Safeguarding - concern for an adult

Safeguarding is about protecting an adult’s right to live in safety, free from abuse and neglect. Every adult has the right to be treated with dignity, respect, and to live a life free of fear.

While all adults have the right to make their own decisions and take risks, some are at greater risk of harm due to their reliance on others for day-to-day living. The term "adult at risk" refers to individuals who may require support to protect themselves from abuse or neglect.

Under the Care Act 2014, an 'adult at risk' is defined as someone who:

• is aged 18 or older
• has care and support needs
• is experiencing, or is at risk of, abuse or neglect
• is unable to protect themselves as a result of their care and support needs

Who is at risk?

People with care and support needs, such as older people or individuals with disabilities, are more likely to be abused or neglected. Some individuals with communication difficulties or cognitive impairments may be unable to identify or report abuse.

Forms of abuse

Abuse can take many forms, including:

• physical abuse
• sexual abuse
• psychological or emotional abuse
• financial or material abuse
• neglect or acts of omission
• discriminatory abuse
• domestic abuse
• modern slavery
• self-neglect

Signs of abuse

Possible indicators of abuse may include:

• unexplained injuries or bruises
• changes in mood, such as fear, anxiety, or withdrawal
• financial inconsistencies, like missing money or unpaid bills
• poor hygiene or unsafe living conditions

Find detailed information on the forms and signs of abuse.

Abuse can be committed by anyone, including:

• family members, partners, or friends
• neighbours or members of the community
• paid carers, volunteers, or professionals
• strangers

Abuse often occurs where there is an imbalance of power, and the person causing harm may also be experiencing mental ill-health or substance misuse.

Learn more about perpetrators on the Lewisham Safeguarding Adults Board website.

Some people may not be able to make decisions themselves, the mental capacity act helps protect people by providing a legal framework to ensure rights and needs of the person are respected. Find out about the mental capacity act and what it covers.

If you suspect abuse or neglect, follow these steps:

• in emergencies: call 999 immediately if someone is in immediate danger
• complete the adult safeguarding concern form and return it to Lewisham Adult Gateway
• contact Lewisham Adult Gateway directly: phone (Office hours) 020 8314 7777 and select option 1 or (Out of hours) 020 8314 7766, fax: 020 8314 3014 or email: gateway@lewisham.gov.uk
• support for deaf or hearing-impaired individuals: Minicom: 020 8314 3309, text message: 07730 637 194
• Glide: LEWISHAM Adult Social Care / 07730 637 194
• contact Crimestoppers UK to report anonymously

Once a report is made:

• the organisation will ensure the person’s immediate safety
• appropriate steps will be taken to assess and respond to the concerns
• the case will be treated seriously and confidentially

Learn more about what happens after you make a report.

Preventing abuse is a shared responsibility. Everyone can help by raising awareness and supporting safeguarding measures.

Learn more about prevention on the Lewisham Safeguarding Adults Board website.

What is mental capacity?

'Mental capacity' means being able to understand, remember and consider information in order to make a decision. Some people may not have the mental capacity to make certain decisions because of:

• a learning disability
• dementia
• a brain injury
• mental health problems

How does the Mental Capacity Act work?

The Act applies to anyone aged 16 or over is based on these five principles:

1. Presumption of capacity: always assume a person can make their own decisions unless proven otherwise.
2. The right to make unwise decisions: people have the right to make choices even if others see them as unwise.
3. Support to decide: help must be provided to enable someone to make a decision before assuming they can't.
4. Best interests: any decision made on behalf of someone must be in their best interests.
5. Least restrictive option: any action taken should interfere with the person's rights and freedom as little as possible.

Who decides when someone lacks capacity?

If someone cannot make a decision, it will be assess by a professional, like a doctor or social worker. The assessment will focus on:

• whether the person can understand and retain information
• whether they can weigh up the information to make a decision
• whether they can communicate their decision

Lasting power of attorney

The Act allows individuals to plan for the future by appointing someone they trust (a relative or friend) to make decisions on their behalf if they lose capacity. This is called 'lasting power of attorney'.

Deprivation of liberty safeguards

If someone needs to be cared for in a way that restricts their freedom, such as living in a care home or hospital, the Mental Capacity Act ensure these restrictions are lawful and in the person's best interest.

For more information, see Mental Capacity Act guidance.

What is suicide prevention?

Suicide prevention means identifying risks and offering support to people who may feel like ending their life is the only options.

Everyone can play a part in preventing suicide by being aware of the signs and knowing how to respond.

