By Alison Gardner, Aisha Abubakar, Imogen Lambert, David Charnock, Rachael Clawson, Rachel Fyson, Nicola Wright , Rowland Seymour
In recent years there has been increasing attention to ‘modern slavery’, human trafficking and wider forms of exploitation both in the UK and internationally. There has also been growing awareness that people can be placed at risk of exploitation by a wide range of personal, social and economic circumstances, including physical and mental health issues. News stories have highlighted examples of people with different forms of cognitive impairment experiencing control and exploitation by those seeking to profit from their labour or property, sometimes over long periods of time. However, statistics on this issue remain elusive. This project aimed to provide the first robust description of the intersection between cognitive impairment and the exploitation of adults in England. We were interested mainly in cognitive impairment as a risk factor prior-to exploitation, rather than impairment caused by experiences of exploitation. Whilst we recognise that there is a wide spread of IQ and cognitive ability across populations, we define cognitive impairment broadly to include both developmental and acquired impairments including intellectual disability, dementia, brain injury, autistic spectrum disorders, ADHD, functional mental health disorders and substance misuse. We also examined a diverse spectrum of exploitation looking at a range of situations where one person, either opportunistically or premeditatedly, unfairly manipulates another person for profit or personal gain. Research methods Our multi—method study included the following methods of data collection and analysis. ■ A wide-ranging scoping review of existing literature. ■ Analysis of statistical information, including data on exploitation and support needs within the Safeguarding Adults Collection (SAC) from NHS England Digital between 2017 and 2022, as well as wider contextual data. ■ Quantitative and qualitative analysis of evidence extracted from Safeguarding Adults Reviews (SARs) featuring exploitation during the same period (2017-2022). SARs (formerly known as serious case reviews) are initiated in cases where an adult with care and support needs has suffered serious harm or death, and abuse or exploitation is suspected. From our initial search of a national library of SARs we identified and analysed 58 narrative SARs featuring exploitation involving 71 people. ■ An open online survey of practitioners who were working in roles relevant to safeguarding people with cognitive impairment, which gained 95 responses. ■ Semi-structured interviews with 24 practitioners and 26 people who had lived experience of cognitive impairments and exploitation. ■ Qualitative comparative analysis (QCA) to inform our understanding of how factors combine to increase risks for exploitation.
Key findings 1 Previous studies suggest that cognitive impairments can increase vulnerability to exploitation Academic literature looking at cognitive impairment and exploitation is sparse, but our scoping review found 20 studies published in English that related to the topic. These covered three types of exploitation (sexual, financial and criminal) with intellectual disability and mental health the most frequently discussed types of impairments. The literature indicated that cognitive impairment was a factor increasing vulnerability to exploitation, but the limited number of studies meant that it was difficult to disentangle complexities in the relationship between cognitive impairment and exploitation without further research. 2 Existing datasets and surveys miss important opportunities to publish intersecting data on cognitive impairment and exploitation. Building on the literature review, we went on to examine the data that was available in England relating to cognitive impairment and exploitation. A review of statistical information found that existing English surveys and datasets currently describe the prevalence of disability and exploitation separately. With minor adjustments these could collate and publish intersecting data on cognitive impairment and exploitation, but at present these opportunities are being missed. Safeguarding Adults Collection (SAC) Data from NHS England includes statistics on support needs (including cognitive impairments) and various forms of abuse and exploitation, but has some limitations. In particular, it does not yet publish data showing the intersections between different types of support needs and forms of abuse. There were also significant regional variations in recorded safeguarding investigations, as well as potential for conflation between abuse and exploitation, which could create data inconsistencies. The SAC data did show increased safeguarding investigations for people who were not previously in contact with services, indicating that more adults with support needs may not be known to services until a crisis occurs. There were also a small but increasing number of reports of modern slavery. 3 Cognitive impairments are present within 96% of individuals in Safeguarding Adults Reviews that include exploitation Analysis of Safeguarding Adult Reviews (SARs) on exploitation showed clearer connection between cognitive impairment and exploitation. Approximately 96% of individuals in reviews that included exploitation between 2017 and 2022 focussed on adults who had some form of cognitive impairment. 4 People are often exploited in multiple ways, and alongside other abuses The relationship between cognitive impairment and exploitation is complex, with multiple forms of exploitation and abuse often co-existing and overlapping, alongside diverse risk factors. Both data from SARs and our survey suggests that financial exploitation and ‘mate crime’ (being exploited by someone posing as a friend) were the most commonly-experienced forms of exploitation. However, these more frequently observed forms often co-occur alongside others, such as sexual, labour or criminal exploitation. People with experience of living with cognitive impairment also identified ‘everyday exploitation’ as part of their regular experience, including issues like being targeted for phone and online scams. 5 Risks for exploitation arise not just from cognitive conditions, but their social impacts. The presence of a coercive and controlling relationship is a key factor. Factors identified as contributing to vulnerability included substance misuse, intellectual disabilities, mental health and dementia or cognitive decline, though in many cases there were multiple diagnoses. Complex and developmental trauma in earlier life was frequently evident. A lack of diagnosis was also a frequent challenge for practitioners seeking to support individuals at risk of exploitation. Beyond clinical factors, a range of social drivers impacted on vulnerability to exploitation, including limited or absent family support, harmful social networks, trauma and isolation. People with lived experience also described the impact of discrimination and hate-crime, and social precarity, sometimes driven through factors such as irregular immigration status or unemployment. Factors such as a history of abuse and/ or other adverse experiences such as bullying could also be present. Coercive and controlling relationships were also a significant factor predicting exploitation alongside the existence of social networks used to target a potential victim.
Nottingham, UK: University of Nottingham, Rights Lab, 2024. 58p.
