This briefing for practitioners is based on a literature review published in the Journal of Adult Protection in March 2022.
This briefing for practitioners is based on a literature review, Discriminatory Abuse: Time to Revive a Forgotten Form of Abuse, published in the Journal of Adult Protection in March 2022.
This briefing forms part of a larger piece of work, and series of activities and resources, to gain a better understanding of discriminatory abuse, and how to recognise equality characteristics in case management, and more broadly recognise unconscious bias and discrimination in practice, approaches and strategies within adult safeguarding.
- a Safeguarding Adult Review and discriminatory abuse webinar, 13 June 2022, specifically looking at discriminatory abuse – with examples of good and emerging practice
- a roundtable with Safeguarding Adults Board managers and chairs 14 July 2022 to build shared understanding and strategies of how to improve recognition and associated actions to forward
- Research in Practice working with practitioners on discriminatory abuse – to grow shared understandings of discriminatory abuse and start identifying best practice.
- Discriminatory abuse is a category of abuse in safeguarding adults work, but it is rarely reported in practice.
- Messages from research and safeguarding adults’ reviews highlight that discrimination might be obscured in practice and reporting may be low due to stigma.
- This has implications for practice skills and how we approach safeguarding work where those affected by abuse or neglect also have protected characteristics.
- This report concludes with some ideas as to how practitioners can improve their confidence when working with discrimination in safeguarding adults work.
What is discriminatory abuse?
The Care and Support Statutory Guidance supports the implementation of the Care Act, 2014. This document defines discriminatory abuse as:
[. . .] forms of harassment, slurs or similar treatment because of race, gender and gender identity, age, disability, sexual orientation, religion”. (Section 14.17)
Discriminatory abuse is a category within the safeguarding adults policy referring to forms of abuse motivated by prejudice or bias, including against those who have protected characteristics. A very similar definition is used by the Safeguarding Adults Collection (which is the basis for data collection) who add that discriminatory abuse also links with hate crime or mate crime. However, discrimination may be a feature or dimension of any other form of abuse (e.g., neglect arising from ageist attitudes or financial abuse due to homophobic views).
How common is discriminatory abuse?
There is a low rate of reporting for discriminatory abuse.
- Less than 1 per cent of the 149,540 Section 42 safeguarding enquiries raised in 2020/21 were linked to Discriminatory Abuse (Safeguarding Adults, England, 2020-21: Experimental Statistics).
- Only two of the 399 Safeguarding Adults Reviews from 2017-19 were completed under the category of Discriminatory Abuse (Analysis of Safeguarding Adult Reviews April 2017 – March 2019).
- Rates of reported disability hate crime – an allied form of abuse – have increased in recent years. A total of 9,208 disability hate crimes were reported in 2020/21 (an increase of 9 per cent on the year before and an increase of 449 per cent since 2012) (Hate Crime Statistics).
Discriminatory abuse in Safeguarding Adults Reviews and Serious Case Reviews
Several Safeguarding Adults Reviews, previously known as Serious Case Reviews, have dealt with situations where discrimination led to, or was a feature of abuse and the death of adults with care and support needs. Here we have included five examples with summaries. These examples relate to real people’s lives and are therefore sensitive, but they also provide important illustrations of why recognition of discrimination is important in safeguarding adult’s work. This is important in view of the disparity between safeguarding adults’ data and disability hate crime statistics. For a full appreciation of what happened, practitioners are encouraged to read the reports in full.
Fiona Pilkington and Francecca Hardwick
Following ten years of severe harassment by local youths, Fiona Pilkington ended her own life and that of her 18-year-old daughter, Francecca Hardwick, who had learning disabilities. The Serious Case Review was undertaken in Leicester, Leicestershire and Rutland in 2008 and pointed to multi-agency failures to identify this family as vulnerable and being targeted.
Steven Hoskin was a 39-year-old man with learning disabilities, who was tortured and murdered in 2006 by a local gang. The Serious Case Review was undertaken in 2007 in Cornwall, and found that in spite of numerous calls to health and social care services, housing and the police, there were issues of communication and information sharing, and action was not taken to prevent his abuse and death. His decision to stop his support package was not discussed or reviewed.
Gemma Hayter was a 27-year-old woman with learning disabilities, who experienced frequent exploitation by people known to her. Although she was known to numerous services, none of these had a full picture of her situation. A Serious Case Review was conducted in Warwickshire after her death in 2010, as a result of murder by those who she thought were her friends.
Peter Farquhar was a retired teacher, who formed a relationship with a man he met through the local church. Although a Safeguarding Adults Review was not completed, a high-profile case review was undertaken in the Diocese of Oxford. This review discussed the lack of an open, inclusive culture around LGBTQ+ relationships in the church community. In this context, Peter was targeted by his abuser, who defrauded, emotionally manipulated and poisoned him, resulting in his murder.
