Kent review

The recommendations made in Kent DHR Jean concerning adopting a trauma informed approach, training and subject matter experts to provide advice and guidance on trauma informed approaches are supported by this DHR. It is recommended that each agency provides an update on the progress that has been made in adopting a trauma informed approach to their service delivery.

The recommendation made by Kent DHR Leanne concerning training in the link between economic abuse and coercive and controlling behaviour is supported by this DHR. It is recommended each agency provides an update on what has been done to improve practitioners’ knowledge of economic abuse and coercive control.

KCSP should check the progress of the proposed new MARAC structure and request that part of this implementation involves an awareness campaign that all participating organisations know what is expected of them in the new way of working.

The Probation Service should provide an update on the status of the measures put in place to tackle Recommendations 11-13 of HM Inspectorate of Probation Thematic Report on Domestic Abuse published in July 2023. This concerns the assessment of domestic abuse risks and the role of Domestic Abuse Safety Officers. See https://www.justiceinspector ates.gov.uk/hmiprobation/w p- content/uploads/sites/5/202 3/07/Domestic-Abuse- Thematic-inspection-report- v1.1.pdf

Victims of serious domestic abuse with co-occurring mental health issues and substance dependencies need special consideration. This should complement the 10-year Government Drug Action Plan. The County Council Substance Misuse Commissioners should be approached to consider additional detox and residential treatment and recovery programmes that meet this need and mitigate the high-risk implications of the trio of vulnerabilities.

Mental health practitioners need to understand that people with substance dependencies and mental health issues should be offered parallel care. KMPT should detail what action they propose to take that closes the default position that a dependency should be treated first before any mental health support is offered. This should include training forums, internal reflective briefings, monthly newsletter, dip checks of discharge decisions made for referrals where the trio of vulnerabilities is evident. The DNA policy for CMHT and the urgent mental health helpline for people with co-occurring conditions of substance misuse and domestic abuse should be reviewed.

The Acute Hospital to share the findings of their review of patients with complex needs discharging themselves against medical advice. The research will be hospital centric and patient good practice can be shared internally within the NHS. KCSP to seek updates from the Kent and Medway Safeguarding Adults Board regarding the progress of the Kent and Medway Multi-Agency Risk Management (MARM) Framework currently in development to be trialled. MARM seeks to improve multi-agency responses for adults at risk. (MARM frameworks may be used where there is risk of harm due to disengagement from services, as well as a number of other scenarios.)

The General Practice should review its prescribing practices in respect of quantities of addictive medications. There should be regular liaison with the substance misuse service providers to avoid the risk of dual prescriptions for patients being prescribed medicine used for Opiate Substitute Therapy. Conducting a Significant Event Meeting to discuss the response by the GP Practice to the needs of the victim will assist in this process.

Explore the feasibility for a PNC marker for high-risk victims of domestic abuse. The PNC is in the process of being replaced so this may be a capability that is provided in the new system. The functionality of the PND may be another direction to take to achieve this outcome.

Female prisoners released on licence should be managed by probation officers who have been trained in a trauma informed approach as recommended by the Probation Service Female Offender Strategy.

ASC should promote good practice in effective information sharing with multi-agency partners.

Vulnerable patients should not be discharged until identified risks have been mitigated. Triage process to be aligned to disengagement guidelines and professional curiosity promoted, documented in an accurate and timely way on patient records.

Promote KMSAB task and finishing group findings on co- occurring conditions including substance and alcohol abuse.

Implement the new domestic abuse policy and provide additional training for housing/customer service operatives in domestic abuse.

Robust record keeping demonstrating the provenance of source information, action taken and the rationale for decisions made will provide a comprehensive history to manage repeat referrals in an informed way.

Introduce a process for alleged perpetrators in police custody for domestic abuse are signposted to support programmes or organisations that facilitate behavioural change/support alcohol and/or drug dependencies when appropriate. Currently only victims of domestic abuse are signposted to support services.

Review policy, procedures and working practices generated by the missed opportunities/good practice identified in the completion of the IMR for this DHR. This includes case management and supervision, completion of documentation and fact checking, boundaries of partnership working and the role of the IDVA.

All staff should undertake refresher training in domestic abuse and trauma informed approaches to manage complex cases.