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.
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AI-generated summary The review highlights concerns regarding inadequate multi-agency information sharing, particularly concerning domestic abuse and the perpetrator's mental health and substance misuse. It also notes challenges in assessing the perpetrator's …
AI-generated summary The review identified systemic missed opportunities by multiple agencies to identify and respond to escalating domestic abuse, coercive control, and stalking. These included failures in information sharing, consistent referral to specialis…
AI-generated summary The review identified significant failures in mental health service provision for the perpetrator, including inadequate risk assessment, poor inter-agency communication, and a lack of care coordination, which left him vulnerable during a p…
AI-generated summary The review identifies significant failings in multi-agency safeguarding responses to alleged sexual abuse, including inadequate initial assessment by Children's Social Care, missed referrals by Housing and Health, and a lack of robust supp…
AI-generated summary The DHR found the perpetrator's undiagnosed psychotic illness was the primary factor. Key concerns include missed opportunities for early intervention for the perpetrator's mental health and substance misuse, and insufficient support and i…
AI-generated summary The report highlights concerns regarding the identification and support of male victims of domestic abuse, particularly within the BAME community, and the need for increased professional curiosity and effective information sharing among ag…
AI-generated summary The report highlights inconsistent agency responses to domestic abuse, including missed opportunities by GPs and ineffective multi-agency risk assessment conference (MARAC) processes. Failures in managing the perpetrator's bail, prison com…
AI-generated summary The review highlights challenges in identifying the primary aggressor in cases with mutual allegations, exacerbated by alcohol use and the victim's disengagement from services. It also notes missed opportunities in multi-agency information…
AI-generated summary The report identifies concerns regarding multi-agency responses to non-intimate partner domestic abuse, particularly sibling violence, and the effectiveness of safeguarding for older children. It highlights challenges in assessing cumulati…
AI-generated summary Agencies missed opportunities to identify and respond to domestic abuse disclosures, conduct risk assessments, and consider the increased risks during separation. There were also issues with inconsistent record-keeping and information shar…
AI-generated summary The review highlights limited agency awareness of the domestic abuse experienced by the victim, who was isolated and feared reporting due to perpetrator threats and misconceptions about social services. It identifies missed opportunities f…
AI-generated summary The review highlights challenges in enabling older people experiencing abuse to disclose their needs due to cultural and situational barriers. It notes missed opportunities for agency intervention, including a lack of MARAC referral despit…
AI-generated summary The review identified concerns regarding the ineffective processing of urgent mental health referrals, a lack of consistent GP care, and insufficient assessment of the victim's needs as a carer. There was also a failure to routinely enquir…
AI-generated summary The DHR identified failures in multi-agency working, risk assessment, and recognition of domestic abuse (coercive control) of an older person, compounded by unaddressed mental health and alcohol issues in the perpetrator, leading to inadeq…
AI-generated summary The review identifies concerns regarding the recognition and response to adult child to parent domestic abuse, particularly where coercive control is present and victims are vulnerable or have language barriers. It highlights the impact of…
AI-generated summary The report identifies significant delays in DHR completion and a lack of agency awareness regarding the DHR process. It also highlights challenges in engaging with LGBT+ communities, missed opportunities in addressing the perpetrator's men…
AI-generated summary The review identified a lack of coordinated multi-agency response to the victim's domestic abuse, mental health, and substance abuse issues. Key concerns include insufficient information sharing, lack of professional curiosity, and the imp…
AI-generated summary The report identifies missed opportunities by agencies to recognise and respond to the victim's domestic abuse and coercive control. Key concerns include inadequate multi-agency information sharing, a lack of understanding of risk assessme…
AI-generated summary The review identified systemic failures in recognising and responding to domestic abuse, particularly concerning the victim, an adult with profound disabilities. Key issues included inadequate adult safeguarding, inconsistent application o…
AI-generated summary The review highlights the victim's consistent refusal of care and support, alongside the perpetrator's escalating stress and mental health challenges as a carer. Agencies missed opportunities to identify and address the perpetrator's distr…
AI-generated summary The report identifies significant failings in police firearms licensing decisions, including inadequate risk assessment and missed opportunities to revoke the perpetrator's certificate. It highlights the impact of domestic abuse and contro…
AI-generated summary The review identified systemic failures in inter-agency information sharing and risk assessment, particularly concerning escalating domestic abuse and stalking. There was a consistent failure to recognise and safeguard children as direct v…
AI-generated summary The report identifies systemic failures in recognising familial domestic abuse, often obscured by mental illness and substance misuse. It highlights inadequate risk assessments for older victims and carers, and a lack of coordinated multi-…
AI-generated summary Agencies missed opportunities to identify and assess domestic abuse risks for the victim and perpetrator, particularly concerning male victims and older individuals. There were inconsistencies in information sharing, internal processes, an…
AI-generated summary The review highlights missed opportunities by agencies to conduct comprehensive risk assessments, particularly regarding the perpetrator's controlling behaviour and the victim's vulnerability. Insufficient information sharing and contextua…
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.