What Counts as Sexual Abuse of an Adult at Risk? Consent, Capacity and the Law

On this page

1. 1What counts as sexual abuse of an adult at risk?
2. 2How do consent and capacity work for sexual activity?
3. 3Which sexual offences protect adults who cannot consent or are pressured?
4. 4Who is at greater risk of sexual abuse, and why?
5. 5What are the warning signs of sexual abuse in an adult?
6. 6What should you do if an adult tells you they have been sexually abused?
7. 7What are the immediate steps, including preserving evidence?
8. 8Who do you report sexual abuse to, and what happens next?
9. 9Can you share information if the person does not want you to?
10. 10How does the law apply to people with learning disabilities, dementia or mental health conditions?
11. 11How can staff support relationships and sexual expression without ignoring the risks?
12. 12What if the person alleged to have caused harm is a member of staff?
13. 13How should you record a disclosure or concern?
14. 14How do you support the person and staff afterwards?
15. 15How do the rules differ in Wales, Scotland and Northern Ireland?
16. 16What checklist can managers and staff use?
17. 17What training helps staff recognise and respond to sexual abuse?
18. 18Frequently asked questions

This guide is for care workers, nurses, managers, social workers, and housing and support staff in England, checked on 1 November 2026, with a boxed section on the other nations. It is non-graphic and every example is invented. See also our guides to safeguarding adults and the Mental Capacity Act. General information, not legal advice.

What counts as sexual abuse of an adult at risk?

The safeguarding duties apply to an adult who has care and support needs, is experiencing or at risk of abuse or neglect, and cannot protect themselves because of those needs (section 42 of the Care Act 2014). The Care and Support Statutory Guidance (the guidance), paragraph 14.17, lists sexual abuse as one of ten categories. It names rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, and sexual assault. It also names “sexual acts to which the adult has not consented or was pressured into consenting”.

Abuse does not need force. The guidance describes serial abuse, where the person responsible seeks out and grooms people, as a pattern sexual abuse sometimes follows (paragraph 14.19), and says the person responsible is far more likely to be known to the adult and in a position of trust and power than to be a stranger (paragraph 14.34). Whether something is a crime is for the police and Crown Prosecution Service. Your job is to recognise and report it.

How do consent and capacity work for sexual activity?

Under the Sexual Offences Act 2003, a person consents if they agree by choice and have the freedom and capacity to make that choice (section 74). The NHS adds that saying nothing, feeling you have to say yes, or having said yes before is not consent, and that consent can be withdrawn at any time (NHS, last reviewed 6 November 2024). See also consent in health and social care.

Capacity comes from the Mental Capacity Act 2005. Section 1 says to assume capacity, take all practicable steps to help the person decide, and not treat a decision as incapacitous merely because it is unwise. Capacity is judged for a particular decision at a particular time.

For sex, the leading case is A Local Authority v JB [2021] UKSC 52, decided on 24 November 2021. The Supreme Court dismissed the appeal and agreed that the information relevant to a decision to have sexual relations includes that the other person must be able to consent and must in fact consent, before and throughout. The test is decision-specific. It is ordinarily framed generally, about the nature of the activity rather than who the partner is, though it can be framed around a particular person in some cases, such as a long-standing couple where one partner develops dementia.

Nobody can consent to sexual relations on another person’s behalf (section 27(1)(b)), so a relative cannot agree for someone who lacks capacity for that decision. Staff should not decide capacity alone: CQC’s 2019 guidance on relationships and sexuality says professional advice must be sought where it is hard to determine. Its checklist predates JB, so follow your employer’s policy.

A short decision flow for staff (our summary, not a legal test):

1. Is anyone hurt or in danger? Call 999 and get medical help first.
2. Assume capacity. Do not judge it from age, a diagnosis or appearance (Mental Capacity Act section 2(3)).
3. Look at how the “yes” was obtained. Pressure, gifts, threats, dependence, grooming or deception mean agreement may not be free.
4. If you doubt capacity, say so. Tell your manager or safeguarding lead so a trained assessor can assess it.
5. If the person lacks capacity, nobody can consent for them. Report it. If both people lack capacity, CQC says support both.
6. If the other person is in a care role, report it whatever the person says, because the care worker offences do not depend on consent.

