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

Somerset review

CSP: Somerset Published: October 2024 Year of death: 2021 Extracted: 18 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
Agencies missed opportunities to identify and respond to domestic abuse, mental health concerns, and the cumulative impact of trauma on the family. Information was often held in isolation, hindering a comprehensive understanding of the risks and preventing timely support.

Home Office classifications

37 tags

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

  • Victim - died by suicide
  • Victim - alcohol misuse
  • Victim - housing issues
  • Victim - mental ill health
  • Victim - anxiety
  • Victim - depression
  • Victim - suicidal thoughts
  • Victim - suicide attempts
  • Victim - had been a victim of an abuser before
  • Children - under 18 shared parental responsibility (victim and perpetrator)
  • Children - under 18 shared parental responsibility (between victims)
  • Children - under 18 shared parental responsibility (between perpetrators)
  • Children - living with victim (including adult children)
  • Children - living with perpetrator (including adult children)
  • Children - present at homicide (including adult children)
  • Child - primary address same as victim
  • Perpetrator - mental ill health
  • Perpetrator - depression
  • Perpetrator - known to agencies as a domestic abuse perpetrator
  • Perpetrator - known to police as a domestic abuse perpetrator
  • Aggravating factors - separation
  • Aggravating factors - coercive or controlling behaviour
  • Aggravating factors - stalking
  • Aggravating factors - physical stalking
  • Aggravating factors - psychological or emotional abuse
  • Aggravating factors - physical abuse
  • Aggravating factors - economic abuse
  • DHR process - police recommendations
  • DHR process - health services recommendations
  • DHR process - idva or other domestic abuse support service recommendations
  • DHR process - school recommendations
  • DHR process - community safety partnership recommendations
  • DHR process - training recommendation themes
  • DHR process - policy recommendation themes
  • DHR process - multi agency working recommendation themes
  • DHR process - awareness raising recommendation themes
  • DHR process - other recommendation themes

Extracted recommendations

18 recommendations pulled from the report

Recommendation 18.1

Addressed to Project, Change & Improvement Officer in Public Health (Community Safety)

Review of MARAC policy to include ‘when agencies become aware there has been a MARAC in another area, enquiries are to be made for a referral to be made to Somerset MARAC’. Once amended a clear procedure and training is to be offered to partner agencies.

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

Recommendation 18.2

Addressed to Education Safeguarding

Education Safeguarding to become integral partners of MARAC and share actions and information with schools to support the safety and action plans for victims.

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

Recommendation 18.3

Addressed to Education Safeguarding | Head teachers of Beckington and Springmead Schools

Domestic abuse to be stand-alone training for all members of educational staff to understand behaviours, complexities surrounding domestic abuse, the DASH RIC, the domestic abuse pathway, and support available within the county.

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

Recommendation 18.4

Addressed to Education Safeguarding

Education Safeguarding to make Somerset Council On-line Domestic Abuse Training mandatory to all staff in Somerset schools.

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

Recommendation 18.5

Addressed to Head teachers of Beckington and Springmead Schools

Schools to review the effectiveness of training in terms of impact, partnership working, referrals and safeguarding.

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

Recommendation 18.7

Addressed to Senior Commissioning Officer Interpersonal Violence (SCC)

Education Safeguarding to attend the Domestic Abuse Board and carry out the domestic abuse Audits required.

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

Recommendation 18.8

Addressed to Improvement and Assurance Officer for Domestic Abuse (Avon and Somerset Constabulary)

Review the Call Handling Grading and Deployment Operational Procedure to try and identify those messages that present the greatest risk and require a prompt attendance.

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

Recommendation 18.9

Addressed to Improvement and Assurance Officer for Domestic Abuse (Avon and Somerset Constabulary)

To adopt and implement the college of policing guidance to responders and call takers for stalking and harassment offences. All staff within the control room to receive training and use the College of Policing question set to determine risk along with the THRIVE risk assessment principles.

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

Recommendation 18.10

Addressed to Improvement and Assurance Officer for Domestic Abuse (Avon and Somerset Constabulary)

Officers to ensure they offer a variety of options with regards to speaking with victims especially when there may be reluctance or a possibility of minimisation. Officers need to be proactive in seeking evidence to support the safety of victims and prosecute those using abusive behaviours.

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

Recommendation 18.11

Addressed to Senior Commissioning Officer Interpersonal Violence (SCC)

Training offered to include local domestic abuse services and specialist male victim services promoting partnership working with the most up to date information and support.

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

Recommendation 18.12

Addressed to Senior Commissioning Officer Interpersonal Violence (SCC)

Training to include how to identify primary victims and perpetrators when there are dual allegations.

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

Recommendation 18.13

Addressed to SDAPB Chair | Comms and learning Group Chair | Senior Commissioning Officer Interpersonal Violence (SCC) | Mankind Initiative | SIDAS | ICS

Develop a co-ordinated and multi-agency awareness campaign and roll out to the community and professionals regarding domestic abuse and to include male victims and the impact on mental health and suicide.

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

Recommendation 18.14

Addressed to LSU Detective Inspector (Avon and Somerset Constabulary)

LSU to increase supervisory oversight of cases through audits and dip sampling to increase consistency in decisions to contact victims of domestic abuse where a crime is recorded.

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

Recommendation 18.15

Addressed to Open Mental Health

Although Open Mental Health is available to find online there needs to be positive work raise awareness in other forms ensuring those who may not have access to the internet or social media can seek information of the support available.

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

Recommendation 18.16

Addressed to Health Improvement Manager for Public Health

The Suicide Prevention Partnership Forum will ensure that a representative from the Domestic Abuse Partnership is invited to forum meetings which occur quarterly.

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

Recommendation 18.17

Addressed to Domestic Abuse Partnership

A representative from the Domestic Abuse Partnership (alongside other professionals within the field) are to be invited to sit on the Suicide Prevention Partnership Forum working group for the High-Risk Groups workstream when they focus on domestic abuse.

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

Recommendation 18.18

Addressed to Senior Commissioning Officer Interpersonal Violence (SCC)

A member from the Somerset Suicide Prevention Partnership (Public Health or other relevant agency) is to be invited as a panel member for any future domestic abuse suicide reviews within Somerset.

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