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About this book

Safeguarding adults is a rapidly evolving area of professional practice and this timely new text book provides an authoritative guide that critically engages with the recent developments and encapsulates some of the emerging approaches to contemporary adult safeguarding practice. Written by a collection of authors with a wealth of academic and practice experience, and with a strong focus on multi-disciplinary working, the text covers key topics such as:

Safeguarding adults who lack capacity, or whose level of capacity is unknown or unclear

Common issues and tensions surrounding the various UK laws and policies that seek to safeguard adults with mental health problems

Safeguarding older adults, with a unique and insightful focus on the perspective of carers

Current limitations in practice, including the blurred nature of the boundaries between informal and legally mandated care, relating to the safeguarding of people with learning disabilities.

Illustrated throughout by engaging case studies to help readers apply what they have learnt to everyday practice, this comprehensive guide to safeguarding adults is essential reading for students across a broad range of health and social care disciplines, as well as practitioners looking for an up-to-date source of reference.

Table of Contents

1. Introduction

Safeguarding adults is a rapidly evolving area of professional practice that has been subject to significant policy and legislative development over the last decade in the United Kingdom (UK) and Northern Ireland (NI). This book aims to critically engage with those developments and to encapsulate some of the emerging approaches to safeguarding adults in contemporary practice. Addressing multi-disciplinary working with a range of stakeholders, including social workers, health practitioners, the police, service users and carers, and wider communities, the book combines conceptual thought and key messages from research and practice experience to provide what we hope will be a valuable resource for students on qualifying and post-qualifying social work and health courses and related disciplines. It also serves as a timely resource to support the continuing professional development of health, social care and allied professionals involved in this ethically contentious area of practice. Adult safeguarding can be considered to be a continuum incorporating within its parameters a range of interventions and safeguards to prevent adults from harm (Stewart, 2016) including compulsory treatment at one end and provision of traditional welfare supports at the other. This may include those who are unable to protect themselves by virtue of mental disorder, learning disability, physical disability and/or physical frailty. Consequently a number of legislative avenues may be drawn upon to ensure protection, often creating a complex and interactive legislative framework for practitioners to navigate.
Gillian MacIntyre, Ailsa Stewart, Pearse McCusker

Part 1


2. Safeguarding Adults: Key Issues and Concepts

The expectation of care, treatment, support and protection for those unable or unwilling to secure or seek it for themselves is a fundamental right in a civilised society (Stewart, 2016; Ash, 2015). The way in which society supports individuals to secure this right either individually or through state intervention is the basis for many actions under adult safeguarding. This broad area of policy and legislation is therefore an acknowledgement by governments that they have a duty towards adults who may be at risk of harm and who may be unable to safeguard themselves due to a variety of factors including poor mental health, cognitive impairment, disability or physical infirmity (Greenfields et al., 2012; Johns, 2007; SCIE, 2006). The acceptance and language of this requirement in the social policy and legislative landscape of the UK gained particular currency with the election of the New Labour administration in 1997 when more detailed consideration of vulnerability, risk, harm and safeguarding became commonplace (Ash, 2015). A re-evaluation of this discourse has taken place over the last five years resulting in greater consideration of the relationship between the individual and the State and a potential limitation or withdrawal of the State’s intervention in the lives of its citizens as part of the drive towards self-care and self-management (Ash, 2015). Adult safeguarding is therefore an evolving and dynamic area of practice that often reflects the prevailing political ideology with regard to the extent to which individual rights and responsibilities promote or negate the requirement for state intervention.
Gillian MacIntyre, Ailsa Stewart, Pearse McCusker

3. The UK Policy Context for Safeguarding Adults: Rights-Based v Public Protection?

Adult safeguarding policy is an acknowledgment by governments that they have responsibilities towards a range of adults who may be at risk of harm and who may be unable to safeguard themselves due to poor mental health, cognitive impairment, disability or physical infirmity. It is multi-agency in nature as it requires engagement by social care, police, health, housing and regulatory agencies. It also overlaps with other policy streams such as domestic violence. However this chapter narrows down its exploration of the context to the core functions of the identification, investigation and possible intervention into the individual lives of adults at risk of harm. This means looking at its situation within general social care and health provision and examining its interaction with mental capacity and mental health legislation for adults who may require compulsory legal orders to support and protect them. Underlying this complex area of law and policy are questions around if, when, why and how governments choose to intervene in the lives of adults (Stewart, 2012; Mackay, 2008). For example, what responsibility does a government have towards its adult citizens with care and support needs? How do governments balance individual human rights with protection of that adult or of others? Such questions lead us to look not only at political views but also at the views of society at large and the attention the media gives to adult safeguarding.
Gillian MacIntyre, Ailsa Stewart, Pearse McCusker

