Including assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.

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

Including rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.

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

Including psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence.

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

Including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks.

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

Including theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits.

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

Encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.

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

Including forms of harassment, slurs or similar treatment; because of race, gender and gender identity, age, disability, sexual orientation or religion.

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

Including neglect and poor care practice within an 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. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organization.

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

Including ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating.

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

This covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.

Possible 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