A focus on the mental capacity of adults who were financially abused in a Lincolnshire market town “eclipsed consideration” of how coercion and control drove their decision-making, a safeguarding adults review (SAR) has found.
The review by Lincolnshire Safeguarding Adults Board (LSAB) focused on the histories of 10 people over a seven-year period from 2007 to 2014.
All had longstanding mental health problems, with eight also being dependent on drugs and alcohol. The review heard of their “harrowing” experiences, including having their benefits and bank cards stolen and their homes taken over, along with instances of physical, emotional and sexual abuse.
It found agencies working with them were aware of their situations. All 10 individuals were known to the police, and a total of 21 referrals relating to them were made to Lincolnshire council’s adult safeguarding team.
The SAR identified “many examples of committed practitioners and agencies, working hard to help the individuals reduce risk”, and a few cases of “excellent” multi-agency working. Yet it also uncovered “substantial blocks” in terms of how safeguarding adults procedures functioned, with 11 safeguarding referrals resulting in no further action being taken – often because people were deemed to have capacity to make unwise or risky decisions.
“The rightful focus on capacity and consent eclipsed consideration of coercion and control and duties relating to public and vital interests,” the SAR concluded. “There was limited use of the [local] multi-agency partnership and so missed opportunities to use this combined strength to safeguard individuals and others in the community.”
‘Many years’ of exploitation
The decision to commission an SAR came in the wake of a police officer following up information about vulnerable adults being targeted for financial exploitation in the Lincolnshire market town, which was not named.
An investigation between the local multi-agency safeguarding partnership and the police established that this had been going on for “many years”, with at least 34 people affected, including the 10 whose cases the SAR focused on. Among the adults subjected to abuse were:
- ‘Julie’, a woman in her fifties with a long history of mental illness. She made repeated allegations of exploitation from 2008, including theft of possessions and bank cards and her house being taken over by drug users. Following the latter report she was referred to the safeguarding team but declined involvement and was “deemed to have capacity for this decision”.
- ‘David’, a man in his thirties with a diagnosis of schizophrenia and personality disorder, who was addicted to “illicit” substances. He first reported intimidation, assault, theft and exploitation in 2007; the SAR heard that the abuse he suffered “escalated in frequency and severity”. David made repeated allegations to mental health services and the police, eventually consenting to a safeguarding adults referral in August 2014 after he reported being held hostage in his home. The SAR recorded the resulting chronology as saying that “adults with capacity have the right to make unwise decisions” and one practitioner saying she “does not see a role for herself” because of David’s reluctance to work with the police.
- ‘Rob’, a man in his fifties and receiving a high level of support from primary care and mental health services who from 2007 reported money and medication being taken. At various times he declined help and attacked a police officer who attended his home. A number of safeguarding referrals were made but no further action taken.
The SAR found that many of the people who were abused received high levels of benefits and prescriptions to medication that heightened their appeal as targets. “[In many cases] their dependency made them susceptible to coercive control by violent individuals,” it said.
Coercive and controlling behaviour typically sees perpetrators exerting power over victims, often without them realising it, via a systematic pattern of behaviours that isolates them from others. In domestic settings such behaviour has been a criminal offence punishable by up to five years imprisonment since 2015, though police forces have been slow to make use of the new law.
‘Sense of hopelessness’
The review noted that at the beginning of its scope period the Mental Capacity Act 2005 was still new and “generally poorly applied”. Lincolnshire’s safeguarding adults procedures “provided guidance on capacity, consent and best interests and how this applies in making decisions [but did not] make reference to coercion and undue influence and how this affects consent,” it said.
Some mental health professionals believed it a waste of time making referrals for individuals who had capacity to make “unwise” decisions but declined to engage with services, because the local authority would screen them out.
This was the “primary roadblock” preventing referrals being effectively managed via multi-agency safeguarding procedures. “Some of the records conveyed a sense of hopelessness and that everything had already been tried,” the review found.
But the SAR also found a lack of shared understanding among different practitioners as to what constituted exploitation, and what circumstances should be addressed through multi-agency arrangements or directly to the police. There was a danger, too, that some professionals had become “blunted” by seeing clients habitually live with high-risk behaviour.
There was a fear among practitioners of seeming “too paternalistic”, one professional reported.
Meanwhile a restructure in the local NHS trust meant caseloads rose during the scope period on the assertive outreach team (AOT), which worked intensively with people who had complex mental health needs, diluting its effectiveness.
‘Learn from domestic abuse’
The SAR concluded, among a series of key learning points, that professionals needed to extend the understanding of coercion and control developed in relation to domestic abuse into other areas of adult safeguarding.
“Agencies need to recognise the complex contributory factors [around associating with abusers and declining to take action against them], including how a victim may try to protect themselves in situations of chronic fear,” it said.
“Where risks are high and a capacitous person has declined a safeguarding response, there remains a duty of care to take reasonable steps to reduce harm to the person and/or others who may be at risk,” the review added.
It highlighted the under-use of multi-agency arrangements, noting that a new ‘Safeguarding Lincolnshire Together’ team had the opportunity to strengthen these but that this was still a work in progress.
Barry Earnshaw, independent chair of the Lincolnshire Safeguarding Adults Board, said he was “pleased” LSAB had undertaken the review.
“Our partnership approach continues to develop and we aim to give people affected by financial exploitation the appropriate support and ensure steps are taken to crack down on those responsible,” Earnshaw said.
“The recommendations set out in the report range from opportunities to share intelligence, to improving care and support and removing the barriers people may face in accepting that support,” Earnshaw added. “We are also taking steps to further engage with local communities as well as trading standards and financial institutions to protect adults at risk of exploitation.”