4. Safeguarding Adults With and Without Mental Capacity

Adult protection and safeguarding can be considered as a continuum with functions and criteria ranging from compulsory detention in hospital to the provision of traditional welfare supports, contained within a suite of policy and legislation in the UK (SCIE, 2015). As discussed in Chapters 2 and 3, across the four jurisdictions of the UK these frameworks vary considerably but commonly provide agreed criteria for care, treatment, support and protection for adults who may claim these rights or have them imposed upon them (Carr, 2014; Sherwood-Johnson, 2012; Stewart, 2012). The range of adults for whom safeguarding may apply is therefore considerable and is likely to include those who retain capacity, those who lack capacity and those where the level of capacity is not known. This may include, but is not limited to, people with learning disabilities, those with mental health problems, older adults and those with dementia. The types of harm from which adults may be at risk is extensive but can be broadly categorised as psychological harm, financial harm, sexual harm and/or exploitation, physical harm, self-neglect or self-harm (Scottish Government, 2011; Cooper et al., 2008; O’Keeffe et al., 2007).
Gillian MacIntyre, Ailsa Stewart, Pearse McCusker

5. Multi-disciplinary Working: Moving Beyond Rhetoric

This chapter explores adult safeguarding law in practice with respect to multi-disciplinary working. Put another way, it illustrates the outcomes in practice of the law in theory (Jenness and Grattet, 2005), which requires agencies to collaborate operationally and strategically to safeguard adults at risk of harm. Drawing principally on research and practice experience in Scotland and England, the authors demonstrate well-known barriers to multi-disciplinary working and how they may be overcome. These are further explored in a case study at the end of the chapter. The architecture of public services across the UK is being redesigned, not least in health and social care, in a search for greater efficiency (in the wake of ‘austerity’), integration and delivery through the joint efforts of agencies, which have stakes in respective policy areas (Dudau and McAllister, 2010). The hopeful expectation is that collaborative advantage results from agencies, working in partnership, achieving more than they might do separately.
Gillian MacIntyre, Ailsa Stewart, Pearse McCusker

Part 2


6. Safeguarding Those Experiencing Mental Ill-Health

There is considerable variation in UK laws and policies that seek to safeguard the rights of people with mental health problems. This chapter will highlight a number of common issues and tensions. As a general principle, laws and policies designed to safeguard adults should normally be applied to the situation of those with mental health problems alongside more specialist mental health and capacity laws (Johns, 2011: 93–97); these will be discussed in the first part of this chapter. We will then identify the policy drivers and legal requirements associated with capacity and mental health laws, in particular substitute and supported decision making in England and Wales (Brayne and Carr, 2010; Brown et al., 2009), and Scotland (Armstrong, 2008). Attention will also be paid to the particular situation in Northern Ireland where there are no distinct vulnerable adults laws but where practice is shaped by reference to common, criminal and civil law, a number of policy initiatives (Carter Anand et al., 2013) and the newly enacted Mental Capacity Act (Northern Ireland) 2016. The chapter will then describe and analyse assessment processes, safeguards and oversight processes, mindful of some of the criticisms of policy and practice evidenced in the literature. In our discussions we are mindful of the views of those who are subject to these laws and policies. We will use the term service user to describe people in these circumstances, but are mindful of the contested nature of this concept (McLaughlin, 2009). Reference will then be made to studies of service user views, some carried out by peer researchers, about these processes, one of which forms a case study later in the chapter. The chapter concludes with a case study that illustrates the key themes brought together in the chapter.
Gillian MacIntyre, Ailsa Stewart, Pearse McCusker

7. Safeguarding Older Adults: Carers’ Perspectives

This chapter explores the issue of safeguarding older adults, with a particular focus upon the perspective of carers of older adults. Older adults (as well as other adults with care needs) are more likely to experience abuse or neglect than the general population and are less likely to report this abuse (Penhale and Iborra, 2014). This chapter therefore draws on the views and experiences of carers in order to understand some of the key issues that must be considered in relation to safeguarding this particular group. Beginning with a review of the literature, including an overview of the position in the different jurisdictions of the United Kingdom, this chapter will go on to draw upon a small-scale piece of research conducted with carers of older adults who, although they had no direct involvement in formal safeguarding processes, were able to offer some useful insights and observations about harm to older adults and when caring for a vulnerable adult has the potential to become harmful. As a counterpoint to that, we will then go on to explore the story of one carer, whose experience of the safeguarding process of a relative was unfortunately negative. Whilst it is not claimed that this represents the experience of all carers, it does provide a reminder of the importance of information being delivered in a timely manner by professionals and of recognising the importance of taking a broader view of safeguarding adults – one that goes beyond a technical interpretation and application of the law. It should also be highlighted that preparation for the writing of this chapter did not involve direct work with older adults, and this is highlighted as an area for further research. The chapter concludes with a discussion of the implications for practice. Within the context of this discussion, carers are defined as those who provide unpaid care to a family member, friend or neighbour. Written from a Scottish perspective, the issues raised nonetheless have broader implications for current understandings of safeguarding as it relates to carers and older people.
Gillian MacIntyre, Ailsa Stewart, Pearse McCusker

