About this page. This page summarises a Domestic Homicide Review published in the Home Office DHR Library. The full report is available at the source link below. Victim and perpetrator names are not included in extracted summaries on this page.
Source · Domestic Homicide Review

Wiltshire review

CSP: Wiltshire Published: February 2024 Year of death: 2020 Extracted: 5 recs

Statutory domestic homicide review under section 9 of the Domestic Violence, Crime and Victims Act 2004. Source: Home Office DHR Library.

Original review (PDF) ↗ Source: Home Office DHR Library

Summary AI-generated

Verify against the full report at the source link
The review identified a lack of coordinated, holistic multi-agency support for the victim's complex needs, including mental health, drug misuse, and domestic abuse. Deficiencies were noted in information sharing, risk assessment, safeguarding practices, and professional curiosity regarding domestic abuse.

Home Office classifications

24 tags

Source-supplied classifications used by the Home Office to catalogue this review.

  • Victim - alcohol misuse
  • Victim - substance misuse
  • Victim - housing issues
  • Victim - physical disability
  • Victim - mental ill health
  • Victim - self harm
  • Victim - serious or life limiting illness
  • Victim - had been a victim of an abuser before
  • Perpetrator - known to agencies as a domestic abuse perpetrator
  • Perpetrator - known to police as a domestic abuse perpetrator
  • Perpetrator - known to idva or other domestic abuse support service as a domestic abuse perpetrator
  • Perpetrator - known to others as a domestic abuse perpetrator
  • Perpetrator - known to family as a domestic abuse perpetrator
  • Aggravating factors - separation
  • Aggravating factors - coercive or controlling behaviour
  • Aggravating factors - sexual abuse
  • Aggravating factors - psychological or emotional abuse
  • DHR process - family contributed to dhr
  • DHR process - family received draft report
  • DHR process - health services recommendations
  • DHR process - identification of risk recommendation themes
  • DHR process - policy recommendation themes
  • DHR process - multi agency working recommendation themes
  • DHR process - record keeping recommendation themes

Extracted recommendations

5 recommendations pulled from the report

Recommendation 1

Addressed to Local Agencies

Work should take place with the local agencies involved in this case to ensure improved understanding of the referral process for Adult Social Care. This means staff are clear on when and how to refer, and that any referrals they make are of a consistent high quality.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 2

Addressed to Avon and Wiltshire Partnership NHS Trust

Adult mental health services should examine their policies and processes to ensure that they offer adequate opportunities for family engagement in care planning and review of people with complex needs. Services should review current practice and consider what could be improved to address any barriers to involving families in support plans and reviews.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 3

Addressed to Wiltshire Safeguarding Vulnerable People Partnership

The use of the DASH risk assessment should be promoted as the primary tool for assessment of risk in relation to domestic abuse and seek assurance that it is being used appropriately and consistently across the partnership.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 4

Addressed to Local Agencies

Agencies should examine current systems for the sharing of information between organisations (including cross boundary) relating to actual or suspected domestic abuse and identify any areas for improvement to ensure that risk to a potential domestic abuse victim can be adequately assessed.

Verified wording from the published review · Original review (PDF) ↗

Recommendation 5

Addressed to Wiltshire Safeguarding Vulnerable People Partnership

The SVPP should promote the learning about the multi-faceted aspects of family members and carers supporting adults with complex needs and encourage all agencies to adopt a standard line of enquiry about identification of carers and provision of information about carer support services.

Verified wording from the published review · Original review (PDF) ↗