Abuse in Health and Social Care

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1.1 What is abuse?
Abuse is the infringement of an individual's human and civil rights by another individual or persons. The following is the definition of abuse in The Protection for Persons in Care Act (PPCA). In this statement, "abuse" is defined as mistreatment, whether physical, sexual, mental, emotional, and financial or a combination of any of them, that is reasonably likely to cause death or that causes or is reasonably likely to cause serious physical or psychological harm to a person, or significant loss to the person's property.

Abuse of a person often includes behavior that is abusive in one or more of the categories outlined on the following pages. In particular, the majority of people who are experiencing abuse of any kind will also be experiencing psychological abuse.

General indicators of an abusive relationship often include the misuse of power by one person over another and are most likely to be found in situations where one person has power over another. For example, where one person is dependent on another for their physical care or due to power relationships in society (such as, between a professional worker and a service user, a man and a woman or a person of the dominant race/culture and a person of an ethnic minority).

Abuse may consist of a single act or repeated acts. It may be physical, verbal or psychological, it may be an act of neglect or an omission to act or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she had not consented or cannot consent. Abuse can occur in any relationship and may result in significant harm to or exploitation of the person subjected to it.

It is essential to be alert to signals or non-verbal communication or challenging behavior, and to be aware this could indicate unacceptable practice that is being deliberately hidden or denied.

1.1.1 Types of abuse
There are different forms of abuse and these are described below: •Physical abuse
Physical abuse is non-accidental pain or injury inflicted on a service user by a health or care worker. This can include hitting, shaking, rough treatment or inappropriate use of restraint. The health and social care professions do not permit any physical contact that is not necessary for administering a treatment, or for which the service user has not given their consent.

Sexual abuse
Sexual abuse usually refers to any sexual activity that is unwanted and is inflicted by physical force or other methods of coercion such as threats or intimidation. Sexual contact between workers and service users is forbidden in the health and social care environment because it could be harmful to the therapeutic value of the treatment being given and is likely to be based on the exploitation of a service user's vulnerability and the power imbalance inherent in the relationship.

Financial abuse
Financial abuse covers any way that a health or social care worker unlawfully uses his or her relationship with the service user for financial gain. This includes, but is not limited to: oCharging a fee for services that should be free of charge

oCharging for services that are not in the service user's best interest oUnnecessarily prolonging treatment for financial gain
oIncreasing agreed fees after a treatment has begun
oReceiving financial inducements for recommending other products or services to the service user oTheft from the service user (including items being 'borrowed' and not returned).

Psychological/emotional abuse
This refers to the psychological or emotional exploitation of the relationship between a health or social care worker and a service user. It is the most difficult form of abuse to define because it relies heavily on individuals' feelings and perceptions rather than on physical or tangible evidence. The following principles can be useful in identifying psychological or emotional abuse.

oIs the health or social care worker disclosing...
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