Which sexual offences protect adults who cannot consent or are pressured?

The Sexual Offences Act 2003 applies in England and Wales. You do not decide which offence fits, but the outline explains why some conduct is a crime even when the person seemed willing. Maximum sentences are on conviction on indictment (in the Crown Court), taken from legislation.gov.uk on 1 November 2026.

“Mental disorder” here means any disorder or disability of the mind (section 79(6) of the 2003 Act and section 1(2) of the Mental Health Act 1983). Under section 42, someone is involved in a person’s care if, for example, they work in a care home, NHS body or independent hospital with regular face-to-face contact with the person, or provide care, assistance or services in connection with the person’s mental disorder, whether or not employed. Narrow exceptions cover spouses and civil partners (section 43) and relationships that pre-date the care (section 44).

The “abuse of position of trust” offence in section 16 applies where the other person is under 18, so for adults the care worker offences do that job. For providers registered with CQC, regulation 13 treats behaviour towards a person using the service that is an offence under the 2003 Act as “abuse”, and requires systems to prevent it and to investigate any allegation immediately.

Who is at greater risk of sexual abuse, and why?

The official sources give figures but no ranked list of causes, and none measures how common sexual abuse is in services.

CQC’s learning from safety incidents page (updated 15 April 2026) says sexual incidents happen in all types of health and social care services and are mostly carried out by people who use services. In its 2020 report, stakeholders told CQC that sex is often treated as a taboo subject, which can mean predatory behaviour is missed or normalised. The guidance names the sexual exploitation of people who may lack the capacity to understand that they have the right to say no as a concern (paragraph 14.154).

Our own suggestion, not a scoring tool, is to ask four questions about everyone you support:

• Isolation. Does one new “friend” or staff member have unusual access to the person?
• Dependence. Does the person rely on others for intimate care or money, so saying no feels risky?
• Communication. Can the person tell you something is wrong?
• Past experience. Has the person been abused before?

What are the warning signs of sexual abuse in an adult?

These are indicators, not proof. The Social Care Institute for Excellence (SCIE) guide to types and indicators of abuse (last reviewed December 2020) lists the signs below. The NHS notes that someone who has been sexually assaulted may have no physical injuries or signs, so the absence of signs proves nothing. Many signs have innocent causes, including illness, medication, bereavement or dementia. Patterns matter more than single signs, and your role is to record and report, not to decide.

What should you do if an adult tells you they have been sexually abused?

A disclosure may be partial or may come from a person who struggles to find the words. Take it seriously however it arrives. The NHS advice is to listen but not ask for details or why the person did not stop it, because that can make them feel blamed.

Do:

• Stay calm and listen. Tell the person it is not their fault.
• Check they are safe now and whether they need medical help.
• Explain honestly that you must tell your manager or safeguarding lead.
• Ask what they want to happen. Making Safeguarding Personal means outcomes should reflect their wishes wherever possible (paragraph 14.79).
• Write down what you were told, in their words, as soon as you can, and tell your manager or safeguarding lead immediately.

Don’t:

• Promise secrecy. The guidance says confidentiality must not be confused with secrecy (paragraph 14.187).
• Ask for details, repeat questions, or ask why they did not stop it.
• Confront the person alleged to have caused harm, or investigate yourself.
• Tell the person to forget it, suggest they are mistaken because of a diagnosis, or discuss it with colleagues who do not need to know.

What are the immediate steps, including preserving evidence?

If the incident was recent, evidence can be lost within hours, so act in this order:

1. Danger and injury first. Call 999 if anyone is in danger or seriously hurt, and get medical help for injuries.
2. Involve the police early where a crime may have happened. The guidance says this helps ensure forensic evidence is not lost or contaminated (paragraph 14.84), and CQC’s 2019 guidance says to preserve evidence and protect the scene after a serious assault.
3. Do not clean up. Until the police or a SARC advise, do not tidy the area or wash or discard clothing, bedding or other items. The NHS says to try not to wash or change clothes immediately, but the person can still report if they have washed.
4. Respect the person’s choices. The NHS says a forensic medical examination is the person’s choice, they can have some parts and not others, and it can be arranged before they decide whether to report. Where a person may lack capacity for a decision, the professionals involved decide in their best interests (Mental Capacity Act section 1(5)).
5. Offer specialist support. NHS sexual assault referral centres (SARCs) offer medical, practical and emotional support, including forensic examinations, emergency contraception and access to an independent sexual violence adviser (ISVA). The Rape Crisis support line (0808 500 2222) is free, open 24/7 and for people aged 16 or over.
6. Stay with the person if they want that, keep them apart from anyone they fear, and tell your manager or safeguarding lead now, noting times and instructions.

