Assessing the mental health needs of older people
What you can do if suspect abuse
Abuse is defined as 'a single or repeated act, or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to the older person' (Action on Elder Abuse, 1995). It can take many forms: physical, sexual, psychological, financial, and discriminatory abuse, and neglect and acts of omission. See Further information for a full list of types of abuse and their indicators.
The following advice on what you should do if you suspect abuse is taken from Kent and Medway's Multi-Agency Adult Protection Policy.
In all cases priority must be given to ensuring the safety and care of the vulnerable adult(s).
Remember: Every staff member has a professional and moral duty to report any witnessed or suspected abuse to their line manager. This information should be referred to Social Services and every reported case must be assessed as a matter of urgency to determine an appropriate course of action. This assessment will take place, either during telephoned consultations with other professionals or during a formal planning meeting.
It is the function of the planning process to consider the issues as widely as possible and to plan any agreed intervention. Factors that will be considered include:
- the possibility that the alleged abuse is a criminal offence
- the impact of the alleged abuse on the vulnerable person
- the need for any emergency or other protective action
- the capacity of the vulnerable adult for self-determination
- the vulnerability of the individual
- the extent of the abuse to this or other vulnerable adults
- the length of time it has been occurring
- the risk of repeated or escalating acts involving this or other vulnerable adults
- the reliability/credibility of the information received
- the need for investigative action
- the terms of reference for the investigation
- who will be involved in the investigation.
It is possible that an older person with mental health needs may directly disclose to you that they have been abused. Even if the older person is considered to be confused, such disclosures should be taken seriously. Listen carefully to what you are being told, and even if it sounds fanciful do not dismiss it. Although some older people with mental health needs may experience memory loss, cognitive impairment or delusional thoughts, it is also possible that they have been abused in the way they describe, or that something else distressing has occurred. Be reassuring, try to understand what may have happened, but do not interrogate the person or suggest you do not believe them.
A manager investigating possible abuse in a care home was trying to interview Mrs S, a resident who was said to be confused. In the course of the interview Mrs S asked whether her mother knew she was in the care home. The manager gently asked Mrs S the year she was born, how old her mother had been at the time, reminded her what year it was now and helped Mrs S to work out that her mother could no longer be alive. Mrs S then reflected, 'I thought that must be the case. If my mother had known I was here, I know she would have written to me.' Although unable to provide confirmation of abuse, there could be no mistaking Mrs S's sense of abandonment and unhappiness.
Kent and Medway's Multi-agency Adult Protection Policy offers the following suggestions in the event that someone discloses abuse to a practitioner:
- Stay calm and try not to show shock or disbelief.
- Listen carefully to what they are saying.
- Be sympathetic ('I am sorry that this has happened to you').
- Be aware of the possibility that medical evidence might be needed.
- Tell the person that:
- they did the right thing to tell you
- you are treating the information seriously
- it was not their fault
- you are going to inform the appropriate person
- you/the service will take steps to protect and support them.
- Report to your line manager, senior manager, or to social services or the police.
- At the first opportunity make a note of the disclosure
and date and sign your record. You should aim to:
- note what the people actually said, using their own words and phrases
- describe the circumstances in which the disclosure came about
- note the setting and anyone else who was there at the time
- separate factual information from your own opinions.
- use a pen or biro with black ink, so that the report can be photocopied, and be aware that your report may be required later as part of a legal action or disciplinary procedure.
- Do not press the person for more details, this will be done at a later date.
- Do not stop someone who is freely recalling significant events, as they may not tell you again.
- Do not promise to keep secrets: you cannot keep this kind of information confidential.
- Do not make promises you cannot keep.
- Do not contact the alleged abuser.
- Do not be judgemental.
- Do not pass on the information to anyone other than those with a legitimate 'need to know', such as your line manager or other appropriate person.
See Types and indicators of abuse for a list based on work by the Multi-Agency Adult Protection Policy for Kent and Medway.
At present there is no adult protection legislation in England and Wales, as there is for child protection, although the Scottish Executive is consulting on the possibility of introducing such legislation in Scotland. For more information on the legal and policy context, see Section 8.
The Department of Health in conjunction with the Home Office has issued to guidance to local authority social service departments on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse.
The Commission for Social Care Inspection has also issued advice and guidance about the protection of vulnerable adults
And SCIE has issued a guide
For more information on care standards and the protection of vulnerable adults, see Section 8.
For Department of Health recommendations on protecting vulnerable older people in care homes, see Moving on: Key learning from Rowan Ward.
The Royal College of Psychiatrists' Faculty for the Psychiatry of Old Age has also produced a guidance note for members: The Rowan Report: implications and advice.
Action for Elder Abuse provides information about the abuse of older people and offers information and support.
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