This chapter was added in April 2025.

1. Introduction

Safeguarding adults means protecting a person’s right to live in safety, free from abuse and neglect (Care and Support Statutory Guidance, Department of Health and Social Care, 14.7); see also (Adult Safeguarding chapter). Adults with learning disabilities may have a greater need for protection if they are unable to keep themselves safe. They can experience abuse and neglect from people they know such as family, friends, neighbours, support staff and other practitioners, but also from complete strangers.  It is important for staff to understand the issues, recognise signs of potential abuse, and empower adults with learning disabilities to identify and understand the risks they may face. Staff should also help them know what to do if they have concerns or feel frightened about someone.

It is essential for staff to participate in ongoing safeguarding training to ensure they have the knowledge and skills needed to protect adults effectively.

1.1 Findings from LeDeR

The Learning Disabilities Mortality Review Programme (LeDeR) reviews all deaths of people with a learning disability and aims to identify learning to help prevent similar deaths in the future.

LeDeR reviews have found that people with learning disabilities die younger than those without learning disabilities; six out of 10 people with a learning disability die before they reach the age of 65, compared to one in 10 in the general population. The programme also found that people with learning disabilities are twice as likely to die from avoidable causes than the general population, with almost half of all deaths being classified as avoidable.

Some of the most common concerns found during LeDeR reviews relate to:

  • delays in the diagnosis and treatment of illness;
  • poor care coordination and communication between agencies;
  • omissions in care and the provision of substandard care;
  • poor application of the Mental Capacity Act 2005;
  • a lack of timely referral to specialists, including learning disability services and neurologists.

In response to these findings, organisations should prioritise improving access to healthcare for people with learning disabilities, ensuring reasonable adjustments are made, and providing mandatory training for healthcare professionals.

2. What is a Learning Disability?

Mencap defines learning disability as:

 ‘a reduced intellectual ability and difficulty with everyday activities – for example household tasks, socialising or managing money – which affects someone for their whole life. People with a learning disability tend to take longer to learn and may need support to develop new skills, understand complicated information and interact with other people.’

However, with personalised support, many adults with learning disabilities can lead fulfilling and independent lives.

2.1 Causes of learning disabilities

Before birth, damage to a baby’s brain and spinal cord (called the central nervous system) can cause a learning disability. This may include if the mother has an accident, illness, infection or is exposed to environmental toxins while pregnant, or if the parents pass certain genes or an inherited condition to the unborn baby. A baby can also be born with a learning disability if they do not get enough oxygen during childbirth, have a traumatic head injury, or are born too early (premature birth). A learning disability can also be caused by early childhood illnesses (such as meningitis or measles), seizures, accidents or abuse or neglect, which result in injury or trauma to the brain. Sometimes the cause of a learning disability is not known.

2.2 Types of learning disabilities

There are nearly 1.2 million adults in the UK with a learning disability (Mencap), which can be mild, moderate, severe or profound. In all cases, a learning disability is a lifelong condition.

Mild learning disabilities can be difficult to diagnose as the adult will often socialise well with other people, can manage most daily tasks and require only limited support. However, they may need support in some areas, such as completing forms or finding a job.

Adults with a severe learning disability or a profound and multiple learning disability (PMLD) will have greater needs for care and support, including mobility, personal care and communication, especially if they also have a physical disability or disabilities. People with a moderate learning disability may also need support in these areas, but that is not always the case.

2.3 Related conditions

Some adults with learning disabilities may also have other conditions, including:

  • autism – approximately half of autistic people may also have a learning disability – see What is Autism? (Mencap);
  • cerebral palsy, which is a physical condition that affects movement, posture and coordination– see Cerebral Palsy (Mencap);
  • challenging behaviour, also known as behaviour of concern, is not a learning disability but adults with learning disabilities are more likely to show it – see Challenging behaviour (Mencap);
  • Down syndrome (also called Down’s syndrome) is a genetic condition that usually causes some level of learning disability – see Down Syndrome (Mencap).

For further information, see Learning Disability and Conditions (Mencap).

2.4 Learning difficulties

A learning disability is different from a learning difficulty, as a learning difficulty does not affect general intellect. A learning disability affects somebody across all areas of their life. Specific learning difficulties, such as dyslexia, only affect a subset of skills and are not the same as a learning disability.

