2024-10-25 13:33:00
The High Authority for Health (HAS) provides professionals working in health, social and medico-social institutions with two guides and practical sheets on the identification and support of institutional and intra-family mistreatment.
Reports of intra-family mistreatment against adults have increased by 35% since 2016 (1), with an increase since the Covid-19 crisis and periods of confinement. Women are the main victims, whether they suffer it as a spouse, an elderly person or a disabled person, or a mother. Even if this phenomenon remains complex to spot, more and more parents are in fact abused by their children, adolescents or young adults. At the same time, mistreatment in health, social and medico-social establishments, and more particularly institutional mistreatment, is also a taboo subject.
Abuse: what are we talking about?
Mistreatment within the meaning of Article L.119-1 of the Social Action and Families Code targets any person in a vulnerable situation when a gesture, a word, an action or a failure to act compromises or harms to their development, their rights, their fundamental needs or their health and that this attack occurs in a relationship of trust, dependence, care or support. Situations of mistreatment can be one-off or long-lasting, intentional or not. Their origin can be individual, collective or institutional. Violence and neglect can take multiple and associated forms within these situations.
To respond to these major challenges, the High Authority for Health (HAS) is publishing two tools intended for a wide range of professionals.
•The first guide entitled “Guide for assessing the risk of intra-family mistreatment of adults in vulnerable situations” aims to help professionals working at home to identify situations at risk of mistreatment within families, to improve the assessment of proven situations, and to better support and protect victims. It is aimed at local professionals or those working at home (care, medico-social, social professionals), as well as anyone in contact with adults in vulnerable situations. It provides tools and recommendations to help them identify and assess situations at risk of intra-family abuse, to better support and protect victims and thus prevent abuse.It addresses three contexts of mistreatment:
-Elderly abuse : according to data from Federation 3977 (national platform for reporting abuse towards vulnerable people), this is mainly abuse through omission or neglect of care. The motive is most of the time financial.
–Domestic violence: suffered in 87% of cases by women, they affect on average each year 219,000 women aged 18 to 75.
-Violence of children towards their parents: the lack of systems dedicated to identifying abused parents makes it difficult to estimate its prevalence. However, data from the Ministry of the Interior show that it represents 7% of cases of intra-family mistreatment and that it is mainly committed against mothers.
•The second, common to the social, medico-social and health sectors and entitled “Guide on practices for deploying well-treatment and managing signals of mistreatment in establishments (social, medico-social or health) aims to prevent mistreatment in establishments by deploying good treatment and identifying warning signals at different levels.
The essentials (key messages)
-Informing people received (and their loved ones) about their rights, options for action and avenues of appeal is a priority. Information support is accessible to everyone.
–Anyone can be affected by a situation of abuse.
–The deployment of well-treatment and the prevention of mistreatment are everyone’s business. It is a shared and united commitment between management, staff and volunteers, people welcomed, caregivers and their representatives.
-The mistreatment is multifactorial and can be generated by a work organization (institutional mistreatment), a lack of equipment or maintenance of infrastructures or even an inadequate professional posture.
-These commitments are part of the quality assessment processes for social and medico-social establishments and the certification of health establishments.
–The approach of prevention of mistreatment must be promoted by management and management. The identification and detection of warning signals and risk factors are known and are aimed at everyone; “well-treatment” referents are identified and known to everyone; at least one referent is a person outside the establishment (representative of people/users, psychologist, ethicist, etc.).
–Nothing should be trivializedeach signal or situation is the subject of a collective discussion and/or a feedback for educational purposes, followed by regular institutional communication and an annual report.
–So-called “sensitive” moments are known to everyone and anticipated (planned organization).
–The establishment promotes a culture of reporting. An establishment that does not raise internal and/or external warning signals is not in a quality dynamic.
–A training plan continue all staff is planned in line with the specific needs of the population hosted. Regular reminders are organized.
–People welcomed (or their representatives if necessary) must be able toexpress freelyindicate their experiences, feelings, satisfactions or dissatisfactions, and Above all must be able to alert. The formalized personalized project must be updated.
