By Aisha M Abubakar, Rowland G Seymour, Alison Gardner, Imogen Lambert, Rachel Fyson, Nicola Wright

Background

Exploitation poses a significant public health concern. This paper highlights ‘jigsaw pieces’ of statistical evidence, indicating cognitive impairment as a pre- or co-existing factor in exploitation.

Methods

We reviewed English Safeguarding Adults Collection (SAC) data and Safeguarding Adults Reviews (SARs) from 2017 to 22. Data relevant to exploitation and cognitive impairment were analysed using summary statistics and ‘analysis of variance’.

Results

Despite estimates suggesting cognitive impairments may be prevalent among people experiencing exploitation in England, national datasets miss opportunities to illuminate this issue. Although SAC data include statistics on support needs and various forms of abuse and exploitation, they lack intersectional data. Significant regional variations in recorded safeguarding investigations and potential conflation between abuse and exploitation also suggest data inconsistencies. Increased safeguarding investigations for people who were not previously in contact with services indicate that adults may be ‘slipping through the net’. SARs, although representing serious cases, provide stronger evidence linking cognitive impairment with risks of exploitation.

Conclusions

This study identifies opportunities to collect detailed information on cognitive impairment and exploitation. The extremely limited quantitative evidence-base could be enhanced using existing data channels to build a more robust picture, as well as improve prevention, identification and response efforts for ‘at-risk’ adults.

Journal of Public Health, Volume 46, Issue 4, December 2024, Pages 498–505,

By Aisha Abubakar, Rowland Seymour, Alison Gardner, Nicola Wright, Rachel Fyson, Imogen Lambert, and Rachael Clawsona

People with an illness, disability or other health conditions are more likely to experience various forms of exploitation in comparison to other groups, particularly if their health condition necessitates assistance with daily functioning such as personal care, financial management, or socialising. For the purpose of this study, we consider a wide range of cognitive impairments and differences that affect processing, understanding, and memory, and therefore may cause additional challenges in everyday life. People with ‘hidden’ disabilities such as mental health conditions, cognitive decline, intellectual disabilities, autism, and ADHD are more vulnerable to exploitation than people with other types of disability. For example, they may be vulnerable due to trauma from adverse experiences leading to dissociation, or addiction means they can be exploited to fulfil their needs. They may struggle to recognise when they are being exploited and may be unable to effectively communicate or report abuse. Adults with cognitive impairment living alone may be vulnerable, while those having difficulty understanding financial matters may be more vulnerable to financial exploitation. The aforementioned factors not only increase vulnerability to exploitation but also amplify the severity of harm when exploitation occurs, making the relationship between cognitive impairment and exploitation a complex and multidimensional phenomenon. Hence, implementing strategies that pay attention to these factors is imperative in preventing exploitation and mitigating the severity of harm. Yet, there is a lack of public and official statistics to quantify the intersections between exploitation and disability/cognitive impairment to inform appropriate strategies for mitigation. Adults with cognitive impairments may be classed as a vulnerable group of individuals at increased risk of being exploited because of their reduced capacity to identify and report abuse or exploitation. Hence the prevalence of exploitation in this population is

not well understood, it is thought to be under-reported due to the challenges faced by these individuals in communicating their experiences . Section 42 (S42) of the Care Act 2014 requires local authorities in England to conduct investigations when they have reasonable grounds to suspect that an adult with care and support needs is experiencing, or is at risk of experiencing, abuse, neglect, or exploitation. Social workers, health professionals, the police, and other relevant stakeholders are all involved in S42 investigations, with the aim of ensuring the safety and well-being of adults with care and support needs, as well as preventing and responding to incidences of maltreatment. Hence, these enquiries are intended to garner information about the adult and their circumstances, assess the risks to their safety, and determine the best way to protect them. Estimates from the Crime Survey for England and Wales (CSEW) show that between 2014 and 2020, people with cognitive impairment aged between 16 and 59 were more likely to be victims of different forms of domestic abuse and sexual assaults than people with other forms of impairment, particularly women. However, it is not possible to extrapolate what incidents reported by individuals with lived experience constitute exploitation in the CSEW. Hence this paper is an exploratory study aimed at quantitatively understanding the intersections between cognitive impairment and exploitation. Given that there is currently very little intersecting data, quantitative statements about how people with cognitive impairment are at risk of, or are being exploited, need to be extrapolated. To extrapolate the relationship between cognitive impairment and exploitation, this