The main types of learning difficulty are dyslexia (which mainly affects reading and writing skills and sometimes information processing), dyspraxia (which affects physical co-ordination and can cause people to perform less well than expected in daily activities) and dyscalculia (which is persistent difficulty in understanding numbers which can lead to a range of difficulties with maths). It is possible for a person to have both a learning disability and a learning difficulty. Sometimes neurodevelopment and neurological conditions like ADHD are confused with a learning difficulty or a learning disability, but they are not the same.

3. Abuse and Neglect of Adults with Learning Disabilities

The Care and Support Statutory Guidance (Department of Health and Social Care)  identifies the following types of abuse and neglect, all of which can affect adults with learning disabilities;

If an adult with a learning disability has communication needs, this may make them more vulnerable to abuse and exploitation.

3.1 Hate crime

Disability hate crime is a criminal offence motivated by hatred or prejudice towards a person because of their actual or perceived disability.

The Crown Prosecution Service define disability hate crime as:

‘Any incident / crime which is perceived by the victim or any other person, to be motivated by a hostility or prejudice based on a person’s disability or perceived disability’. Disability Hate Crime and other Crimes against Disabled People – Prosecution Guidance (Crown Prosecution Service).

Hate crime can include:

  • verbal and physical abuse;
  • threatening behaviour;
  • damage to property;
  • online abuse;
  • stalking and harassment.

Hate crime directed at adults with learning disabilities should be reported to the police, or online at www.stophate.org.uk.

3.2 Befriending crime or mate crime

Whilst not a category of abuse within the Care and Support Statutory Guidance, befriending crime (or mate crime) is another type of abuse often experienced by adults with learning disabilities. It occurs when someone pretends to be the friend of an adult simply to take advantage of them. It can include:

  • grooming or forcing an adult to commit a crime;
  • taking an adult’s money;
  • forcing an adult to work for little or no pay (see also Modern Slavery chapter);
  • preventing an adult’s access to food or basic needs;
  • harassment or emotional abuse;
  • sexual assault / abuse or physical abuse.

3.3 Cuckooing

Adults with learning disabilities may also be victims of ‘cuckooing’. This is when a person or group of people befriend an adult who is in some way vulnerable and then move into their property and use it to deal drugs and / or as a base for sex work or other criminal activities. Adults with learning disabilities, particularly those who are living on their own, are at increased risk of being targeted by such criminals as they may not fully understand risks and dangers or know how to ask for help, so they can be easily manipulated or frightened. They may also be receiving higher rates of benefits from the Department of Work and Pensions due to their disability, which can result in them being an additionally attractive target of financial fraud.

Concerns that an adult with learning disabilities is experiencing, or at risk, of any type of abuse of neglect should be shared with the local authority safeguarding adults team.  Wherever possible, practitioners should speak to the adult first to discuss their concerns and ask their views and what they would like to happen. However, practitioners can still share safeguarding concerns with the local authority even if they are not able to speak to the adult first, or if the adult does not give their consent.

3.4 Organisational abuse

Organisational abuse (also called institutional abuse) includes neglect and physical and / or psychological abuse or poor care practices within a residential or other specific care setting; including care provided to an adult in their own home. This could be a one-off incident or involve ongoing, long term or recurring poor treatment of an adult.

Organisational abuse can involve neglect or poor professional practices linked to the structure, policies, processes and practices in place in an organisation. In some organisations, poor practices can result in a ‘closed culture’ where not many people visit the care setting (if the care setting is located away from towns and cities and is not easily accessible by transport, for example) and adults are at risk of harm, including human rights breaches and abuse. See also Closed Cultures (Care Quality Commission) (https://www.cqc.org.uk/guidance-providers/all-services/how-cqc-identifies-responds-closed-cultures ).

In care settings where organisational abuse is a concern, it is vital that staff have the right tools and approach to recognise and address issues early. Effective communication is key in identifying signs of abuse or neglect, especially for adults with learning disabilities who may find it difficult to express themselves. By actively engaging with the individual, understanding their preferences, and providing appropriate support, staff can help ensure that the needs and rights of vulnerable adults are prioritised. This approach not only prevents the risk of abuse but also empowers individuals to have a voice in their care, which is fundamental in fostering a safe and respectful environment.

