Protective Marking: / Not protectively Marked / Publication (Y/N): / N
Title: / Investigation of Adults at Risk incidents - Questions and Answers
Summary: / Investigation of Adults at Risk incidents - Questions and Answers
Branch / OCU: / TP - Capability and Business Support, Public Protection Team
Date created: / 15the September 2015 / Review date: / September 2019 / Version: / 2.0
Author: / TP CS Safeguarding Team
Vulnerability and Protection of Adults at Risk Toolkit
Investigation of Adults at Risk Incidents - QAs
What are the barriers to investigating and reporting?
Adults at risk - may fear detrimental outcomes e.g. being placed in institutional care rather than at home. There may also be a reluctance to report safeguarding concerns to police out of a fear of bringing shame to the family honour.
Adults lacking mental capacity - may be unable to make a decision about how to pursue their safety at a time when it is needed. Agencies (including the police) have an obligation to ensure that decisions are made in the best interests of the adult concerned (see Mental Capacity Act 2005 in Useful Resources)
Failing to obtain an account directly from the adult at risk - in order to overcome this barrier you should speak to the adult at risk and secure other evidence and information from as many sources as possible. This will maximise opportunities for a successful outcome.
Failing to assess risk - to overcome this barrier you have to make a determination of the risk of harm to the person or to another. The views of the adult at risk must be sought and form the basis of the risk assessment. Police officers when acting in the public interest or applying the criminal laws, make decisions about a person without their consent. This includes making referrals to adult social care and sharing restricted information with our statutory partners. Ensure all your decisions are documented on the Merlin and CRIS.
Failing to obtain access to the adult at risk - there is no basis in law for removing an adult to a place of safety unless section 136 Mental Health Act (MHA) 1983 applies. Therefore this can only be carried out with consent, or where the adult lacks capacity in accordance with the Mental Capacity Act 2005 best interest principles (see Mental Capacity Act 2005 in Useful Resources)
Difficultly to gain entry to premises for welfare related concerns - you can only use PACE to enter premises section 17(1) - subject to the following provisions of the section, and without prejudice to any other enactment, a constable [or SOCA designated person] may enter and search any premises for the purpose - of saving life or limb or preventing serious damage to property. Parliament has set the level high as it was a very serious matter for a citizen to have their house entered by the police without a warrant. And therefore saving life and limb requires that there should be a fear that something has happened or may happen which would involve serious injury to a person.
Officers and staff having assumptions/prejudices towards adults at risk - do not make judgements as to whether a witness is likely to be accepted as competent by the courts. You should not make assumptions based on the vulnerability of the victim. For example, repeated calls received from an adult placed in a mental health setting who is alleging they have been assaulted by other service users or staff should be visited, despite doubts about their credibility.
Historically, adults at risk have been treated as second class citizens either as active citizens within society or have been discriminated by criminal justice services. These prejudices are based on false perceptions as to the effects of the very conditions that make them vulnerable having on their other abilities. Professor Steven Hawking is the most notable example of why these prejudices should be challenged.
The purpose of current government and MPS policy is to confer the balance of belief and credibility back to adults at risk through ensuring that those in the position to listen and assist, do so, without prejudice. It is important that we the MPS do not use one’s vulnerability - which may make them appear less capable - inadvertently against them.
What is the role of an Interview Supporter?
The report ‘Home Office (1998) Speaking up for Justice’ emphasized the value of social support for vulnerable witnesses at all stages of an investigation and subsequent trial. It is good practice, from the outset, to identify an individual who knows the adult at risk well and so may fulfill a supportive role in looking after the best interests of the adult at risk throughout the investigative process. They are known as an interview supporter. The interview supporter must be a person independent of the police and may be a carer and/or relative, friend, neighbour or a social worker. These individuals can provide an important role in assisting an investigation through their personal knowledge of the adult at risk. In some circumstances, using an interview supporter who is well known to the adult at risk may be counterproductive, as their presence may inhibit the disclosure of information in sensitive cases (for example, sexual abuse). Officers must consider the impact this may have on the welfare of the victim and the investigation, and ask the views of the vulnerable victim or witness before contacting the interview supporter. There are a number of key issues that officers need to be aware of when identifying the most appropriate interview supporter: See ACPO guidance for further information.
What is Abuse?
Abuse is defined, as the violation of an individual’s human and civil rights by any other person or persons. Abuse may consist of a single or a series of repeated acts and may be physical, verbal or psychological, an act of neglect or an omission to act. It may occur when an adult at risk is persuaded to enter into a financial or sexual transaction in which he or she has not consented or does not have the capacity to consent. Defining abuse is complex and can be subject to wide interpretation. It must be emphasized that many instances of abuse equate to serious crimes against society’s most vulnerable individuals and involve intent, recklessness, dishonesty or negligence by the perpetrator.
Some abuse does not necessarily amount to a crime and may be perpetrated as a result of ignorance or poor or unsatisfactory professional practice. This may still require initial police investigation to identify the mens rea (criminal intent) and will always require referral to the local authority in accordance with their safeguarding policy. This will ensure that approaches other than criminal investigation may be considered, for example, disciplinary action, social care or health assessment or action by inspection or regulatory bodies.