Widespread abuse of residents with learning disabilities and autism at Winterbourne View was uncovered in a BBC Panorama programme. The subsequent Serious Case Review highlighted an organisational culture where this abuse was permissible and highlighted multi-agency, commissioning and inspection issues.
What can we learn from the literature and research on discriminatory abuse?
Research indicates that low reporting may link with low recognition of discrimination in practice. There are several reasons why this might occur:
- Discrimination includes slurs and harassment based on protected characteristics, as per the official policy definition above, but broader societal issues also make discriminatory abuse more likely, due to widening societal inequalities – for example inadequate housing or experiences of poverty (Keeping control’: a user-led exploratory study of mental health service user experiences of targeted violence and abuse in the context of adult safeguarding in England).
- Discrimination may not be recognised as abuse ‘in its own right’, because it manifests itself alongside / within other abuse types. As a result, the dynamics of discriminatory motives may be less recognisable than the abusive acts that are experienced, (an assault motivated by racism or homophobia may be seen as physical abuse because discriminatory motivations are difficult to identify).
- Discrimination links with protected characteristics, so fears of stigmatisation or feelings of shame may prevent people from reporting this form of abuse (Abuse and older lesbian, gay bisexual, and trans (LGBT) people: a commentary and research agenda).
- Discrimination is commonplace in society, and some people experience forms of discrimination on an everyday basis. Therefore, abuse may be normalised or difficult to distinguish from everyday experience, leading to low reporting (Adult protection and effective action in tackling violence and hostility against disabled people: some tensions and challenges).
- Dealing with discriminatory abuse through one-off interventions may not be effective, follow-up/preventative work regarding the potential for repeat incidences are crucial. This is because protected characteristics are usually a static factor, and the person may be targeted in a patterned way, so may remain at further risk in the community (‘It spreads like a creeping disease’: experiences of victims of disability hate crimes in austerity Britain).
Emerging messages for practice
Further work is underway to explore the implications for practice in more detail. This work is being led by the ‘Care and Health Improvement Programme’ (CHIP)*, the charity Research in Practice and Royal Holloway, University of London. However, several messages have emerged for practitioners from this initial literature review:
- How do you identify if a person participating in a safeguarding enquiry has protected characteristics? Some of these may be visible, but others such as religion, disability or sexual orientation, may be hidden or unknown.
- Actively consider that people may have multiple protected characteristics, for example, an older person from a Black, Asian or other minoritised ethnic background who is also a gay woman with disabilities. An intersectional approach that appreciates the interaction between these characteristics is therefore essential.
- When undertaking safeguarding work with a person who has protected characteristics, it is important to sensitively identify, in partnership with the person experiencing abuse or neglect, what significance these protected characteristics may have in terms of the motivation for abuse, everyday experiences of discrimination and future risk of abuse or barriers to safety, recovery, leading a fulfilled life and overall wellbeing.
- Differences related to protected characteristics may mean that adverse experiences are more difficult to talk about or identify due to shame, stigma, language barriers or a mistrust of statutory services. Specialist, culturally specific or local voluntary sector services can be important here. This includes services offering advocacy and peer support, which should enable a person-centred and sensitive approach, that people may find more accessible.
- Taking an inclusive approach to how discrimination manifests itself is important. Although people may experience overt and interpersonal examples of discrimination, such as the slurs or harassment mentioned in the statutory guidance, more subtle examples may occur. For example, an absence of culturally appropriate meals in a formal care setting, may indicate a lack of care about the person’s needs based on ethnicity, religion, culture practice and ideological beliefs, which may be underpinned by institutional racism.
- ‘Othering’ attitudes, as seen above in the ‘Winterbourne View’ case, which seek to distance people who do not fit an assumed societal norm (such as those with protected characteristics) can be prevalent or normalised in organisations. Paying attention to this, discussing it in teams, through supervision or other forums is important.
- Consider how discrimination is nested within social contexts. For example, poor neighbourhood safety, poor housing or poverty may mean that people with protected characteristics do not feel able to participate or access their community safely.
- ‘Making Safeguarding Personal’ emphasises a person-led approach, and this can provide a vehicle for effective work with people who have protected characteristics and experience forms of abuse or neglect, where discrimination may have motivated this. This should be culturally informed, affirmative and respectful of people's protected characteristics
Focus on Skills - How might I put this into practice?
Think about how to discuss protected characteristics and their interaction with safeguarding in practice, bearing in mind that this may be extremely sensitive or difficult to talk about – for example, some people will not want to draw attention to their protected characteristic due to stigma or shame. Doing this effectively requires practitioners to engage with empathy, show understanding of how this may be difficult to speak about, and to build rapport and supportive relationships to support the work. Some possible approaches may include:
“People may be targeted by others because they are seen as different – possibly because of (e.g., ethnicity, sexuality, age, disability etc.). Do you think this might connect with your own experience and what has happened to you? (If relevant) Can you tell me more about this?”
