyn Street, SE8 5QX

020 8694 0323


Lewisham and Southwark College

Lewisham Way, London SE4 1UT

020 3757 3340


Lewisham Speaking Up

Deptford Albany, Douglas Way, SE8 4AG

020 8692 1862



1st Floor Equitable House, 7 General, Gordon Square, Woolwich SE18 6FH

020 8305 5000


Second Wave Youth Arts

1 Creek Rd, London SE8 3BT

020 8694 2444


More information on Hate Crime can be found on the Lewisham Council Website

Domestic abuse +

Types of domestic abuse

Domestic abuse can be characterised by any of the indicators of abuse relating to:>

  • Psychological
  • Physical
  • Sexual
  • Financial or economic
  • Emotional

Domestic abuse includes any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been, intimate partners or family members regardless of gender or sexuality. It also includes so called 'honour’ based violence, female genital mutilation and forced marriage. (This definition will change once the Domestic Abuse Act 2021 comes into force).

Possible indicators of domestic abuse

  • Low self-esteem
  • Feeling that the abuse is their fault when it is not
  • Physical evidence of violence such as bruising, cuts, broken bones
  • Verbal abuse and humiliation in front of others
  • Fear of outside intervention
  • Damage to home or property
  • Isolation – not seeing friends and family
  • Limited access to money

Coercive or controlling behaviour is a core part of domestic violence +

A pattern of controlling or coercive behaviour can be well established before a single incident is ever reported to support services. In many cases the conduct of the perpetrator might seem innocent - especially if considered in isolation of other incidents - and the victim may not be aware of, or be ready to acknowledge, abusive behaviour. 

"In many relationships, there are occasions when one person makes a decision on behalf of another, or when one partner takes control of a situation and the other has to compromise. The difference in an abusive relationship is that decisions by a dominant partner can become rules that, when broken, lead to consequences for the victim."

Building on examples provided within the Statutory Guidance, relevant behaviours to be aware of can include:

  • Isolating a person from their friends and family
  • Depriving them of their basic needs
  • Monitoring their time
  • Monitoring a person via online communication tools or using spyware
  • Taking control over aspects of their everyday life, such as where they can go, who they can see, what to wear and when they can sleep
  • Depriving them access to support services, such as specialist support or medical services
  • Repeatedly putting them down such as telling them they are worthless
  • Enforcing rules and activity which humiliate, degrade or dehumanise the victim
  • Forcing the victim to take part in criminal activity such as shoplifting, neglect or abuse of children to encourage self-blame and prevent disclosure to authorities
  • Financial abuse including control of finances, such as only allowing a person a punitive allowance
  • Control ability to go to school or place of study
  • Taking wages, benefits or allowances
  • Threats to hurt or kill
  • Threats to harm a child
  • Threats to reveal or publish private information (e.g. threatening to 'out' someone)
  • Threats to hurt or physically harming a family pet
  • Assault
  • Criminal damage (such as destruction of household goods)
  • Preventing a person from having access to transport or from working
  • Preventing a person from being able to attend school, college or University
  • Family 'dishonour'
  • Reputational damage
  • Disclosure of sexual orientation
  • Disclosure of HIV status or other medical condition without consent
  • Limiting access to family, friends and finances

This is not an exhaustive list and you should be aware that a perpetrator will often tailor the conduct to the victim, and that this conduct can vary to a high degree from one person to the next.

See our Adult Safeguarding Pathway for Coercive Control Resources

Economic Abuse +

Economic abuse involves behaviours that interfere with an individual’s ability to acquire, use and maintain economic resources such as money, transportation and utilities. It can be controlling or coercive. It can make the individual economically dependent on the abuser, thereby limiting their ability to escape and access safety.

Examples of economic abuse

Examples of economic abuse include:

  • Having sole control of the family income
  • Preventing a victim from claiming welfare benefits
  • Interfering with a victim’s education, training, or employment
  • Not allowing or controlling a victim’s access to mobile phone/transport/utilities/food
  • damage to a victim’s property

Indicators of Economic Abuse

There are some common warning signs to look out for in victims of economic abuse.

These include:

  • A person often not having enough money
  • There being a conflict with joint finances, such as one person controlling a couple’s money;
  • Shopping habits including always using cash or not being able to buy something without a partner’s permission.
  • Changes in someone’s working life, such as leaving a job they enjoyed
  • If they suddenly stop socialising and seeing friends
  • Their appearance changes, or they become overly anxious

Financial or material abuse +

Types of financial or material abuse

  • Theft of money or possessions
  • Fraud, scamming Age UK Avoiding Scams Guide
  • 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 – eg. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship

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

Modern slavery +

Types of modern slavery

  • Human trafficking
  • Forced labour
  • Domestic servitude
  • 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

Possible indicators of modern slavery

  • Signs of physical or emotional abuse
  • Appearing to be malnourished, unkempt or withdrawn
  • Isolation from the community, seeming under the control or influence of others
  • 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
  • Fear of law enforcers

A new local guidance document on Modern Slavery and Human Trafficking will be published in 2022, but professionals should also refer to the Lewisham Modern Slavery Victim Care Pathway.

Further Home Office information on identifying and reporting modern slavery

London Directory of Services
The Human Trafficking Foundation has created a Directory of Survivor Support Services in London, which is constantly updated.

