1. Scottish Head Injury Foundation 25.03.11 Adult Support & Protection: Ensuring Rights & Preventing Harm Adult Support and Protection

2. Adult Support & Protection: Ensuring Rights & Preventing Harm Who is an adult at risk?

3. Adults at Risk The Adult Support and Protection (Scotland) Act 2007 provides a legal definition of an Adult at Risk. It defines Adults at Risk, through a three-point test, as adults, aged 16 years or over, who: 1. are unable to safeguard their own well-being, property, rights or other interests; 2. are at risk of harm; and 3. 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. All 3 conditions must be met to meet the definition of Adult at Risk Adult Support & Protection: Ensuring Rights & Preventing Harm

4. Human Rights Act 1998 - Convention of Rights The Act Sets out that people have the right to: Life Liberty & Safety Respect for Private & Family Life Marry and Found a Family Education Protection of Property Free Elections A Fair Trial Freedom of Thought Conscience & Religion Expression Assembly & Association 3 Categories of Rights According to the Human Rights Act 1998, it is unlawful for any public authorities, which include voluntary and private bodies which undertake public functions, to act in a manner which is incompatible with rights guaranteed in the European Convention on Human Rights Adult Support & Protection: Ensuring Rights & Preventing Harm

5. Human Rights Act 1998 - Convention of Rights Absolute Rights Rights which cannot be interfered with under any circumstances. i.e. they cannot be balanced against any public interest: Article 2 - Right to Life Article 3 - Prohibition of torture or to inhuman or degrading treatment or punishment Article 4 - Prohibition of slavery and forced labour Article 7 - No punishment without law Protocol 1, Article 3 - Right to free elections Adult Support & Protection: Ensuring Rights & Preventing Harm

6. Human Rights Act 1998 - Convention of Rights Limited Rights Rights which are subject to predetermined exceptions: Article 5 - Right to liberty and security Article 6 - Right to a fair trial Article 12 - Right to marry Adult Support & Protection: Ensuring Rights & Preventing Harm

7. Human Rights Act 1998 - Convention of Rights Qualified Rights Rights which can be interfered with where there is a legitimate aim and the interference is proportionate: Article 8 - Right to respect for private and family life Article 9 - Freedom of thought, conscience and religion Article 10 - Freedom of expression Article 11 - Freedom of assembly and association Protocol 1, Article 1 - Protection of property Protocol 1, Article 2 - Right to education Adult Support & Protection: Ensuring Rights & Preventing Harm

8. Types and Patterns of Harm

9. What is harm? Harm includes all harmful conduct and, in particular includes: -  conduct which causes physical harm  conduct which causes psychological harm (e.g. by causing fear, alarm or distress)  unlawful conduct which appropriates or adversely affects property, rights or interests (e.g. theft, fraud, embezzlement or extortion)  conduct which causes self-harm Adult Support and Protection (Scotland) Act 2007 Adult Support & Protection: Ensuring Rights & Preventing Harm

10. Types of harm  Physical Harm: this can include hitting, slapping, pushing, kicking, misuse of medication, restraint or inappropriate sanctions  Sexual Harm: this can include rape and sexual assault or sexual acts to which the vulnerable adult has not consented, could not consent or was pressured into consenting  Psychological Harm: this can include emotional harm, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal harm, isolation or withdrawal from services or supportive networks Adult Support & Protection: Ensuring Rights & Preventing Harm

11. Types of harm  Harm caused by Financial, Material or Property Abuse: this can include theft, fraud, exploitation, pressure in connection with wills, property, inheritance, financial transactions, or the misuse or misappropriation of property, possessions or benefits  Harm through Neglect and Acts of Omission: this can include ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition or heating Adult Support & Protection: Ensuring Rights & Preventing Harm

12. Types of harm  Harm through Discrimination: actions (or omissions) and / or remarks of a prejudicial nature focusing on a person’s age, gender, disability, race, colour, sexual or religious orientation  Harm through Information Misuse: for example, failure to adhere to the relevant ‘Data Protection Act’ guidance, failure to provide adequate and appropriate information about Complaints / Customer Services procedures etc.  Institutional Harm: for example when an institution or organisation is run for the ease and benefit of the institution and not for the benefit of the clients/patients.  Harm through denial of Human Rights: this can include denial of an understanding of Criminal Justice processes or a fair hearing Adult Support & Protection: Ensuring Rights & Preventing Harm

