Care & Support Services - Safeguarding Standards

Protecting Vulnerable Adults

Protection of vulnerable adults

A vulnerable adult is an individual over the age of 18, who is in - or may need - community care services due to disability, age or illness.

Many adults in care are deemed to be unable to look after or protect themselves from significant harm, exploitation or abuse.

Abuse can be physical, sexual, psychological, emotional, financial, neglect or discrimination.

This section will explore:

- Definition of vulnerable adults
- What constitutes abuse?
- Intervention
- Abuse investigation, procedure and process

Sexual Abuse of Individuals with a Learning Disability/ Sexual Offences Act 2003

The sexual abuse of individuals with a learning disability is a wider and more complex area than can be fully addressed here. Whilst there are many sources of information, the reader is referred to two which this site has drawn upon for this topic area.

First, the Government document 'No Secrets - Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse' (2000) (See area of this website - Protection of Vulnerable Adults).

Secondly, the document 'Behind Closed Doors' (2001) which was a combined initiative of Voice, Mencap and Respond. These three organisations were concerned about the level of sexual abuse of individuals with a learning disability who appeared to get little protection and redress from the law.

The document 'Behind Closed Doors' was written in response to an earlier Government discussion document called 'Setting the Boundaries' (2000), a report which surrounded the reforming of the law on sex offences. The Government went on to produce a statement of intent in their document 'Protecting the Public' (2002) recommending a number of changes, including new sex offences to protect children and vulnerable adults, which culminated in the Sexual Offences Act 2003 -see later.

Living in the community

Individuals with a learning disability have the same rights as others to engage in sexual relations and to have an intimate and private life (further information on 'Rights' - see separate section on this website).

Community care philosophy has rightly provided individuals with a learning disability with greater inclusion in their local community and with a chance to lead more independent lives. Such freedoms can also increase the risk of sexual abuse. It is therefore important that in acknowledging the rights of people with learning disabilities and sexual autonomy, we also offer protection from exploitation and abuse.

Risk Factors
The factors which place people with a learning disability at a greater potential risk of sexual abuse are:

• A lack of capacity or education to appreciate potentially abusive situations
• The lack of 'power' and/or personal self-confidence to stop abuse
• Years of being socialised into a climate of 'compliance' to do what other people (particularly those without a learning disability) tell them to do
• Being unaware and lacking the formal knowledge to appreciate that what they have experienced was abusive and to report it
• Being afraid to report abuse because of threat or intimidation
• A communication problem may prevent disclosure
• There may be a totally dependent relationship with the perpetrator of the abuse and thus a reluctance on the part of the victim to disclose
• The victim may feel too guilty to disclose, or fear the ridicule of not being believed 
• A lack of knowledge regarding whom it is appropriate to report or disclose to

How prevalent is sexual abuse?
It has been suggested that the prevalence of sexual abuse is four times greater to individuals with a learning disability than it is to the wider population. (One Australian study has reported incidence a staggering 10.7 times greater than that experienced by non-learning disabled adults!)
Brown, Stein and Turk (1995) described a large study of a two-year incidence survey on the reported sexual abuse of adults with a learning disability in 1991-2. It was estimated that there are likely to be on an annual basis, about four new cases of sexual abuse in every health authority, and even this they consider a conservative figure. A very high percentage of these cases are likely to be a serious assault.

The learning disabled who are victims of sexual abuse are mostly women (73 percent). Historically the perpetrators are also shown to be mostly men featuring in 97 percent of cases and being known to their victim in 87 percent of cases. The largest group of offenders/perpetrators to individuals with a learning disability were reported to be other people who had a learning disability - amounting to some 42 percent. As a matter of real concern, 14 percent of abusers were staff or volunteers of some description and 17 percent were known and trusted people or friends. These two latter groups, when in juxtaposition with abusing family members (18 percent), gives a total of nearly 50 percent of all abusers who are seen to be closely associated with, and in a position of trust, to the individual with a learning disability who is then victimised.

When considering how intellectually disabled those people were who had been abused it was found that 20 percent had a profound disability, 40 percent had a severe or moderate disability and 40 percent had a mild or borderline disability.
With approximately 70 percent of abuse occurring to those people who lived in some sort of managed or care setting, this raises clear implications for awareness, early diagnosis, supervision and safeguards by professionals who are charged to deliver care.

Sexual Offences Act 2003

Although there have been changes to legislation recently and these have been incorporated into the Sexual Offences Act 2003, it will remain to be seen what impact this will have regarding future criminal prosecutions for those who abuse individuals with a learning disability. History, however, shows in the past prosecutions have been minimal.

David Congdon, Director of Mencap, spoke on BBC Radio 4 in the 'File on 4' programme in 2002, about their society report 'Barriers to Justice' written in 1997. Research had shown that out of 284 of suspected cases of sexual abuse to people with a learning disability only 63 (22 percent) were investigated by the police.

Hillary Brown et al, reporting in 1995, said only 6 percent of alleged sexual abuse cases towards individuals with a learning disability were reaching prosecution.

The previously cited Mencap report maintained that less than 1percent of alleged perpetrators were ultimately likely to get convicted.

