Find recommendations from statutory reviews of domestic homicides, published in the Home Office DHR Library. Victim and perpetrator names are never displayed on this page.
Newest publication first
AI-generated summary The review identified systemic failures by agencies to recognise and respond to coercive control, economic abuse, and the increased risk during separation. It also highlighted issues of victim-blaming, institutional bias, and inadequate in…
AI-generated summary The report highlights concerns regarding the significant strain on the perpetrator as a carer due to the victim's dementia and his own deteriorating health, coupled with his reluctance to accept support. It identifies a need for improved i…
AI-generated summary The review highlights missed opportunities by health and police services to identify and assess escalating coercive control and stalking behaviors, particularly post-separation. It also points to a general lack of awareness of non-physical…
AI-generated summary Agencies struggled to link the victim's declining mental health and suicidality with the sustained coercive control he experienced. Challenges included fragmented multi-agency coordination, inadequate risk assessment, and a lack of underst…
AI-generated summary The review identified a pattern of hidden domestic abuse, including coercion, control, and economic abuse, which was not detected by agencies despite multiple contacts regarding the victim's children and health. Key concerns included misse…
AI-generated summary Agencies did not consistently assess the risk of inter-familial harm, particularly regarding the perpetrator's domestic abuse history beyond intimate partners. Information sharing between probation and housing was a gap, and police respons…
AI-generated summary The review identified significant failures in multi-agency information sharing and a lack of recognition of intra-familial violence, leading to inadequate risk assessments and a failure to safeguard the victim and family members.
AI-generated summary The review identified inconsistent and uncoordinated agency responses to domestic abuse, including a failure to conduct risk assessments and refer to specialist services. It also highlighted missed opportunities to assess the victim's comp…
AI-generated summary The review identifies missed opportunities by agencies to recognise and respond to inter-adult family violence, entrenched criminality, and substance misuse between the victim and the perpetrator. Inconsistent information sharing and a lac…
AI-generated summary The review highlights concerns regarding the unrecognised high risk posed by the perpetrator, the lack of cumulative assessment of safeguarding concerns for the victim, and insufficient multi-agency coordination and information sharing. It…
AI-generated summary The review highlights missed opportunities by health services to address the victim's deteriorating mental health and potential domestic abuse, including a missed referral and lack of a risk assessment. It also notes communication gaps bet…
AI-generated summary Key concerns include the perpetrator's subtle, unrecognised coercive and controlling behaviors that escalated to extreme violence during the separation period. The review highlights the victim's lack of disclosure, limited agency awareness…
AI-generated summary The report identifies an underestimation of the psychological impact of domestic abuse and coercive control, inadequate inter-agency information sharing, and a lack of recognition of the link between domestic abuse and suicide, alongside c…
AI-generated summary The review identified pervasive coercive control, missed opportunities for agency intervention due to limited professional curiosity and unconscious bias, and a lack of community awareness regarding domestic abuse signs and reporting pathw…
AI-generated summary The review highlights poor inter-agency communication and delayed, uncoordinated responses from police and mental health services to the victim's escalating distress and stalking, contributing to missed opportunities for safeguarding and p…
AI-generated summary The review concluded that domestic abuse was a causal or contributory factor in the victim's suicide, identifying missed opportunities by agencies to identify abuse and a lack of professional curiosity. It also highlighted challenges in pr…
AI-generated summary The review identifies failures in agencies' identification and response to the victim's coercive control, economic abuse, and self-neglect. It highlights a lack of professional curiosity, inadequate multi-agency information sharing, and ga…
AI-generated summary The review identified systemic failures in recognising and responding to escalating domestic abuse, including coercive control and reproductive coercion. Agencies lacked professional curiosity, timely engagement, and effective information …
AI-generated summary The review identified inconsistent multi-agency responses to the perpetrator's domestic abuse, mental health, and substance misuse issues. It highlighted missed opportunities for earlier intervention and information sharing, particularly c…
AI-generated summary The review highlights a perpetrator's extensive history of violent and coercive control across multiple relationships, alongside systemic failures in inter-agency information sharing, risk assessment, and professional curiosity, which coll…
AI-generated summary The review identified systemic failures in agencies' understanding and response to complex domestic abuse, including coercive control and child-to-parent abuse, particularly for vulnerable adults with dementia and perpetrators with autism,…
AI-generated summary The review identified a consistent failure across multiple agencies to recognise and respond effectively to domestic abuse disclosures, leading to inadequate risk assessments and poor information sharing, particularly concerning the link b…
AI-generated summary The review identified inconsistent domestic abuse risk assessments, inadequate responses to coercive control and stalking, and fragmented multi-agency information sharing. Concerns also include a lack of trauma-informed practice and insuff…
AI-generated summary The review highlights a lack of consistent recognition and multi-agency response to the complex, bidirectional domestic abuse between the brothers and within the wider family, exacerbated by mental health issues, substance misuse, and hous…
AI-generated summary The review identified missed opportunities to assess and share information about the perpetrator's risk to others, despite disclosures of aggressive thoughts and past incidents. There was also insufficient multi-agency working and a lack o…
The index holds 692 reviews from the Home Office library. 9 are not yet listed here while recommendation extraction and verification completes. 5,050 of 10,174 verified recommendations are matched to organisations tracked in the index.
These are statutory reviews under section 9 of the Domestic Violence, Crime and Victims Act 2004.