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EXECUTIVE SUMMARY
Introduction to research
1 This report was commissioned by the Scottish Executive (now the Scottish Government) with the aim of reviewing the literature relating to interventions that are available for adults 'at risk' of abuse and harm.
2 The review notes the absence of literature regarding "evidence based practice" in situations of adult abuse. The review is therefore limited in relation to reporting evidence of "what works", but does describe the support and protection that is available in cases of adult abuse.
Introduction to subject area
3 Over the last twenty five years, health and welfare practitioners have been alerted to situations in which adults have been victims of abuse and neglect. Adults can suffer abuse in any setting: domestic settings, health or social care settings, educational institutions, sports communities, faith communities, penal institutions, etc.
Adults "at risk"
4 The Adult Support and Protection (Scotland) Act 2007 ('the ASP Act') defines adults "at risk" as:
(1) "Adults at risk" are adults who-
(a) are unable to safeguard their own well-being, property, rights or other interests,
(b) are at risk of harm, and
(c) because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected.
(2) An adult is at risk of harm for the purposes of subsection (1) if-
(a) another person's conduct is causing (or is likely to cause) the adult to be harmed,
or
(b) the adult is engaging (or is likely to engage) in conduct which causes (or is likely to cause) self-harm.
5 The ASP Act defines 'harm' as: conduct which causes physical harm, psychological harm, self harm, and unlawful conduct which appropriates or adversely affects property, rights, or interests.
Types of abuse and harm
6 A consensus has been reached that lists the following types of abuse:
- Physical
- Psychological
- Financial
- Sexual
- Discriminatory
- Neglect (including self-neglect)
Characteristics of perpetrators of abuse
7 Any individual can be an abuser; the relationship might include:
- A family member (including a partner)
- A stranger to the family
- A health or welfare worker
- Other patient's or client's within a service
- Contractors of a service
- Faith leaders
- Teachers
- Youth or adult leaders
- Volunteers
- Someone with legal powers to take decisions on behalf of an individual
Characteristics of victims of abuse
8 The characteristics of adult abuse are complex and the range of "at risk" groups is significant, including people with: mental health challenges, challenged communication, learning disabilities, development disabilities, complex disabilities, physical disabilities, or people who are older, homeless, refugees, or offenders.
Support and protection measures
9 Support and protection measures can be considered to fall mainly into two broad categories: legal interventions and welfare interventions.
10 The range of legal interventions available to protect vulnerable adults is considerable, and includes both criminal and civil legislation. The ASP Act, when commenced, will add to the available armoury.
11 Welfare interventions include case management, a range of therapeutic interventions for the victim and perpetrator, counselling, family therapy, and in situations of imminent harm removal to a place of safety.
12 Prevention might include public education, professional education, and a zero tolerance of violence in society.
Effectiveness of interventions
13 This report has documented the use of various interventions in relation to different types of abuse, and has categorised those interventions as "primary, secondary, or tertiary" interventions. There are a number of common themes across the interventions which suggest transferability between types of abuse and stage of intervention; for example, advice and support services are used as interventions in relation to a number of types of abuse, and at different stages ( i.e. there is evidence that they are used as primary, secondary, and tertiary interventions).
14 The categorisation used in this report is not intended to suggest a rigid framework of interventions to be used at set stages or in regard to a particular type of abuse, but rather to identify what interventions are currently in place and how they are used.
15 Empirical research regarding the effectiveness of interventions remains limited, and we still await an appropriate evidence base for adult protection interventions. This will help determine the effectiveness of different interventions, the extent to which they are transferable, and the value in extending the use of particular interventions.
Conclusions
16 The continuing prevalence of abuse and harm amongst vulnerable adults remains an issue within our communities. There is no 'magic bullet' solution. However, there are mechanisms of support, empowerment, training and education, and inter-agency co-operation which could help to reduce the risk faced by vulnerable groups. In responding to the recommendations identified within this report, Scotland has an opportunity to lead the United Kingdom ( UK) in the protection of "at risk" adults.
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