study provides a descriptive account of disability prevalence, exploitation prevalence and S42 enquiries in English LAs using data from the Family Resources Survey (FRS), the National Referral Mechanism (NRM), and the Safeguarding Adults Collection (SAC), with the aim of addressing the following important questions: • Are there trends in disability prevalence and exploitation by types of impairment, and if so, what types of cognitive impairment and exploitation are more prominent? • Are there trends in S42 enquiries, and if so, what are they? • What proportion of S42 enquiries involved people with cognitive impairment? • How frequently did exploitation appear as a factor of S42 enquiries? The remainder of the paper is structured as follows. Section 2 explains what data is currently available to quantify the relationship between cognitive impairment and exploitation. The results and discussion in Section 3 then provides a contextual and descriptive account of the prevalence of disability and exploitation in England, including findings from the analysis of S42 enquiries. The final section offers concluding remarks, limitations, and emerging recommendations.

Working Paper 2023 50p.

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.

By Roselle P. Jansen , Stijn Ruiter and Ronald van Steden

Objectives There is a rich body of research on how and why victims report crime to police, but little is known about the crime reporting process itself. This paper explores the relationship between victim satisfaction with the police after reporting crime and the various reporting channels victims used, as well as the subsequent police response. Methods We capitalize on a large-scale nationwide survey among victims in the Netherlands (N=25,760). Using linear regression, we test how victim satisfaction with the police relates to the reporting channel used, follow-up contact by the police, and action taken by the police while controlling for type of crime, its impact on victims, their needs and their sociodemographic characteristics. Results The model explains 38% of the variance in victim satisfaction. The crime reporting channel and subsequent police response to crime reports show largest effects. When victims had in-person conversations with the police, the police reported back to them, and took further action, victims were most satisfied. Conclusions This study shows the importance of how police operate during and after victims report a crime for their satisfaction with police. The results suggest that police may be able to positively affect victim satisfaction by taking relatively simple measures. More research is needed to test this hypothesis using (quasi)experimental designs

Crime Science (2024) 13:30

By Anita Heber, Tea Fredriksson

This article explores how Swedish lay-judges assess victims’ credibility in district court. Previous studies have explored how biases and emotional expressions impact credibility assessments. Adding to this, the present study analyses how lay-judges assess courtroom credibility from an intersectional perspective. Based on 24 in-depth interviews with lay-judges, the study explores three intertwined layers of credibility: appearances, narratives and emotions. The analysis concludes that these layers actualize balancing acts for both victims and the lay-judges assessing them. These layers of credibility can compound for victims, making them particularly credible in the eyes of the lay-judges, especially if and when they perform victimhood in line with expectations set by their intersectional characteristics.

The British Journal of Criminology, 2024, XX, 1–17 pages

By Lisa Wheildon 

The thesis examines the role of survivors of gender-based violence in policy development and mechanisms for engagement. It centers survivors’ voices and perspectives with 12 in-depth interviews, alongside interviews with policymakers and analyses of government and media reports. The thesis includes a case study analysis on the role of survivor Rosie Batty in Victoria’s family violence reforms and a second case study exploring the risks of co-production and the Victim Survivors’ Advisory Council. The findings highlight survivors’ strengths in generating community support, challenging institutional complacency and motivating stakeholders. The results underscore the need for role clarity and addressing power imbalances in co-production activities.

Melbourne: Monash University, 2022.