Most people though, now generally believe that the law protecting vulnerable people has been strengthened with the Sexual Offences Act 2003. The act offers for the first time a definition of consent and makes it clear it must be freely given i.e. 'a person consents if he/she agrees by choice and has the freedom and capacity to make that choice'. This definition will be considered within a context that will give regard to 'a list of circumstances where presumptions will be made as to the complainant giving consent and the defendant's reasonable belief in having consent'. For example - if a threat of immediate violence could be proved to have existed and the defendant could have been shown to have had a reasonable belief of these circumstances, then it would be deemed that consent was not freely given.

In addition to the clauses mentioned above involving consent, there are other offences in this act which offer increased safeguards for individuals with a learning disability and these relate to 'inducement and deception' and 'abuse by a care worker'.

The act makes it an offence to obtain sexual activity by inducements, deception or threats. It is now also an offence for a care worker to have sexual relations with a person in their care. This is because it is taken as understood that any care worker is in a position of trust in an unequal relationship and this would undermine the person's ability to consent freely.

Special Measures for Witnesses

Separate to the Sexual Offences Act 2003, but important to mention, are the special measures which can be offered to witnesses under the Criminal Evidence Act 1999.

To be eligible for 'special measures' a witness must fulfil one of the following categories:

• Be less than 17 years of age
• Have a mental disorder or a significant impairment of intelligence and social functioning which will affect the quality of their evidence
• Have a physical disorder or disability which the court considers likely to affect the quality of their evidence

and...

• The Court is satisfied that the quality of their evidence is likely to be diminished by reason of fear or distress on their part connected with testifying

Special measures are therefore potentially available for individuals with a learning disability giving evidence in a criminal court, but it should be noted they are automatically invoked in cases of sexual abuse. There has been a reluctance on behalf of the police and legal bodies to use individuals with a learning disability as witnesses, but following the valuable work of organisations like 'Voice - UK' ideas are now more enlightened.

Some of the special measures which can be directed to be brought into use are:

• Screens
• Live links
• A cleared court
• Removal of formal legal dress (gowns, wigs etc)
• Use of video recorded evidence
• Use of an intermediary
• Use of communication aids

Post abuse support and treatment

As important as the Government 'No Secrets' (2000) report is, the focus of the document is mostly on policy, procedure and guidelines surrounding the reporting and investigation of sexual abuse towards individuals with a learning disability and very little about their treatment and post abuse support. Considering an incidence of around 1,400 cases of alleged sex abuse occurring nationally, on an annual basis the question is whether there are the resources and expertise available to address this need of post abuse support.

Valerie Sinason writing for the Royal College of Psychiatrists in 2002 about the treatment of people with learning disabilities who have been sexually or physically abused, refers to the trauma and its internal and external consequences. They are:

• The trauma itself (i.e. suddenness of attack, perceived intentionality, severity of hurt, proximity to hurt/violence)
• Internal consequences (i.e. terror, shame, guilt, loss of love, loss of belief in a just world, helplessness, hypervigilance and biological changes)
• Ameliorating or exacerbating factors (such as age, level of attachment, previous experience of trauma, protective features in their environment, being listened to with empathy)
• Further dangers (such as retraumatisation, sexualising of fear or loss, excessive control or risk taking, violent re-entactments, mental health problems/phobias/somatisation/addiction)

Sinason also reports some of the post abuse effects observed across the age groups and gender are:

• Anxiety
• Depression
• Hopelessness and helplessness
• Low self esteem
• Violence to self
• Challenging behaviour (including violence to others, faecal smearing)
• Post traumatic stress (disassociation, flashbacks, startle reactions, hypervigilance)
• Reduction in apparent intellectual ability as a result of trauma induced inability to think clearly
• Incontinence

The misconstruing of challenging behaviour is a particular dynamic which has to be recognised by practitioners. Behaviour problems have all too easily been linked to a person's innate learning disability. The organisation 'Respond' say they have seen symptoms such as self harm, harming others, eating disorders and depression as a way of expressing abuse trauma similar to that which has been witnessed in people without disabilities. In any behavioural assessment undertaken clinicians should be considering sexual abuse as one of the potential causes.

Respond, established in 1989, is an organisation which supports and treats individuals with a learning disability who have been traumatised by abuse. They recognise that if the effects of abuse go untreated it can make people life long victims. They report around 35 men and women are seen each week and people are seen on average therapeutically for between 12-18 months, although it is also stated some have been supported for a number of years.

The organisation announces they continue to receive increasingly more telephone enquires. In 2002 they had 1,400 calls and enquiries, 20 percent being from individuals who have a learning disability. By 2003 this percentage had increased to 30 percent self referring. Respond established their own help line in 1999.

Contact Information

Voice-UK
Wyvern House
Railway Terrace
DERBY
DE21 2RU
Tel: 0132 295775
www.voiceuk.org.uk

Respond
3rd Floor
24-32, Stephenson Way
LONDON
NW1 2HD
Tel: 020 7383 0700
Help Line: 0808 808 0700
www.respond.org.uk

MENCAP
123, Golden Lane
LONDON
EC1Y 0RT
Tel: 020 7454 0454
www.mencap.org.uk

Ann Craft Trust
Centre for Social Work
University of Nottingham
University Park
NOTTINGHAM
NG7 2RD.
Tel: 0115 9515400
www.anncrafttrust.org