Who do you report sexual abuse to, and what happens next?

Tell your manager or safeguarding lead the same day. They decide, within your employer’s policy, what goes to the council, police and CQC. If your manager is the concern, or nothing happens, go directly to the council’s adult safeguarding team or the police. No professional should assume someone else will pass on critical information (paragraph 14.43). Our guide to safeguarding in home care covers escalation.

The council’s enquiry can range from a conversation to a formal multi-agency plan, and the adult should be involved from the beginning unless exceptional circumstances increase the risk (paragraphs 14.77 and 14.80). A police investigation takes priority over other enquiries, but a multi-agency approach should keep the person’s wishes in view even if they do not want to give evidence (paragraph 14.91). The police can use special measures for vulnerable or intimidated witnesses (paragraphs 14.84 to 14.90). After a death or serious harm, the council may consider a safeguarding adults review.

Can you share information if the person does not want you to?

Often yes, but the safeguarding lead decides, case by case, within employer policy and data protection law. The guidance says informed consent should be obtained, but if that is not possible and other adults are at risk it may be necessary to override it, and it is inappropriate to promise absolute confidentiality (paragraph 14.187). Where an adult refuses consent, practitioners must consider whether an overriding public interest justifies sharing (paragraph 14.188).

If the adult has capacity and does not want action taken, this does not preclude sharing information with relevant professionals, so they can assess the risk and be confident the person is not being unduly influenced, coerced or intimidated. It is good practice to tell the adult, unless that would increase the risk of harm (paragraph 14.92). A person with capacity can still decide whether to report to the police or have a forensic examination. See consent to report a safeguarding concern.

How does the law apply to people with learning disabilities, dementia or mental health conditions?

A diagnosis does not decide capacity. CQC’s 2019 guidance says it may be hard to establish whether both people have capacity to consent to sex where someone has dementia, a mental health condition, a learning disability or autism, but that people in these groups can, and do, consent to sexual relations.

• Learning disability and autism. Support includes accessible information about relationships, and explaining in simple language or with visual aids counts (Mental Capacity Act section 3(2)). People may be targeted for exploitation, as with financial abuse and hate crime.
• Dementia. Capacity may change day to day, so review it. CQC says uncharacteristic behaviour should prompt a medical assessment.
• Mental health conditions. Do not assume a person cannot consent, or that their account is unreliable, because of a condition.
• Incidents between two people who use the service. Support both. CQC says providers must investigate and report unwanted sexual behaviour in a timely and appropriate way.

How can staff support relationships and sexual expression without ignoring the risks?

CQC’s 2020 report says it is a basic human right for people to express their sexuality and that they should be empowered, supported and protected. Its 2019 guidance says providers need to enable people to manage their sexuality needs, or risk discriminating against people or breaching their human rights. The statutory guidance says the right to safety must be balanced with rights to liberty, autonomy and family life (paragraph 14.98).

• Talk openly. CQC’s central recommendation is a culture where people and staff can talk about sexuality and raise concerns.
• Assess capacity fairly, when there is a reason to. Not every relationship is abuse: 5% of the incidents in CQC’s 2018 sample described consensual sex.
• Do not minimise. If a person is afraid, pressured, secretive or cannot understand what is happening, treat it as a safeguarding concern. Plan and review risk-taking for relationships that are genuinely consensual.
• Use good resources. CQC signposts Skills for Care supporting personal relationships and the Royal College of Nursing’s guidance for older people in care homes. See also dignity in care.

What if the person alleged to have caused harm is a member of staff?

Report it straight away and do not investigate it yourself. Sections 38 to 41 mean a worker’s sexual contact with a person with a mental disorder can be a crime whatever the person says. A registered provider must act under regulation 13 and tell CQC of any allegation of abuse. See whistleblowing protection, organisational abuse and concerns about people in positions of trust.