By Ania Moroz and Tamar Dinisman 

“Looking back now, I wouldn’t have gone to the police, because it is one of the hardest things you can ever do in your whole life. I can’t even sum up in words what it does to you mentally and physically. You can be the world’s strongest person ever in the world, but going to court can break you. It’s awful.” Victim-survivor It is estimated that 1 in 4 women and 1 in 18 men have been subjected to some form of sexual violence since the age of 16 and that 1 in 6 children have been sexually abused.1 The majority of victim-survivors will not report the offense to the police. Of those who do report it, a very low proportion will receive a charge and have their case go to court. The number of victim-survivors of sexual violence who give evidence in the trial is not openly available. Nevertheless, the Ministry of Justice (MoJ) data shows that in the year ending June 2023, 11,506 defendants were proceeded against for sexual offences2, and, in 2022–23, 3,004 defendants were charged with rape-related offenses.3 This report focuses on the experience of sexual violence victim-survivors where the defendant has been charged and their case has gone through the court process. It focuses on the three main stages of this experience – before, during, and after giving evidence – and highlights the main challenges victim-survivors face at each stage. This report also makes recommendations for changes in policy and practice to address these challenges. To meet the aims of the research, a multimethod approach, combining qualitative and quantitative methods, was used. These include 12 semi-structured interviews with victim-survivors; focus groups and interviews with Victim Support sexual violence practitioners; and Victim Support sexual violence cases analysis.

Cardiff::Victim Support, 2024.   

By Kimberly Starr Nagulpelli and Steven E. Butt

“Operations research” and “sociology” are infrequently discussed together. Though an analytic approach is positioned to benefit society through quantitative measurement and evaluation. This research reviews literature surrounding the sex trafficking victimization experience during a lifetime: namely sex trafficking, lifetime experiences, and Markov modelling. With the results of the literature review, a framework is defined to evaluate and assess the experience of sex trafficking victimization during a lifetime for individuals and/or populations. Particularly valuable outcomes of this research are the extensive review of related literature and the definition of a fully interconnected framework of the experiences individuals face within sex trafficking victimization. The defined framework is presented to support current analytic interests of anti-trafficking and policy-maker groups, as well as provide the foundation for further developments to better support impacted communities and society.

Unpublished paper, 2024.

By Susan A. Batchelor and Caitlin Gormley

Interpersonal repeat violent victimisation

The definition and conceptualisation of interpersonal repeat violent victimisation (RVV) is contested. Interpersonal violence refers to violence between individuals, often subdivided into community violence and violence against women and girls, including domestic abuse. These two forms of interpersonal violence are often studied separately, using divergent theoretical and methodological approaches (Batchelor et al. 2019). Mainstream research on RVV is largely quantitative in orientation, counting recurrent incidences of the same type of violent offence against the same target and identifying risk factors that make some people more prone to victimisation than others. Feminist research on men's violence against women and girls more often draws on qualitative methods to explore experiences of overlapping and intersecting forms of violence, conceptualising repeat physical violence as part of a process of coercive control located within a context of gendered inequality and norms.

Building on these insights, the current research adopts a qualitative approach to unpack patterns of RVV evident in official statistics on non-sexual violence in Scotland. Unlike survey research, which asks respondents to self-report the number of incidents they have experienced over a specified period, typically the previous 12 months, the present study acknowledges the impact of repeat violence and associated trauma on memory, imposing no time limit on participants' experiences. As a result, whilst we invited participants to reflect on recent experiences of physical violence, they also often related experiences of other forms of violence, experienced across the life course.

Edinburgh: Scottish Government, Safer Communities Directorate, 2023. 147p

By Scottish Government, Minister for Victims and Community Safety, Justice Directorate

The former Minister for Community Safety, Ash Regan MSP, asked the Scottish Community Safety Network (SCSN) and the Scottish Government to undertake a review of antisocial behaviour (ASB). This report presents the findings from work undertaken to gather views on the current approach to antisocial behaviour in Scotland. It is based on discussions with key stakeholders across Scotland including those who have experienced antisocial behaviour, frontline staff seeking to prevent and tackle antisocial behaviour and community and equality groups including those representing minority communities in Scotland. The discussions included people from both urban and rural settings across different areas of Scotland.

