This is about direct or indirect involvement in sexual activity without the person’s consent. This is also the inability to consent, or situations where there has been pressure or inducement to consent or take part. In safeguarding adults this will often be where mental capacity is impaired in some way.

As with other forms of abuse, age is no barrier to sexual abuse or violence, but older people, as well as those with profound disabilities, complex mental health needs, and dementia are much more vulnerable because of their dependence on others for day to day support, limited or impaired communication, isolation etc.

This category includes adult sexual exploitation - exploitative situations and relationships where people receive 'something' (e.g. accommodation, alcohol, affection, money) as a result of them performing, or others performing on them, sexual activities. Anybody can be a victim of sexual exploitation. While it mainly affects women, men can also be victims.

At one end of the scale adult sexual exploitation can describe a one-off situation between two adults, while at the other end it may include instances of organised crimes where a number of adults are trafficked and sexually exploited.

Possible signs of adult sexual exploitation:

• evidence or suspicions of sexual assault
• self-harm or significant changes in emotional wellbeing
• developing inappropriate or unusual relationships or associations, including relationships with controlling or significantly older people
• displaying inappropriate sexualised behaviour, language or dress
• being isolated from peers and social networks
• unexplained absences, including persistently being late or going missing
• unexplained acquisition of money, clothes and mobile phones
• using more than one phone, especially if both are used to communicate with different people (for example, if one phone is used exclusively to communicate with a specific group of ‘friends’)
• receiving an excessive amount of texts or phone calls – these may be from multiple callers, some of whom may be unknown

Exploitation does not stop at 18 - Community Care article

Sexual abuse can involve serial abusing in which the perpetrator seeks out and ‘grooms’ individuals. Grooming is defined as developing the trust of an individual at risk of abuse and/or his or her family in order to engage in illegal sexual conduct. There is no specific criminal law against the grooming of an adult, unlike children. However, there are offences which relate to adults at risk who have impaired capacity, and safeguarding interventions are possible outside of the criminal justice system.

Sexual abuse also includes sexual violence, which is often linked with domestic abuse but in fact is any sexual act (or attempt at a sexual act) obtained by using violence or coercion, regardless of the relationship to the victim.

Consent is a key factor here – here is a quick and very easy to understand video on YouTube courtesy of Thames Valley Police – it explains consent in a way that really sticks, using ‘making a cup of tea’ as an example. 

Services and support are available to those with, and without, care and support needs.

In Norfolk we have the Harbour Centre Sexual Assault Referral Clinic which offers free support and advice to people of all ages living in Norfolk who have been raped or sexually assaulted either recently or in the past. It is a fully accessible building including disabled parking and is open 24/7. They have trained specialist staff and there is no pressure to involve the police if the person is unsure or does not wish to report an incident formally. There are also Independent Sexual Violence Advisors (ISVAs). For all help and advice please telephone the 24/7 helpline on 01603 276381 or email [email protected]

Norfolk police have a specialist adult abuse investigation unit and officers who are very experienced in supporting adults with care and support needs through sensitive enquiries, and work in close partnership with health and social care staff to achieve positive outcomes.

What might it look like?

• rape, sexual assault or sexual acts to which the adult has not consented to, was unable to consent to, or was pressured into consenting to
• indecent exposure; sexual harassment
• inappropriate looking or touching
• sexual teasing or innuendo
• sexual photography, subjection to pornography or witnessing sexual acts

How might you recognise it?

• Bruising, particularly to the thighs, buttocks and upper arms and marks on the neck
• Torn, stained or bloody underclothing
• Bleeding, pain or itching in the genital area
• Unusual difficulty in walking or sitting
• Foreign bodies in genital or rectal openings
• Infections, unexplained genital discharge, or sexually transmitted diseases
• Pregnancy in a woman who is unable to consent to sexual intercourse
• The uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude
• Incontinence not related to any medical diagnosis
• Self-harming
• Poor concentration, withdrawal, sleep disturbance
• Excessive fear/apprehension of, or withdrawal from, relationships
• Fear of receiving help with personal care
• Reluctance to be alone with a particular person

Sexual abuse can also happen in care settings, sometimes when people have impaired mental capacity. 

The Social Care Institute for Excellence (SCIE) was asked by the Department of Health and Social Care to undertake a detailed evidence review, and have produced this briefing in March 2022: Sexual Incidents in Adult Social Care. The briefing is a summary of a full evidence review and is relevant to anyone working in adult social care or safeguarding.