What is Serious Abuse?
National Police Chiefs’ Council (NPCC) produced draft guidance defining serious abuse and serious incidents as:
· Any sexual offence involving penetration, or where the victim has a mental disorder (as defined by section 1 of the Mental Health Act (MHA) 1983), or the suspect is a care worker or employed in a position of trust, or the allegation is against a registered sex offender;
· The most serious and violent offences such as sections 20 and 18 of the Offences Against the Persons Act 1861, attempted murder and murder;
· Gross Negligence offences leading to death or serious long-term injury, illness or disability;
· Financial abuse where appropriate specialist investigative skills are required;
· Computer crime where identifiable vulnerable adults are at risk.
What are Serious Incidents?
· A serious abuse which takes place in an institutional care or NHS setting (see Pan London Multi-Agency Policy and Procedures guidance for full details on NHS serious incidents).
· Incidents where allegations have been made against a paid worker or volunteer.
· Incidents involving multiple vulnerable victims and/or suspects.
· Incidents posing threat to life and limb, for example, arson.
· Suspicious death of an adult at risk who is the subject of an ongoing adult safeguarding investigation, regardless of which agency is leading the investigation.
· Historical institutional abuse.
· High-profile media cases.
How can I identify Patterns of Abuse?
Patterns of abuse vary and may include:
· Serial abusing in which the abuser seeks out and grooms adults at risk in the same manner as abusers of children do. This may be through personal contact with the adult at risk, their carer or by other means of communication such as the internet and mobile telephones;
· Long-term abuse within a family relationship, such as domestic abuse;
· Opportunistic abuse such as theft;
· Abuse that arises because pressures have built up and/or because of challenging or difficult behaviour, for example, carer’s stress;
· Neglect of an adult at risk’s needs, because those around them are no longer able to be responsible for their care – this may be because the carer has deteriorating health and social care needs;
· Institutional abuse;
· Racist, sexist, ageist and other discriminatory practice;
· Failure to access appropriate healthcare services such as dentistry, chiropody or pressure sore management.;
· Misuse of benefits and/or use of the adult at risk’s finances.
What if the act of serious harm is by a member of the family in the home?
‘Domestic Violence, Crime and Victims Act 2004 - Causing death or serious harm to a vulnerable adult’
Section 5 of this Act created an offence of causing or allowing the death of a vulnerable adult, or of a child under the age of 16. This act has been amended and extends the offence of causing or allowing the death of vulnerable adult or a child to causing or allowing serious physical harm, like inflicting brain damage or broken bones. This stand-alone offence imposes a duty upon members of a household to take reasonable steps to protect children or vulnerable adults within the household from the foreseeable risk of serious physical harm from other household members. It is an offence triable only on indictment and carries a maximum sentence of 14 years imprisonment or a fine, or both.
What is Medical Manslaughter?
The term of Medical Manslaughter refers to medically qualified individuals who are performing acts within the terms of their duty of care, when an act or omission occurs.
The guidance for incidents where a patient dies within a healthcare setting and where there are allegations that the death is homicide is provided by: Department of Health, ACPO/HSE Investigating patient safety incidents Memorandum of Understanding and also http://www.england.nhs.uk/wp-content/uploads/2013/03/sif-guide.pdf
What is self neglect & hoarding?
Self neglect: this covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. There is no clear operational definition of self-neglect; however, the Care Act 2014 makes clear that self-neglect comes within the legal definition of abuse or neglect, if the individual concerns has care and support needs. The Department of Health defines it as: “a wide range of behaviours neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.” (DoH, 2014).
Skills for Care provided a framework for research into self neglect and identified three distinct areas that are characteristic of this:
1. Lack of self-care: this includes neglect of one’s personal hygiene, nutrition and hydration, or health, to an extent that may endanger safety or well-being;
2. Lack of care of one’s environment: this includes situations that may lead to domestic squalor or elevated levels of risk in the domestic environment (e.g., health or fire risks caused by hoarding);
3. Refusal to accept assistance that might alleviate these issues. This might include, for example, refusal of care services in either their home or a care environment or of health assessments or interventions, even if previously agreed, which could potentially improve self-care or care of one’s environment.
Signs of Self-Neglect:
This could manifest itself in unkempt personal appearance or no longer taking any interest in personal appearance and general hygiene, not wearing appropriate clothing for weather conditions, significant refusal to eat (without apparent illness), not taking medication, non-compliant with care, disinterest in financial affairs, hoarding items and pets, offensive odours, pest infestation, etc. This list is not exhaustive.
Hoarding
Definitions of hoarding are equally difficult; however hoarding often is linked to the acquisition of items with an associated inability to discard things that have little or no value (in the opinions of others) to the point where it interferes with use of living space or activities of daily living.
Compulsive hoarding(more accurately described as "hoarding disorder")is a pattern of behaviour characterised by the excessive acquisition of and inability or unwillingness to discard large quantities of objects that cover the living areas of the home and cause significant distress.
Signs of Hoarding:
Conditions of extreme clutter, especially where necessary objects in the household, like