The findings do not amount to a definitive statement on what people feel needs to be done to change the way we view, prevent and address antisocial behaviour. However, they do provide a qualitative evidence base given the size and breadth of engagement. It is clear from these sessions that there are no quick fixes or easy solutions here. Therefore, we need to look at how we set the path to begin the journey and identify future work activity and milestones.

Overall, 25 engagement discussions involving close to 250 people, representing a wide range of interests (Annex B - methodology summary) were held by the Scottish Community Safety Network and the Scottish Government. We are indebted to all who shared their time and their expertise. This report reflects the views, opinions and experiences from those discussions, and additional written feedback received.

The Scottish Government and its partners believe that everyone has the right to be, and feel, safe in their community and homes. Embedding change which will have a positive sustainable impact, requires a process of innovating, evaluating and building on success. We can also learn from challenging issues and sharing best practice.

What has come across very clearly during this engagement, is that prevention is better than cure and that working collaboratively in partnership is essential to finding long term solutions to address antisocial behaviour and make all of our communities safer and more welcoming places to live.

We all have a role to play in preventing and tackling antisocial behaviour and hope that this report will be used as the starting point of a much broader and deeper discussion of these issues, leading to a long-term road map of how we can work collectively to prevent and address antisocial behaviour in effective ways.

We can, and should, come together to address the mutual problems we face in our communities, but we will achieve little if we approach this in a way that is not properly considered, including the potential for unintended consequences, and therefore we need to develop structures which we can work within to achieve change and incrementally build on approaches which are proven to be successful.

As such, two recommendations arise from our assessment of the qualitative evidence:

Recommendation one

That Scottish Ministers, and statutory, non-statutory and voluntary sector service providers and communities themselves recognise that our approach to preventing and tackling antisocial behaviour needs to be a long-term approach (that recognises societal changes and evolves) and that we need to make a commitment to a programme of activity which will provide a framework that will guide us in taking forward this agenda in alignment with other linked national policies.

Recommendation two

An independently chaired group of experts, potentially including statutory, non-statutory and voluntary service providers, community representatives and other key interests should be brought together to develop a long-term framework for addressing antisocial behaviour.

This should have a strong focus on steps that can be taken to prevent antisocial behaviour from occurring as well as considering the effectiveness of current approaches to tackling the antisocial behaviour which occurs.

The findings in this and other relevant, existing reports should form the foundations of the group’s work and they should not be restricted in identifying what areas are most important to move this agenda forward, which could include considerations of the effectiveness of current legislation.

The group should be able to commission and gather evidence to support their work and have a free hand to engage with anyone who can support this agenda. Central to this work should be building broad support for any long-term work that the group proposes.

Edinburgh:

2023. 63p.

Download here: The former Minister for Community Safety, Ash Regan MSP, asked the Scottish Community Safety Network (SCSN) and the Scottish Government to undertake a review of antisocial behaviour (ASB). This report presents the findings from work undertaken to gather views on the current approach to antisocial behaviour in Scotland. It is based on discussions with key stakeholders across Scotland including those who have experienced antisocial behaviour, frontline staff seeking to prevent and tackle antisocial behaviour and community and equality groups including those representing minority communities in Scotland. The discussions included people from both urban and rural settings across different areas of Scotland.

The findings do not amount to a definitive statement on what people feel needs to be done to change the way we view, prevent and address antisocial behaviour. However, they do provide a qualitative evidence base given the size and breadth of engagement. It is clear from these sessions that there are no quick fixes or easy solutions here. Therefore, we need to look at how we set the path to begin the journey and identify future work activity and milestones.

Overall, 25 engagement discussions involving close to 250 people, representing a wide range of interests (Annex B - methodology summary) were held by the Scottish Community Safety Network and the Scottish Government. We are indebted to all who shared their time and their expertise. This report reflects the views, opinions and experiences from those discussions, and additional written feedback received.