4. Ask, Listen, Do – Practice Guidance Information for Working with Adults with Learning Disabilities

The information in this section is taken from The Oliver McGowan Mandatory Training on Learning Disability and Autism – (NHS)

4.1 Ask

  • Always communicate with the adult first, even if you’re not sure they are able to understand you.
  • Ask what the adult’s preferred methods of communication are.
  • Ask if the adult has a communication passport, hospital passport, care plan or other document that you could see. This could help you understand the adult’s needs and how best to support them.
  • Begin with open questions. If the adult struggles, then provide more support and move on to yes and no questions, if needed.
  • You may need to repeat or rephrase things.
  • Ask:
    • “what would you like to happen?”
    • “how would you like to be supported?”
    • “what is the best way I can help you?”
  • Ask if there is anyone else it would be helpful to talk to.
  • Always consider the adult’s mental capacity to make decisions about sharing information with others. Only share information, or talk to other people, with the adult’s consent or (if they lack mental capacity) where it is in their best interests.
  • If the adult is struggling, do not ask, “what is wrong with you?” but instead, “what has happened to you?”

4.2 Listen

  • Listen to all the ways that the adult might communicate their thoughts, feelings and preferences. This includes body language, tone, behaviour and any other method they use to communicate.
  • Don’t jump in when an adult is taking time to think. Allow time and listen carefully to their views and choices.
  • Adults many need more processing time. Be patient and persevere.
  • Listen to the adult’s own language and understanding; use their words where it is helpful.
  • In listening, check that the adult has understood what you have said; get them to summarise in their own words.
  • Check that the adult is not simply repeating what you have said or just agreeing with you. If you notice any response patterns, try asking questions in a different way to see if you get the same answers.
  • Avoid making judgements or assumptions, which can be barriers to good listening.
  • Consider involving an advocate if the adult needs support in order for their voice to be heard.

4.3 Do

  • Empower adult. Support to them to have choice and control in their own life. Make sure that you keep them at the centre of decision making.
  • Encourage adult e to ask questions and to tell you if they don’t understand something. Never talk about the adult as if they weren’t there.
  • Treat the adult in an age-appropriate way, respecting their roles and experiences.
  • Be respectful and take time to find out about the adult’s preferences and cultural needs.
  • Don’t assume that because the adult has a learning disability they don’t understand. Instead, make sure that things are explained in more simple language. This means avoiding jargon and long, complex sentences.
  • Break things down into chunks or smaller steps.
  • Make use of existing reports and care plans, which help you to understand the adult’s areas of strength and needs and how best to adapt your approach.
  • Think holistically about the adult and their life. Consider their broader needs, such as good supportive relationships, meaningful occupation, the right environment and meeting their mental and physical health needs, and the impact these may have.
  • Promote independence and skills development in a way that is meaningful and accessible for the adult.

4.4 Things to remember

Communication includes both giving and receiving information.

It is important to take responsibility for meeting an adult’s unique communication and information needs.

Even when an adult is unable to communicate verbally, it is important to involve and include them by using communication methods which are suited to their needs.  Itis your responsibility to make that possible.

You may get incomplete or incorrect information from, or about, an adult if they are stressed and finding it difficult to process.

They may be able to understand more than they can express at that moment, because they may be overwhelmed and need space and time to process and understand.

The sensory environment is important for many as it can be overwhelming or frightening. Remember to consider this when choosing a venue.

5. Using the Care Act Principles to Safeguard Adults with Learning Disabilities

To reduce the likelihood of adults with mild or moderate learning disabilities experiencing or being at risk of abuse or neglect, practitioners should provide support and information tailored to their individual needs and level of understanding. The six key principles for safeguarding adults contained in the Care Act 2014 should guide all work to safeguard adults with learning disabilities.

