Physical abuse includes assault, hitting, slapping, pushing, kicking, misuse of medication, being locked in a room, inappropriate sanctions or force-feeding, inappropriate methods of restraint, and unlawfully depriving a person of their liberty.

Possible indicators

• Unexplained or inappropriately explained injuries;
• Adult exhibiting untypical self-harm;
• Unexplained cuts or scratches to mouth, lips, gums, eyes or external genitalia;
• Unexplained bruising to the face, torso, arms, back, buttocks, thighs, in various
• Stages of healing. Collections of bruises that form regular patterns which correspond to the shape of an object or which appear on several areas of the body;
• Unexplained burns on unlikely areas of the body (e.g. soles of the feet, palms of the hands, back), immersion burns (from scalding in hot water/liquid), rope burns, burns from an electrical appliance;
• Unexplained or inappropriately explained fractures at various stages of healing to any part of the body;
• Medical problems that go unattended;
• Sudden and unexplained urinary and/or faecal incontinence. Evidence of over/under-medication;
• Adult flinches at physical contact;
• Adult appears frightened or subdued in the presence of particular people;
• Adult asks not to be hurt;
• Adult may repeat what the person causing harm has said (e.g. ‘Shut up or I’ll hit you’);
• Reluctance to undress or uncover parts of the body;
• Person wears clothes that cover all parts of their body or specific parts of their body;
• An adult without capacity not being allowed to go out of a care home when they ask to;
• An adult without capacity not being allowed to be discharged at the request of an unpaid carer/family member.

Domestic violence is defined as any incident or pattern of incidents of controlling, coercive, 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. The abuse can encompass, but is not limited to: psychological, physical, sexual, financial, and emotional. This can include such things as forced marriage, honour-based violence and Female Genital Mutilation (FGM).

Sexual abuse 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. It includes penetration of any sort, incest and situations where the person causing harm touches the abused person’s body (e.g. breasts, buttocks, genital area), exposes his or her genitals (possibly encouraging the abused person to touch them) or coerces the abused person into participating in or looking at pornographic videos or photographs. Denial of a sexual life to consenting adults is also considered abusive practice. Any sexual relationship that develops between adults where one is in a position of trust, power or authority in relation to the other (e.g. day centre worker/social worker/residential worker/health worker etc.) may also constitute sexual abuse.

Possible indicators

• Adult has urinary tract infections, vaginal infections or sexually transmitted diseases that are not otherwise explained;
• Adult appears unusually subdued, withdrawn or has poor concentration;
• Adult exhibits significant changes in sexual behaviour or outlook;
• Adult experiences pain, itching or bleeding in the genital/anal area;
• Adult’s underclothing is torn, stained or bloody;
• A woman who lacks the mental capacity to consent to sexual intercourse becomes pregnant;
• Sexual exploitation.

Psychological abuse includes ‘emotional abuse’ and takes the form of threats of harm or abandonment, deprivation of contact, humiliation, rejection, blaming, controlling, intimidation, coercion, indifference, harassment, verbal abuse (including shouting or swearing), cyber bullying, isolation or withdrawal from services or support networks.

Possible indicators

• Untypical ambivalence, deference, passivity, resignation;
• Adult appears anxious or withdrawn, especially in the presence of the alleged abuser;
• Adult exhibits low self-esteem;
• Untypical changes in behaviour (e.g. continence problems, sleep disturbance);
• Adult is not allowed visitors/phone calls;
• Adult is locked in a room/in their home;
• Adult is denied access to aids or equipment, (e.g. glasses, dentures, hearing aid, crutches, etc.);
• Adult’s access to personal hygiene and toilet is restricted;
• Adult’s movement is restricted by use of furniture or other equipment;
• Bullying via social networking internet sites and persistent texting.

Modern Slavery encompasses slavery, human trafficking, forced and compulsory 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

Signs of various types of slavery and exploitation are often hidden, making it hard to recognise potential victims. Victims can be any age, gender or ethnicity or nationality. Whilst by no means exhaustive, this is a list of some common signs:

• Adult is not in possession of their legal documents (passport, identification and bank account details) and they are being held by someone else;
• The adult has old or serious untreated injuries and they are vague, reluctant or inconsistent in explaining how the injury occurred.
• The adult looks malnourished, unkempt, or appears withdrawn
• They have few personal possessions and often wear the same clothes
• What clothes they do wear may not be suitable for their work.
• The adult is withdrawn or appears frightened, unable to answer questions directed at them or speak for themselves and/or an accompanying third party speaks for them. If they do speak, they are inconsistent in the information they provide, including basic facts such as the address where they live
• They appear under the control/influence of others, rarely interact or appear unfamiliar with their neighbourhood or where they work.
• Many victims will not be able to speak English
• Fear of authorities
• The adult perceives themselves to be in debt to someone else or in a situation of dependence.

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