Regulated activity providers have a legal duty to refer a person to the Disclosure and Barring Service (DBS) when they withdraw permission to work in regulated activity, or move the person elsewhere, and think the person engaged in relevant conduct or met the harm test. DBS says this applies even if a referral has also gone to a council or regulator, and when the person leaves (GOV.UK, updated 11 September 2026). Safer recruitment, including an enhanced DBS check with a barred list check for regulated activity, reduces risk but does not remove it.

How should you record a disclosure or concern?

The guidance says good record keeping is vital and that records should be clear and accurate (paragraphs 14.180 and 14.181). Record the date, time and place and who was present; what you saw or heard in plain words, with the person’s own words in quotation marks; visible signs, described and not interpreted; the person’s wishes and communication needs; what you did, who you told and what they said; and your name, role and signature.

Do not add opinions or detail you did not witness, and do not rewrite an entry later. Mark additions as late entries and keep the record secure. Records linked to a police investigation may be disclosable in court, so accuracy matters.

How do you support the person and staff afterwards?

For the person, agree support with them: a trusted worker, a choice about who provides personal care where possible, advocacy, GP or sexual health follow-up, and specialist services such as an ISVA, Rape Crisis or Hourglass.

For staff, the guidance says regular face-to-face supervision from skilled managers is essential in difficult and sensitive situations (paragraph 14.57). Offer a debrief and any employee assistance. NHS England’s Sexual safety in healthcare organisational charter (published 4 September 2023, updated 28 August 2026) commits signatories to a zero-tolerance approach to unwanted sexual behaviour towards the healthcare workforce. It is about staff, not people receiving care. We found no CQC equivalent. See sexual harassment in the workplace for employer duties.

How do the rules differ in Wales, Scotland and Northern Ireland?

The statutory guidance, CQC rules and NHS England charter cited here apply to England only.

What checklist can managers and staff use?

These checklists are our suggestions, not a legal form.

What training helps staff recognise and respond to sexual abuse?

Three Nexis CPD courses build the knowledge behind these steps:

Together they cost £18 rather than £27 under the pay-for-2-get-3 offer, and employers training 5 or more staff pay £6 a course place on the team plan. These are awareness-level CPD courses, not regulated qualifications, and they do not replace your employer’s safeguarding policy, local procedures or specialist training. If you take one, start with Safeguarding Adults (Advanced) Level 2: 15 questions, 80% to pass, and an instant certificate. See also coercive control.

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Frequently asked questions

What is sexual abuse of an adult at risk?

Any sexual activity the person has not consented to, cannot consent to, or was pressured, groomed or exploited into. Much of it is also a crime under the Sexual Offences Act 2003.

Is it abuse if a person with dementia or a learning disability says yes?

Not automatically, because people with these conditions can and do consent. It depends on capacity for that decision and whether the agreement was free. If capacity is doubtful, tell your manager. Nobody can consent for the person.

Can a care worker have a sexual relationship with someone they support?

Where the person has a mental disorder and the worker is involved in their care as section 42 sets out, it can be an offence under sections 38 to 41 even if the person agrees, subject to narrow exceptions. Report any such concern.

Should the person wash after a recent assault?

The NHS says to try not to wash or change clothes immediately, because it may destroy forensic evidence, but the person can still report if they have washed. Call 999 or ask the police or a SARC for advice.

What if the person asks me not to tell anyone?

Do not promise secrecy. Explain that you will tell only those who need to know, and tell your manager or safeguarding lead.

Does an awareness course replace my employer’s safeguarding procedures?

No. Awareness CPD is not a regulated qualification. You must still follow your employer’s policy, local procedures and any specialist training your role needs.

General information, not legal advice. If someone is in immediate danger, call 999. This guide reflects the Care Act 2014, the Care and Support Statutory Guidance (under review; GOV.UK page dated 30 October 2026), the Sexual Offences Act 2003, the Mental Capacity Act 2005 and the sources named above as checked on 1 November 2026. Arrangements differ in Wales, Scotland and Northern Ireland, and each employer and local Safeguarding Adults Board sets its own procedures. Nexis CPD courses are CPD-accredited awareness training, not regulated qualifications, and they do not replace your employer’s safeguarding policy, local multi-agency procedures or specialist training.