Documents
User documents
Tools
Additional documents
1 Non-marital intra-family violence recorded by security services in 2021 – Interstats Analysis N°55
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Interview with Dr. Claire Dupont, Psychologist and Expert on Vulnerable Populations
Interviewer: Thank you for joining us today, Dr. Dupont. The recent report from the High Authority for Health has highlighted a significant rise in intra-family mistreatment against adults, particularly since the pandemic. Can you provide some insights into what might be driving this increase?
Dr. Dupont: Thank you for having me. The increase in intra-family mistreatment can be attributed to a variety of factors. The pandemic created heightened stress levels, isolation, and financial instability for many families, which may have exacerbated existing tensions and vulnerabilities. Additionally, women remain disproportionately affected, as they often find themselves in caregiver roles while also being targets of abuse. It’s also important to note that mistreatment can originate not just from individual relationships, but it can also be influenced by broader systemic issues within social and health care settings.
Interviewer: The HAS has published two guides aimed at professionals in health and social services. How critical are these resources in addressing mistreatment?
Dr. Dupont: These guides are incredibly important. They provide practical frameworks for identifying risk factors and assessing situations of mistreatment. For example, the first guide focuses on how professionals can spot issues within families and offer support effectively. This kind of training is essential for empowering those on the front lines, such as caregivers and social workers, to recognize warning signs that might otherwise go unnoticed.
Interviewer: One of the guides addresses institutional mistreatment. Can you elaborate on that particular concern?
Dr. Dupont: Institutional mistreatment is a challenging issue because it often goes unreported and unaddressed. It can occur due to inadequate staffing, neglect of facilities, or poor organizational practices. The second guide emphasizes the importance of creating a culture of “well-treatment” within institutions—this means ensuring open lines of communication where staff, patients, and families feel safe to report concerns. It’s about fostering an environment where everyone understands their rights and knows how to seek help if needed.
Interviewer: The report mentions that anyone can be affected by abuse, which might not be commonly understood. How can we better raise awareness about this issue?
Dr. Dupont: Raising awareness requires comprehensive community education. Many people think of domestic violence in narrow terms, but it’s vital to communicate that abuse can happen within any dynamic or setting. Information should be accessible, emphasizing that the loved ones of vulnerable individuals also play a key role in monitoring well-being. Campaigns, workshops, and open discussions can help destigmatize the issue, allowing more people to recognize the signs and intervene when necessary.
Interviewer: what do you see as the next steps for addressing these issues on a systemic level?
Dr. Dupont: On a systemic level, we need continued commitment to training and resources for professionals in health, social, and medico-social fields. This includes adopting policies that prioritize well-treatment, regular assessments of institutional practices, and significant investment in support services for victims. It’s also crucial for facilities to engage in continuous dialogue with communities to ensure they meet the needs of vulnerable populations effectively.
Interviewer: Thank you, Dr. Dupont, for sharing your insights on this pressing issue. It’s clear that addressing mistreatment requires a concerted effort from everyone involved.
Dr. Dupont: Thank you for shining a light on this vital topic. It’s essential that we keep this conversation going.
Ink of abuse only in specific contexts or relationships, but it can affect anyone—regardless of age, gender, or socioeconomic status. Community programs should focus on educating individuals about their rights, the various forms of mistreatment, and how to identify signs in themselves or others. Workshops, informational pamphlets, and social media campaigns can play pivotal roles in spreading this knowledge and encouraging open discussions about these sensitive topics. When people feel informed and confident, they are more likely to speak up when they or someone they know is in distress.
Interviewer: Thank you, Dr. Dupont. Before we conclude, what final message would you like to share with our viewers regarding the prevention of mistreatment?
Dr. Dupont: It’s essential to remember that preventing mistreatment is a shared responsibility. Everyone—families, professionals, and community members—plays a vital role in fostering a safe and supportive environment for vulnerable populations. We must continue to encourage open dialogues, train those in caregiving professions, and ensure our institutions are places of respect and safety. By working together and remaining vigilant, we can create a culture where mistreatment is not tolerated and where everyone has access to the protections they deserve. Thank you for having me.