Neglect and Acts of Omission

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

Possible indicators of neglect and acts of omission

  • Poor environment – dirty or unhygienic
  • Poor physical condition and/or personal hygiene
  • Pressure sores or ulcers
  • Malnutrition or unexplained weight loss
  • Untreated injuries and medical problems
  • Inconsistent or reluctant contact with medical and social care organisations
  • Accumulation of untaken medication
  • Uncharacteristic failure to engage in social interaction
  • Inappropriate or inadequate clothing

Organisational or institutional abuse +

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

Possible indicators of organisational or institutional abuse

  • Lack of flexibility and choice for people using the service
  • Inadequate staffing levels
  • People being hungry or dehydrated
  • Poor standards of care
  • Lack of personal clothing and possessions and communal use of personal items
  • Lack of adequate procedures
  • Poor record-keeping and missing documents
  • Absence of visitors
  • Few social, recreational and educational activities
  • Public discussion of personal matters
  • Unnecessary exposure during bathing or using the toilet
  • Absence of individual care plans
  • Lack of management overview and support

Physical abuse +

Types of physical 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)

Possible indicators of physical abuse

  • 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
  • Subdued or changed behaviour in the presence of a particular person
  • Signs of malnutrition
  • Failure to seek medical treatment or frequent changes of GP

Psychological or emotional abuse +

Types of psychological or emotional 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

Possible indicators of psychological or emotional abuse

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

Self-neglect +

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
  • Failure to seek help or access services to meet health and social care needs
  • Inability or unwillingness to manage one’s personal affairs

Indicators of self-neglect

  • Very poor personal hygiene
  • Unkempt appearance
  • Lack of essential food, clothing or shelter
  • Malnutrition and/or dehydration
  • Living in squalid or unsanitary conditions
  • Neglecting household maintenance
  • Hoarding
  • Collecting a large number of animals in inappropriate conditions
  • Non-compliance with health or care services
  • Inability or unwillingness to take medication or treat illness or injury

7 Minute Briefing - Self-Neglect and Alcohol and Substance Misuse - Teeswide Safeguarding Adults Board

Sexual abuse +

Types of sexual 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

Possible indicators of sexual abuse

  • 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
  • Poor concentration, withdrawal, sleep disturbance
  • Excessive fear/apprehension of, or withdrawal from, relationships
  • Fear of receiving help with personal care
  • Reluctance to be alone with a particular person

National Rape Crisis Helpline logo image Safeline Helpline for men image of logo

Sexual violence

Sexual violence includes any form of sexual activity (involving physical contact, words, or photographs) that takes place without the other person's full and informed consent. Rape and sexual assault are mostly carried out by someone known to the victim: a husband, boyfriend, friend, colleague or other family member.

Sexual violence can happen to anyone regardless of age, gender, race, sexual orientation, religion, class, or background.

Research shows that the majority of sexual violence is experienced by women and girls, but men and boys can also be victims. If you are a man who has experienced sexual violence, Lewisham Council and Refuge provide help and information and links to further resources to Support Men.

Sexual violence can include:

  • Pressuring or forcing someone to do something sexual
  • Touching someone sexually without their permission
  • Unwanted sexting — sending sexually explicit texts and images to someone without their consent
  • Unwanted sexual attention — for example 'wolf-whistling' and making sexualised comments about women's bodies
  • Watching a sexual act take place without permission
  • Engaging in sexual acts with someone who is too drunk, or too intoxicated, to give consent
  • Engaging in a sexual act with someone who is asleep or unconscious
  • Having sex with someone who cannot legally consent — for example, a boy or girl under the age of 16, or someone with a disability who does not have the capacity to understand the situation
  • Making someone watch or appear in pornography against their will
  • Preventing someone from using contraception

Understanding consent

When you're having sex, or doing something intimate with another person, it's important to be sure that they want to be doing it too — that they have consented. Even if you're in a relationship with someone it's important to make sure your partner agrees to any sexual act every time.

  • Consent is showing or verbally communicating a clear 'yes' to your partner. If you're not sure if someone is consenting, ask
  • To be able to consent, a person must have both the capacity to say yes and must understand what is happening and what they are agreeing to do
  • The absence of "no" doesn't mean yes. Someone might have been pressured or frightened into doing something they don't want to — this means they haven't consented. If you are not sure if your partner is consenting, ask
  • Everyone has the right to say no to any kind of sexual activity, or to change their mind at any time before or during sex
  • It's also important to remember that there are some groups of people who cannot consent under law. If someone is not physically or mentally capable of making a decision to have sex — or they can't understand what they're agreeing to — they cannot give consent. For example, if someone is very drunk or intoxicated when they agree to sex, the law recognises that they don't have the capacity to give `true' consent
  • The age of consent in the UK is 16

If you have been sexually assaulted or raped

If you have just been raped or sexually assaulted, try to remember that you are not alone and you are not to blame for what has happened. Here are some simple steps you can take to help ensure your safety:

  • Find somewhere you feel safe
  • You might be in shock, so wrap up warm
  • Consider telling someone you trust about what happened. If you don't feel comfortable telling anyone yet, you can call the 24 hour National Domestic Abuse Helpline for support on 0808 2000 247
  • Call 999 if you require urgent medical attention

You might want to consider contacting a Sexual Assault Referral Centre (SARC). SARCs provide support to victims of rape or sexual assault — including providing a confidential space for interviews, examinations and collecting evidence. Some may also offer counselling services. These services are available regardless of whether you feel you want to report to the police.

If you are considering reporting what happened, or simply want more information about your options, see Support Services in London.

Find out about the specialist services Refuge Athena Lewisham provides to victims of sexual violence.

Information for Professionals

Space for Self: The therapeutic model of the Rape and Sexual Abuse Support Centre (RASASC). The report evaluates the outcomes of using the RASASC therapeutic empowerment model for children and young people aged up to 25.


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