Background
In our Safeguarding Adults Review in respect of Tom (2024) it was recognised that Tom’s wife and paid carer exhibited ‘disguised compliance’, which created a significant barrier for staff.
What is ‘disguised compliance’?
The reviewer describes it as “where a family member or carer gives the appearance of cooperating with professionals to avoid raising suspicions, to allay professional concerns and ultimately to reduce professional involvement” (2024, page 22).
In Tom’s case, this ‘disguised compliance’ was hiding a level of coercion and control, which led to both his then-wife and paid carer being sentenced to eight years in prison with a further three on licence.
Who might exhibit ‘disguised compliance’?
The term is most commonly used in children’s social care, healthcare, and safeguarding work, in reference to behaviours of a child’s parent/carer. However, the idea of ‘disguised compliance’ can also be seen in adult safeguarding cases, and so can be present across all ages, and in a variety of settings. This could be, as was the case with Tom, ‘disguised compliance’ by an adult’s carer, or by the adult themselves.
Why do people respond in this way?
There are many reasons why someone may exhibit behaviours associated with disguised compliance’. This can include:
- fears around what may happen if staff are allowed to see the reality of the situation, including fear of being judged as a result of shame or perceived stigma;
- previous negative experiences of working with agencies;
- feelings that nobody can help them, and that help is pointless; or alternately,
- feelings that they are coping and don’t need support;
- a lack of capacity whereby they may agree to demands and want change, but lack the practical skills, resources, or executive functioning to execute the agreed actions.
What might ‘disguised compliance’ look like?
You may notice that, either the adult themselves, or their carer(s), are over-eager to please, and agree to interventions without any reflection or questions. This may be an indication that they are saying what they think staff want to hear, with little or no intention of following through.
They may avoid unannounced home visits, and instead insist on pre-arranged visits, which give them the opportunity to prepare and present a certain picture to staff, which may not be reflective of the daily reality.
There may be a history of missed appointments, or vague reasons for why appointments have not been attended. There may also be evidence of control or coercion and abuse and/or neglect in relationships, leaving one party fearful to share the reality of the situation with staff.
The adult or carer(s) may seem overly critical of services or staff, as a way to divert attention from their own behaviour.
What are the dangers of ‘disguised compliance’?
In the case of our Safeguarding Adults Review in respect of Tom, the ‘disguised compliance’ of his wife and paid carer meant that their coercion and control and significant neglect was allowed to continue unchecked for four years. Furthermore, agencies were unable to see the full picture, which impacted their ability to respond appropriately.
‘Disguised compliance’ can lead to missed opportunities for intervention and may lead staff to make inaccurate assessments of risk. These key outcomes can ultimately lead to a failure to safeguard the adult at risk.
How can we mitigate against ‘disguised compliance’?
The key to mitigating against ‘disguised compliance’, is knowing how to recognise its signs, as well as signs of coercion and control. You can reduce the risk of ‘disguised compliance’ by ensuring that you facilitate meaningful engagement with adults and their carer(s). Whenever possible, this should include facilitating in-person statutory reviews, and creating opportunities to speak with the adult alone, and not in the presence of family or carers.
You should also ensure that you:
- use a trauma-informed approach;
- are person-centred in your approach;
- recognise strengths and any positive change to build trust;
- ensure that you are professionally curious;
- engage in multi-agency working.