  1. Prevention: Where possible, adults should be provided with appropriate level information and education about what safeguarding is, the signs of harm and abuse and what to do if they believe they, or someone they know, are at risk of or are experiencing abuse or neglect. Providing a sound knowledge base in this way can help to reduce the likelihood of abuse being recognised and reported. Taking preventive measures will help reduce the overall risk to the adult and empower them to take control of their own lives. Organisations such as Mencap or local learning disability teams provide easy read guides which can be used to support adults with learning disabilities (see Easy Reads and Easy Read Library, Mencap). Positive risk management plans can also be used to help the adult live the life they want to live while seeking to minimise any risks they may face.
  2. Empowerment: It is essential to involve adults in decisions about their lives and seek their views on what they want to happen (see Section 4 , Ask, Listen, Do – Practice Guidance Information for Working with Adults with Learning Disabilities). Too often, when working with adults with learning disabilities, practitioners and medical professionals make decisions on their behalf and without consulting them This may be because the adult lacks the mental capacity to make the decision themselves (see Mental Capacity chapter) or because practitioners do not realise that making decisions for adults may not be in their best interests or reflect their wishes. Even if the adult lacks mental capacity to make a decision, their views still need to be sought. Seeking the adult’s views should start when a safeguarding concern is first raised; practitioners should ask them the adult what they want to happen and what outcome they want to achieve at the end of the safeguarding process (see Making Safeguarding Personal chapter). By putting the adult at the centre of the process, it ensures their voice is heard and that they are kept informed about what is happening, what will happen next and if the outcome they want can be achieved. The adult’s preferred outcomes should guide the safeguarding process as much as possible. Under section 42 of the Care Act, the adult is not required to give consent for a safeguarding enquiry to take place, as the local authority has a duty to investigate a safeguarding concern if all the relevant criteria is met (see Responding Safeguarding Procedures for Responding in Individual Cases chapter). However, once the safeguarding enquiry is underway, the local authority will need to decide what action it is going to take following the investigation. The adult, who is the subject of the safeguarding process, does need to be involved in this, unless there are exceptional circumstances where the risk to the adult would increase.
  3. Proportionality: Practitioners should not rush to make decisions, without considering the least intrusive response to any safeguarding concern. Failing to consider the most appropriate response can have a negative impact on adults with learning disabilities, especially if they are protective of the alleged abuser who could be a partner, family member, friend or a longtime carer. They may not want to feel they have got the person in trouble with adult social care or, potentially, the police. Therefore, when a concern is raised, practitioners need to make sure they take a proportionate response by assessing the situation and taking the least restrictive approach to reducing the risk, while always keeping the adult at the centre of the safeguarding process.
  4. Protection: Practitioners need to make sure that they provide support to those at most risk of harm and that they have a key support network around them, which can help them feel able to tell a trusted person what is happening to them. This can be done by ensuring the adult has access to advocacy (see Independent Advocacy chapter), key workers, and regular visits from practitioners from other agencies as applicable, including provider services. It is also important that if a safeguarding referral is received, the relevant practitioner regularly checks in with the adult to see how much they want to be involved in the process and what this could look like for them. For example, one adult may want to attend the safeguarding meetings whilst someone else may want an advocate to go on their behalf. Practitioners need to ensure that accessible information is provided to assist with explaining the process such as easy reads, pictorial support, sign language or any other form of communication that will meet their needs (see Interpreting, Signing and Communication Needs chapter).
  5. Partnership: Working in partnership with other agencies and local communities is key to keeping adults with learning disabilities safer. This ensures the adult themself to know who they can go to for support and also provides information and knowledge to the community about their role in safeguarding adults. It also enables the adult to maximise their independence, knowing that they are safer. One of the ways this has been done is the introduction of ‘safe places’, where shops and community centres sign up to provide a safe place for vulnerable people to access support and assistance if they are scared or need a place of safety. Safe places can be identified by a yellow sticker in the window – see Keep Safe with Safe Places).
  6. Accountability: Practitioners need to make sure they are accountable for their actions and are transparent with the adult they are supporting. The adult must be kept informed, in a way which is appropriate to their particular needs, so that they understand what everyone’s role is and what they can expect to happen.

These six key principles underpin the making safeguarding personal agenda, which focuses on what the adult wants to happen as an outcome of the safeguarding process. Working this way supports adults with learning disabilities to feel more confident as they know their views, wishes and feelings will be heard. Making Safeguarding Personal is a significant move away from the previous approach where adults with learning disabilities would often have things ‘done to them’ to keep them safe, without involving them in the decision-making process. As Lord Justice Mumby stated “What good is it making someone safer if it merely makes them miserable?”  (see Local Authority X v MM & Anor (No. 1) (2007)).

Practitioners must ensure they promote the adult’s own views and needs.

6. Further Reading

6.1 Relevant chapters

Kindness, Respect and Compassion

Equality, Diversity and Human Rights

Working with Adults with Hidden Disabilities

Interpreting, Signing and Other Communication Needs

6.2 Relevant information

NHS England » Ask Listen Do – feedback, concerns and complaints

Learning Disability – Applying All Our Health (gov.uk)

Core Capabilities Framework for Supporting People with a Learning Disability (Skills for Health) relevant to those working in any sector and all staff working in health and social care

Improving Healthcare Access for People with Learning Disabilities (gov.uk) – guidance for social care staff on how to help people with a learning disability get better access to medical services to improve their health

Annual Health Check Resources and Guide (National Development Team for Inclusion) supports the implementation of health checks for people with a learning disability

Reasonable Adjustments for People with a Learning Disability (gov.uk) is a series of guides on how reasonable adjustments should be made to health services and adjustments to help people with a learning disability to access services

Was this helpful?
Yes
No
Thanks for your feedback!
– End –