8. Safeguarding Adults with Learning Disabilities

This chapter will critically explore current issues facing professionals working in health and social care settings in regards to safeguarding adults with learning disabilities. Particular attention will be paid to the rights of people with learning disabilities in their encounters with health and social care professionals. Current limitations in practice will be identified, including gaps in knowledge, skills and understanding in assessing capacity and in ensuring the legal rights of adults are upheld. To that effect the chapter will critically examine practice examples which highlight the blurred nature of the boundaries between informal and legally mandated care. Practice examples will be drawn from two contexts. The first will examine the issues of adults with learning disabilities accessing secondary health care services such as general hospitals. The second will consider the experiences of adults with learning disabilities using sexual health services within a primary health care setting. The practice examples will draw attention to the importance of health and social care professionals adopting effective partnership working approaches with individuals, carers, family members and where appropriate the wider community. They will also explore the professional’s role in considering the question of capacity and informed consent, and establishing the legal basis for family members’ and carers’ decision making in relation to health care.
Gillian MacIntyre, Ailsa Stewart, Pearse McCusker

9. Self-Harm and Suicide

Self-harm and suicide are poorly understood in the general population (Royal College of Psychiatrists, 2010) and research indicates that people who self-harm and attempt suicide are often subject to stigma and hostility, even from professionals who regularly work with them, including doctors, nurses, the police and social workers (Scottish Association for Mental Health, 2012; Saunders et al., 2011; Royal College of Psychiatrists, 2010). Self-harm and suicide are, however, major public health concerns making it essential for professionals across a range of sectors to have the requisite skills and knowledge to provide effective interventions (Scowcroft, 2016; Timson et al., 2012). This chapter considers these issues further in the context of adult safeguarding to explore current challenges and good practice. It begins by defining self-harm and suicide, and argues that they should be conceived as safeguarding concerns across the UK. Current prevalence and policy are explored, along with emerging themes drawn from adult protection and safeguarding committee reports and discussions with health and social care practitioners. This highlights working with people who frequently present with self-harming and suicidal behaviours as a key challenge. A case study is then used to identify approaches for providing holistic, humane and effective responses to protect this group of adults from harm.
Gillian MacIntyre, Ailsa Stewart, Pearse McCusker

10. Safeguarding within Institutions

The phrase ‘adult safeguarding’ has become commonly used since the influential publication No Secrets in 2000 by the United Kingdom Department of Health (DoH, 2000). The support, empowerment and protection of vulnerable members of society have been debated for centuries, however, with numerous early accounts of conditions for the ‘mentally ill’ (as they were then often described) in the earliest ‘mad houses’ and asylums as well as outside of them (Prins, 1987). Safeguarding of adults who are or may be vulnerable is now a core element of practice across health and social care with well-defined procedures for preventing abuses and for reporting them if this fails (HIS, 2014; DoH, 2012, 2000). The most vulnerable adults are almost certainly those with mental health problems or learning disabilities whose difficulties are severe and/or complex enough to necessitate them residing in some sort of institution. In closed institutions in particular there may be limited autonomy for individuals and limited or no opportunities to raise concerns regarding potential abuse. Even when concerns are raised in such settings, we have a proven track record of not always taking them seriously such as with Kerr–Haslam, Winterbourne View and Mid Staffordshire (Francis, 2013a; DoH, 2012; HM Government, 2005). We will come back to these later to look at what lessons can be learned from them.
Gillian MacIntyre, Ailsa Stewart, Pearse McCusker

11. Conclusion and Key Messages

This final chapter aims to bring together some of the key messages that have emerged throughout the book. While each of the preceding chapters has taken a different focus exploring particular conceptual frameworks or issues for specific service user groups, a number of common themes have emerged across the chapters which can help us to better understand the complex field of adult safeguarding as a whole. This chapter will discuss these themes and will attempt to address some of the ongoing complexities in this field. It will aim to provide clarity around what adult safeguarding is and how this can be understood before considering key ethical dilemmas and issues for practice that have emerged during the course of this volume.
Gillian MacIntyre, Ailsa Stewart, Pearse McCusker
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