The Scottish Government and its partners believe that everyone has the right to be, and feel, safe in their community and homes. Embedding change which will have a positive sustainable impact, requires a process of innovating, evaluating and building on success. We can also learn from challenging issues and sharing best practice.

What has come across very clearly during this engagement, is that prevention is better than cure and that working collaboratively in partnership is essential to finding long term solutions to address antisocial behaviour and make all of our communities safer and more welcoming places to live.

We all have a role to play in preventing and tackling antisocial behaviour and hope that this report will be used as the starting point of a much broader and deeper discussion of these issues, leading to a long-term road map of how we can work collectively to prevent and address antisocial behaviour in effective ways.

We can, and should, come together to address the mutual problems we face in our communities, but we will achieve little if we approach this in a way that is not properly considered, including the potential for unintended consequences, and therefore we need to develop structures which we can work within to achieve change and incrementally build on approaches which are proven to be successful.

As such, two recommendations arise from our assessment of the qualitative evidence:

Recommendation one

That Scottish Ministers, and statutory, non-statutory and voluntary sector service providers and communities themselves recognise that our approach to preventing and tackling antisocial behaviour needs to be a long-term approach (that recognises societal changes and evolves) and that we need to make a commitment to a programme of activity which will provide a framework that will guide us in taking forward this agenda in alignment with other linked national policies.

Recommendation two

An independently chaired group of experts, potentially including statutory, non-statutory and voluntary service providers, community representatives and other key interests should be brought together to develop a long-term framework for addressing antisocial behaviour.

This should have a strong focus on steps that can be taken to prevent antisocial behaviour from occurring as well as considering the effectiveness of current approaches to tackling the antisocial behaviour which occurs.

The findings in this and other relevant, existing reports should form the foundations of the group’s work and they should not be restricted in identifying what areas are most important to move this agenda forward, which could include considerations of the effectiveness of current legislation.

The group should be able to commission and gather evidence to support their work and have a free hand to engage with anyone who can support this agenda. Central to this work should be building broad support for any long-term work that the group proposes.

Edinburgh: Scottish Government, Justice Directorate, 2023. 63p.

By Dubber, Markus Dirk

Two phenomena have shaped American criminal law for the past thirty years: the war on crime and the victims' rights movement. As incapacitation has replaced rehabilitation as the dominant ideology of punishment, reflecting a shift from an identification with defendants to an identification with victims, the war on crime has victimized offenders and victims alike. What we need instead, Dubber argues, is a system that adequately recognizes both victims and defendants as persons. Victims in the War on Crime is the first book to provide a critical analysis of the role of victims in the criminal justice system as a whole. It also breaks new ground in focusing not only on the victims of crime but also on those of the war on victimless crime. After first offering an original critique of the American penal system in the age of the crime war, Dubber undertakes an incisive comparative reading of American criminal law and the law of crime victim compensation, culminating in a wide-ranging revision that takes victims seriously, and offenders as well. Dubber here salvages the project of vindicating victims' rights for its own sake, rather than as a weapon in the war against criminals. Uncovering the legitimate core of the victims' rights movement from underneath existing layers of bellicose rhetoric, he demonstrates how victims' rights can help us build a system of American criminal justice after the frenzy of the war on crime has died down.

New York: New York University Press, 2002. 

By Manudeep Bhuller,  Gordon B. Dahl,  Katrine V. Løken,  Magne Mogstad 

We study the costs associated with domestic violence (DV) in Norway by comparing outcomes before and after a DV report, using those who will be victimized in the future as controls. A DV report is associated with increased mental health diagnoses for both victims and their children and reduced financial resources. Victims experience marital dissolution, more doctor visits, lower employment, reduced earnings, and higher use of disability insurance. Their children are more likely to receive child protective services and commit a crime. Using a complementary regression discontinuity (RD) design, we find declines in children’s test scores and grade completion.   

Journal of Human Resources, April 2024, 59 (S) S152-S186