Lincoln review

Review and refresh (if required) current guidance regarding carers assessment duties for Section 75 LPFT mental health social work team & ACCW Social Care and embed in practice through current training, guidance circulation and a 7 min briefing.

Relevant local CMHT team to have specialist training sessions on the Trust’s safeguarding duty, therapeutic relationships and safeguarding, domestic abuse including the definition of ‘personally connected’, and the actions and processes to be taken upon disclosure of domestic abuse and controlling or coercive behaviours, including non-fatal strangulation, the completion of DASH risk assessments and safety planning including Refuge provision.

They will share reviewed partnership Information Sharing Agreement at point of signoff.

Contact details have been shared with all staff working in the emergency department for the local authorities surrounding NLAG and this is reinforced during supervision and training.

Implement Comprehensive Domestic Abuse Training: Provide mandatory training for all staff on recognizing and responding to signs of domestic abuse and coercive control, with a focus on subtle indicators and appropriate response protocols. This training should empower staff to effectively support patients experiencing abuse and ensure their safety and autonomy are prioritized.

The Safer Lincolnshire Partnership should seek assurance from LPFT to ensure that in similar cases where a number of services are being provided to the same client, that there is a lead professional in place to help coordinate support and appropriate interventions.

Trust will add suicide and self-harm to the domestic abuse training and processes regarding the definition of serious harm.

With the new DHR threshold including DA Homicides linked to suicide, Edan have embedded suicide and risk as a key element to risk assessments throughout support.

NLAG now have a Domestic Abuse Coordinator in post who is actively reviewing NLAG’s training offer around domestic abuse and coercive control. This will include revisiting with staff what the definition of domestic abuse is, and in what situations it can occur, such as in this case of father / daughter domestic abuse. The training will also include when and how to complete a DASH assessment.

Enhance Mental Health Follow-Up Procedures: Develop and implement robust follow-up protocols for patients reporting mental health concerns, ensuring prompt and thorough support. This may include multiple contact attempts, alternative communication methods, and coordination with mental health services to provide timely interventions and prevent escalation of issues.

(i) The Safer Lincolnshire Partnership must ensure that there is a better understanding in their area of coercive and controlling behaviour in cases of familial domestic abuse. (ii) The Safer Lincolnshire Partnership must ensure that awareness is raised with professionals in their area regarding a) Confirmatory Bias and Apparent Competence in cases of Domestic Abuse when the victim is suffering from Mental Health issues. And b) The importance of professionals to not dismiss a victims account because of their behaviours due to their mental health condition.

A feedback and reflection session with the Section 75 mental health social work staff member involved during the disclosure of abuse.

Provide a briefing to Section 75 LPFT mental health social work teams and ACCW regarding revisiting a DASH’s risk assessments when disclosures are made.

Complete an Internal Review of this case to explore learning and wider themes and trends which may include risk assessment of closing cases and contingency planning.

For research on mental illness, suicide and domestic abuse to be included in the both the Trust’s domestic abuse and risk assessment and management training; with a Trust wide communication to reflect this.

Access to training to increase knowledge on supporting neurodivergent clients.

Strengthen Patient Autonomy Policies: Review and strengthen policies related to patient autonomy and confidentiality, particularly in situations where family members may be involved in the patient's care. Emphasize the importance of obtaining explicit patient consent for involvement of family members and establish clear guidelines for safeguarding patient autonomy in decision-making processes.

The Safer Lincolnshire Partnership should consider commissioning a programme for familial domestic abuse perpetrators. (It is appreciated that the numbers maybe too small to make this viable.)

Review of the guidance in place for Customer Services Staff when referrals do not meet the criteria for consideration under Section 42 duty.

As the main provider of mental health services, the Trust must ensure that the pertinent mental health questions 5, 24 & 25 in the DASH risk assessment (including question 11 of the stalking – DASH) are focused on, in all of the Trust’s domestic abuse training, thus improving the decision making about risk and ensuring that the multi-agency have the Trust’s mental health expertise when managing high risk cases.

The Safer Lincolnshire Partnership should consider providing a communication in relation to adverse childhood experiences and advising that practice is delivered in a trauma informed manner.

The Trust’s Safeguarding Team to receive specialist training to refocus and upskill them on their analysis of DASH and S-DASH risk assessments, decision making regarding high risk including suicide, and cases that are high risk of serious harm or homicide, requiring multi agency presentation at MARAC, this will also include a refresher on the Trusts role at MARAC.

The Safeguarding Adult Board in company with The Lincolnshire Fire and Rescue Service should consider reviewing the hoarding protocol, to also include consideration of hoarding in relation to the trauma of domestic abuse. This needs to be communicated across all agencies so that professionals understand the rationale of the protocol.

The Trust’s Carer Lead and Safeguarding Team to work together to ensure that all of the Trust’s carers information and communications include the safeguarding of the carer and those cared for.

The group that leads for the Lincolnshire Suicide Prevention Strategy, should ensure it incorporates within the strategy the link between domestic abuse and suicide. The Safer Lincolnshire Partnership should promote the refreshed Suicide Prevention Strategy to ensure it is understood within all agencies and professionals.

For the Trust’s to identify a pathway for trauma informed care for people with secondary mental health diagnoses which is commensurate and accessible to all, aligned to NICE guideline [NG116] Post-traumatic stress disorder. This should include how to manage trauma in people currently experiencing abuse.

The Safer Lincolnshire Partnership needs to seek assurance from partners that there is now in place within the partnership a greater understanding of non-fatal strangulation and the harm that this causes and how the non-fatal strangulation is often a risk factor for escalation to homicide.

The Trust’s Safeguarding Team restructure to create a Safeguarding Hub with increased staffing and a co-ordinating lead, so that review of DASH risk assessments, MARAC referring and advice on cases are less likely to be passed between safeguarding staff and that staff are better equipped and supported to safeguard patients and the public.

The Trust would like the DHR panel and author to consider access to Refuge provision for victims of domestic abuse who have a serious mental illness, as the lack of access to this in Lincolnshire and the United Kingdom prevents Trust staff from being able to readily access safety for victims, using this route.