“Have you ever felt unsafe because of your (e.g., ethnicity, sexuality, age, disability etc.)? Can you tell me more about that? Can you remember a time when this happened? Do you think this might be true of what has happened this time?”
“You have told me that you believe (e.g., racism, homophobia, ageism, ableism etc.) may have motivated the abuse you experienced. Does this (e.g., racism, homophobia, ageism, ableism etc.) affect your ability to feel safe and to participate in your community, or meet your needs on a more general basis? Can you tell me about a time when you felt this way? (If relevant) Do you think this might still be happening? Do you think this might this happen in the future?”
Given the sensitive nature of this work, these are suggestions for starting a conversation, they should not be treated as a script, but to think about your skills. In discussion, if a person indicates that discrimination did not take place, practitioners should think about any barriers to disclosing this (stigma, shame, etc.) before discounting it.
Knowledge of specialist support services
Ensure that you are aware of community services that support those with protected characteristics in your local area. Some examples include:
Black, Asian and minority ethnic (BAME) includes a range of services that support people from Black, Asian and other minoritised ethnic communities with their mental health across the country
Lesbian, gay, bisexual and trans (LGBT+) includes information and advice, and some specialist support services for older people who are LGBTQ+
Disability hate crime links provides information about disability hate crime and some of the services that can help
Take some time to find out about other services that you have locally, to support those with protected characteristics
Reflective practice involves reviewing your practice experiences, including the emotional content of these, and considering how you can improve your practice in future. This can be undertaken privately, in supervision or in small groups or teams. Discriminatory abuse requires thinking about power, rights and inclusion and therefore links to ethics and values. Reflecting on our practice in discriminatory abuse involves professional curiosity and a willingness to challenge familiar ways of working. It may involve thinking through, talking about and acting on questions such as:
How do we identify or work with those who have protected characteristics, so that discriminatory acts of abuse are explicitly addressed in our safeguarding practice?
In what ways might discrimination be obscured in our work, and how can we use hypotheses and curiosity to uncover and consider the possibility that discrimination is motivating safeguarding issues?
Is it possible that a person’s protected characteristics could have motivated the abuse and how can we address this?
What support do we need to improve our practice, including our knowledge of the daily experience of people from Black, Asian and minoritised ethnic communities, or groups or skills to hold the sensitive conversation that this work requires?
How do our own values and biases influence our work, and are there areas that we feel less familiar or comfortable – how can we overcome this in order to work effectively with people who have these characteristics and identities?
In what ways might our own practice exclude or reinforce stereotypes or stigma, faced by people with protected characteristics and what can we do to prevent this?
Care and Health Improvement Programme
The Care and Health Improvement Programme (CHIP) funded by the Department of Health and Social Care (DHSC) is delivered by the Local Government Association (LGA) in association with the Association of Directors of Adult Social Services (ADASS).
This briefing was written by Karl Mason, lecturer in Social Work at the Royal Holloway, University of London, and commissioned on behalf of CHIP.
- Mason, K., Biswas Sasidharan, A., Cooper, A., Shorten, K. & Sutton, J. (2022), 'Discriminatory Abuse: Time to Revive a Forgotten Form of Abuse?', Journal of Adult Protection, pp. 1-17.
- NHS Digital (2021), Safeguarding Adults, England, 2020-21: Experimental Statistics, NHS Digital, Leeds
- Preston-Shoot, M., Braye, S., Preston, O., Allen, K. and Spreadbury, K. (2020), Analysis of Safeguarding Adult Reviews April 2017 – March 2019: Findings for Sector-Led Improvement, LGA, London.
- Allen, G. and Zayed, Y. (2021), Hate Crime Statistics, House of Commons Library, London.
- Carr, S., Hafford-Letchfield, T., Faulkner, A., Megele, C., Gould, D., Khisa, C., Cohen, R. and Holley, J. (2019), “‘Keeping control’: a user-led exploratory study of mental health service user experiences of targeted violence and abuse in the context of adult safeguarding in England”, Health and Social Care in the Community, Vol. 27 No. 5.
- Westwood, S. (2018), “Abuse and older lesbian, gay bisexual, and trans (LGBT) people: a commentary and research agenda”, Journal of Elder Abuse & Neglect, Vol. 31 No. 2, pp. 97-114.
- Sin, C.H., Hedges, A., Cook, C., Mguni, N. and Comber, N. (2011), “Adult protection and effective action in tackling violence and hostility against disabled people: some tensions and challenges”, Journal of Adult Protection, Vol. 13 No. 2, pp. 63-74.
- Healy, J. (2020), “‘It spreads like a creeping disease’: experiences of victims of disability hate crimes in austerity Britain”, Disability & Society, Vol. 35 No. 2, pp. 176-200.