13. Types of harm  Self Harm: This is when an individual engages, knowingly or unknowingly, in any behaviour or activity that, directly or indirectly, can cause harm/serious harm to their physical, psychological or social well-being. Self-harm is a broad term and is seen as a way of expressing very deep distress. People may injure or poison themselves by scratching, cutting or burning their skin, by hitting themselves against objects, taking a drug overdose or swallowing or putting other things inside themselves. Less obvious forms are staying in an abusive relationship, developing an eating problem (anorexia or bulimia), being addicted to alcohol or drugs, or simply not looking after their own emotional or physical needs. (Paraphrased from a definition of Self Harm by Mind (National Association for Mental Health). Adult Support & Protection: Ensuring Rights & Preventing Harm

14. Patterns of harm Patterns of harm vary and reflect very different dynamics. These include:  Neglect of a person’s needs because those around him or her are not able to be responsible for the person’s care or with deliberate intent;  Situational harm which arises because pressures have built up and/or because of difficult or challenging behaviour;  Long term harm in the context of an ongoing family relationships e.g. between siblings, generations;  Unacceptable ‘treatments’ or programmes which include sanctions or punishment such as withholding of food & drink, seclusion, unnecessary or unauthorised use of control & restraint; Adult Support & Protection: Ensuring Rights & Preventing Harm

15. Patterns of harm  Opportunistic harm such as theft occurring because money has been left around;  Institutional harm which features poor care standards, lack of positive responses to complex needs, rigid routines, inadequate staffing and an insufficient knowledge base within the service;  Serial abusing in which the perpetrator seeks out and ‘grooms’ vulnerable individuals. Sexual harm usually falls into this pattern as do some forms of financial harm. Department of Health: No Secrets (2000) Adult Support & Protection: Ensuring Rights & Preventing Harm

16. People who are harmed People who are harmed very often have or are:  Socially isolated  Communication difficulties  Impaired intellect, memory or physical function  Behavioural problems  History of poor quality long term relationships  Pattern of family violence Adult Support & Protection: Ensuring Rights & Preventing Harm

17. Who may be the person causing the harm?  Anyone  member of staff or management  any professional  volunteer  another service user  another adult at risk  spouse, relative, friend  formal or informal carer  neighbour, member of the public or stranger Adult Support & Protection: Ensuring Rights & Preventing Harm

18. Legislation to help Support and Protect

19. The Adult Support & Protection (Scotland) Act 2007 The purpose of the Act is: To provide ways in which protection can be offered to people with disability and illness, where the disability and illness affect the person’s ability to protect themselves from harm and/or abuse.  Intention of this legislation is to provide the means to intervene & prevent harm continuing – consistently!  To put in place strengthened measures to give greater protection for those at risk from harm  To improve interagency cooperation and promotion of good interdisciplinary practice Adult Support & Protection: Ensuring Rights & Preventing Harm

20. General Principles of Adult Support and Protection (Scotland) Act 2007 Section 1 o intervention must provide benefit to the adult o actions should be most supportive & least restrictive Section 2 – must have regard to o wishes of adult, nearest relative, carer, guardian o importance of adult’s participation o adult must not be treated less favourably o adult’s abilities, background and characteristics Adult Support & Protection: Ensuring Rights & Preventing Harm

21. Roles & Responsibilities Under the Act Councils have a Duty to: make inquiries about a person’s well-being, property or financial affairs if they know or believe that the person is an adult at risk and that they might need to intervene to take protective action. Adult Support & Protection: Ensuring Rights & Preventing Harm

22. Roles & Responsibilities The Act also sets out Duties of Co-operation for certain public bodies and their office-holders: Councils; NHS Boards; the Police; the Care Commission; the Mental Welfare Commission; and the (Office of) Public Guardian. Members and staff of all of these bodies have a duty to:  report the facts and circumstances to the local council when they know or believe that someone is an adult at risk and that action is needed to protect that adult from harm;  cooperate with the Council and each other to enable or assist the council making inquiries. Adult Support & Protection: Ensuring Rights & Preventing Harm