Further research needed on peer-to-peer abuse in more settings

A new report on peer-to-peer adult abuse highlights the need for greater understanding and training on differentiating and responding to this type of abuse.

The research was conducted for Safeguarding Ireland by the Health Information and Quality Authority (HIQA).

The report aims to deepen understanding and practice on incidents of aggression and abuse between adults with intellectual disabilities, or decision-making capacity challenges (Dementia), living in residential care settings. This is called peer-to-peer abuse.

A central theme in Report on Peer-to-peer Abuse: Informing Definitions and Thresholds is a recommendation for differentiation between peer-to-peer aggression and peer-to peer abuse – and to report and respond accordingly.

Peer-to-peer abuse is described as: “Offensive, aggressive and intrusive verbal, physical, sexual, and material interactions between service users that in a community setting would likely be unwelcome and potentially cause physical or psychological distress or harm to the recipient/victim.”

However, it sets out circumstances when either a person commits an abusive act but is unable to understand it as such, or lower level acts (such as shouting at someone, blaming or pushing someone) – and describes these as ‘peer-to-peer aggression’.

The report discusses the challenges in deciding when an act changes from being aggressive to abusive. It says that for an incident to be abusive, it would need to be clear that the person carrying out the act was able understand their actions and did it on purpose.

In order to differentiate, the report recommends that the following be considered:

• To examine if a person acted on purpose and was able to understand their actions
• How the person on the receiving side sees the way they were being treated
• The behavioural history of the person causing harm
• The environmental supports that have been provided to the person causing harm.

The report reviewed information about peer-to-peer incidents in nursing homes, centres where people with disabilities live, day services and mental health centres.

It found that peer-to-peer incidents happen often in all of these settings. However, most incidents involved low-level, minor disagreements or disputes. It found very few examples of where such incidents were reported to An Garda Síochána, which suggests there was no concern that abuse took place.

In centres where people with disabilities live, most peer-to-peer incidents were reported as ‘psychological’ (emotional or mental abuse), followed by physical incidents. In nursing homes, the most common type was physical incidents. In day services and mental health services, verbal abuse was most common.

The research also found an over-reporting of incidents of peer-to-peer aggression to HIQA. This appears to be because services are not sure how to decide if abuse has taken place and they then make the decision to simply report all incidents.

A review of training in a wide range of service provider organisations found that most provide training on safeguarding. However, there was no training that specifically covered manging and responding to peer-to-peer aggression or abuse.

In its recommendations the report included:

• A move to differentiate peer-to-peer incidents into two different circumstances – ‘peer-to-peer aggression’ and ‘peer-to-peer abuse’
• To promote understanding of the recommended criteria for deciding if an incident is aggressive or abusive
• To develop training for health and social care staff and other relevant professionals on identifying and responding to peer-to-peer aggression and abuse
• To improve reporting requirements for peer-to-peer aggression and abuse, including a system that supports assessment and review of these incidents.

Commenting on the study and its recommendations Safeguarding Ireland Chairperson Patricia Rickard-Clarke said: “Peer-to-peer abuse is a significant adult safeguarding issue to be dealt with through evidence-informed policy and practice that assists with the appropriate recognition of such abuse, and of the triggers of negative interactions between service users.

“This study highlights the need for clear definitions in different peer-to-peer interactions – what should be reported, when, to whom, and how services learn from both individual incidents and patterns across services. Safeguarding Ireland is clear that, in the development of policy and practice guidance, both aggression and abuse cause harm to the victim and cannot be normalised or tolerated.

“Definitions, thresholds and training on peer-to-peer abuse should be developed and adapted in HSE policy and procedures on adult safeguarding, including within the remit of its 2024 report Moving Forward: Adult Safeguarding in the Health Service Executive.

“In conclusion, Safeguarding Ireland believes that a further, wider, more comprehensive study should be undertaken to ascertain the extent to which peer-to-peer abuse occurs within health and social care services which are not subject of formal regulation and mandatory notifications. This research should also be extended to residential services provided and commissioned by other Government departments and their agencies.”

Further Information

Ronan Cavanagh, Cavanagh Communications: (086) 317 9731.
The full report can be viewed here and at www.safeguardingireland.org
A plain English summary can be viewed here and at www.safeguardingireland.org

Safeguarding Ireland promotes safeguarding of adults to protect them from all forms of abuse by persons, organisations and institutions and to deliver a national plan for promoting their welfare.

Safeguarding means putting measures in place to uphold our rights, to support our health and wellbeing, to reduce our risk of harm – and to empower us to protect ourselves. Safeguarding involves ourselves, our families, services and professionals all working together to prevent and respond to adult abuse, neglect or coercive control.