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 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…
AI-generated summary The review highlights fragmented care for a vulnerable individual with complex mental health needs, substance misuse, and experience of domestic abuse, exacerbated by cross-border service engagement and missed opportunities for safeguardin…
AI-generated summary The review found that domestic abuse, including stalking and coercive control, was a significant factor in the victim's suicide. It highlighted concerns regarding multi-agency responses, including overshadowing of domestic abuse by mental …
AI-generated summary The review identifies concerns regarding the victim's inconsistent engagement with support services, often due to fear of losing child contact. It also highlights missed opportunities by agencies in risk assessment, information sharing, an…
AI-generated summary Key concerns include inadequate multi-agency responses to domestic abuse, particularly for vulnerable individuals with mental health and alcohol issues. Gaps in information sharing, risk assessment, and specialist support for older and LGB…
AI-generated summary The review identified missed opportunities by agencies to recognize and respond to coercive control and domestic abuse, leading to inadequate risk assessment and delayed intervention. There was also a lack of professional curiosity and und…
AI-generated summary The review identified concerns regarding communication barriers, missed opportunities for domestic abuse enquiry, and insufficient training for carers. It also highlighted how unconscious bias and intersecting identities created additional…
AI-generated summary The review identified a lack of coordinated multi-agency response, poor information sharing, and ineffective joint risk assessment for the victim. Concerns also included inadequate housing procedures for domestic abuse victims and an insuf…
AI-generated summary The review identified challenges in inter-agency information sharing and follow-up, inconsistent victim engagement, and missed opportunities to assess risk, particularly concerning the links between domestic abuse, complex health needs, so…
AI-generated summary The review identified systemic failures by multiple agencies to recognise the victim's long-term entrapment in a coercively controlling relationship, leading to fragmented responses, inadequate risk assessments, and ineffective perpetrator…
AI-generated summary The review identified systemic failures in multi-agency information sharing and risk assessment regarding the perpetrator's domestic abuse history and the victim's complex mental health. Agencies missed opportunities to identify and respon…
AI-generated summary The review highlights systemic failures in the risk assessment and management of the perpetrator by probation and police, alongside inadequate information sharing between agencies. This contributed to a lack of awareness and intervention r…
AI-generated summary The review highlights challenges in multi-agency engagement and information sharing, particularly due to the victim's repeated refusal of support despite disclosures of domestic abuse. It identifies missed opportunities to address coercion…
AI-generated summary The review highlights missed opportunities by police and health professionals to identify and respond to domestic abuse, particularly concerning the male victim's experiences and the impact of alcohol misuse. It also notes a lack of inter-…
AI-generated summary The review identified an overreliance on parental decision-making without adequate mental capacity assessments, leading to ineffective monitoring of the victim's health and a lack of escalation when interventions were declined. Communicati…
AI-generated summary The review highlights failures by legal professionals and the Family Court to identify and address the perpetrator's controlling behaviour and economic abuse during protracted divorce and financial remedy proceedings, which significantly i…
AI-generated summary The review highlights systemic challenges in multi-agency responses to a victim with complex needs, including severe alcoholism and cognitive impairment, who experienced high-risk, wide-ranging domestic abuse and coercive control. It ident…
AI-generated summary This Domestic Homicide Review identified that the victim was subjected to prolonged coercive and controlling behaviour by her partner, which her family believed contributed to her death. The review also highlighted missed opportunities by …
AI-generated summary 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 ris…
AI-generated summary The review identified disjointed interagency communication, inconsistent identification and response to domestic abuse, and a lack of professional curiosity regarding the victim's multiple and intersecting vulnerabilities, including mental…
AI-generated summary The review highlights inadequate mental health assessments and care for the perpetrator, poor inter-agency communication and information sharing, and a lack of clear responsibility for case management, compounded by resource constraints in…
AI-generated summary Agencies missed opportunities to pursue evidence-based prosecutions and apply protective orders. There was a failure to understand the victim's non-engagement, particularly regarding the perpetrator's coercive control, highlighting a need …
AI-generated summary The review identified multi-agency missed opportunities in consistently identifying, assessing, and responding to the victim's long-term domestic abuse, mental health issues, and substance misuse. Challenges in inter-agency information sha…
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.