Who is at risk?

Anyone can experience suicidal thoughts but people may be at higher risk if they:

• feel isolated or lonely
• are struggling with their mental health
• have experienced trauma or abuse
• are dealing with financial, relationship or housing problems
• have lost a loved one

Signs to look out for

• sudden changes in mood, like feeling hopeless or angry
• talking about feeling like a burden or wanting to die
• withdrawing from friends, family or activities
• giving away possessions or saying goodbye

What can you do?

If someone you know is struggling:

• listen - let them talk without judgement
• ask questions - gently ask if they are thinking about suicide

encourage help - suggest speaking to a GP, counsellor or helpline

• stay connected - keep checking in with them

Emergency help

If someone is in immediate danger, call 999 or take them to A&E. For urgent support contact:

• Samaritans - call 116 123 (free, 24/7)
• Mind - call 0300 123 3393 or text 86463
• CALM (Campaign Against Living Miserably) - call 0800 58 58 58

How we are helping

Lewisham Council provides resources, and campaigns to raise awareness and offer support for people at risk of suicide. The focus is on:

• encouraging open conversations about mental health
• training professionals and communities to recognise and respond to the signs
• providing local support services for those in need

For more information see our suicide prevention plan.

When is someone deprived of their liberty?

Some adults, who are in hospitals, care homes and certain other types of accommodation, can't make their own decisions about their:

• living arrangements
• treatment
• care

This is because they lack the mental capacity to do so. For example someone with:

• a severe brain injury
• dementia
• a learning disability

These people need more care and protection than others to make sure their wellbeing is maintained and they do not suffer any harm. Treating and caring for people who need extra protection may mean restricting what they can or cannot do. This is called deprivation of liberty.

A person is likely to be deprived of their liberty if they:

• don’t have the capacity to decide on their living and care arrangements
• are under continuous supervision and control
• are not free to leave the hospital, care home or other accommodation, because harm will occur

An example would be stopping a person leaving a care home because they are very likely to have a serious accident.

It is illegal to deprive someone of their liberty in a care home or hospital without a DoLS.

What is a deprivation of liberty safeguard (DoLS)?

A DoLS sets out when and how certain restrictions can be used. It could be granted to help give a care home or hospital the right to keep a person from leaving, so they don’t come to harm. DoLS do not apply to people detained in hospital under the Mental Health Act.

DoLS assessments determine if it is in the person’s best interests to be kept in the care home or hospital to receive the care or treatment they need. If it is, a DoLS will be authorised.

How to apply for a DoLS

If a care home, or other setting, needs to deprive someone of their liberty, they must apply to our DoLS supervisory body to authorise this deprivation as in the person's best interests. In certain circumstances, the application may need to be made to the court of protection.

What to do if you think someone is being deprived of their liberty without authorisation

Contact the care home or hospital

If you believe someone is being deprived of their liberty without authorisation, or you want an existing authorisation reviewed, you can discuss it with the care home or hospital manager. They can make the authorisation or DoLS review request.

Contact us

You can also email DOLS@lewisham.gov.uk or call us on 020 8314 7172 or 020 8314 3365.

Reviewing a DoLS

A DoLS can be reviewed at any point to see if a person still meets the requirements, or if any conditions need to be changed. The DoLS office will carry out reviews if it is necessary, or if it is requested by:

• the person being deprived of their liberty
• the person’s representative, hospital or care home

An independent mental capacity advocate (IMCA) may be appointed if someone needs an advocate, especially if they have no one to consult with during the DoLS assessments or authorisation.

Your rights

Every person subject to a DoLS must have a representative. This can be a:

• family member
• friend
• paid representative

The DoLS office will appoint the representative when the DoLS is authorised.

In Lewisham, the IMCA and the paid relevant person’s representative (PRPR) services are provided by an organisation called Advocacy For All.

For more information view an easy to read document and our guide for family, friends and carers.

• Deprivation of Liberty Safeguards easy read guide
• Deprivation of Liberty Safeguards for friends, family and unpaid carers

Further information

• standard forms and guidance from central government
• SCIE on mental capacity
• The Law Society guidance for frontline health and social care professionals (to identify when a deprivation of liberty may be occurring)

Contact our DOLS team

DOLS team - Safeguarding Quality Assurance, London Borough Of Lewisham, Second Floor, Laurence House, 1 Catford Road, London, SE6 4RU. Telephone:
020 8314 7172. Email: dols@lewisham.gov.uk.