NHS-related investigations associated with the South West region, with filters for category, recommendation coverage, and publication year.
Mentally disordered man fatally stabs his father. Took his own life after killing
MH homicide of partner after rape and abuse by carers. Ind Inq 2000
Psychotic MH patient fatally stabbed stranger. Repeated failings
Paranoid Schizophrenic fatally and repeatedly bludgeons grandmother with hammer. Indefinite detention under MHA. Had been discharged – not on meds. Inquiry found killing was preventable
Mentally ill man fatally batters parents with hammer then drives them to Lincoln. Many service failings
Mentally ill man fatally stabs friend. Depressive illness, new medication. Victim was also mentally ill
Psychiatric patient kills neighbour. Ind Inq 2004 found failings. Previous Inpatient
Mentally ill man repeatedly & fatally stabs vulnerable former friend. Previous warnings of violence
Psychotic man repeatedly and fatally stabbed his mother and wounded his brother. Family made repeated but unsuccessful efforts to get him help beforehand
MH patient kills woman with brick. Family had tried to get him sectioned beforehand
Psychiatric patient fatally stabbed care assistant in hospital. Had previously killed twice before – wanted to avoid move to MH unit which was non-smoking with no wi-fi.
Paranoid schizophrenic fatally strangles then stabs young son. Long MH history, prev. inpatient
MH patient tortures and murders learning disabled man. Drug history – known MH patient
Delusional mentally ill pensioner repeatedly and fatally stabs his neighbour. Seen by MH staff previous day but not admitted due to lack of beds
Paranoid schizophrenic strangles partner. Ind Inq 2003 found serious failings
Mental health patient beats neighbour to death in row over washing machine. MH history.Ind inq. 2013 HASCAS
Paranoid schizophrenic fatally stabs mentally ill man whilst suffering relapse. Indefinite hospital order with restrictions
Mentally ill man bludgeons ex-wife to death with a hammer. Took his own life afterwards
MH patient fatally stabs friend’s boyfriend 17 times. MH historyInd. Inq. Dale
Schizophrenic fatally strangled partner whilst she was in labour with his child. Ind Inq 2001 13 prev admissions. Prev. violence. Records a mess, No Insight
MH homicide. Ind Inq 2002
Schizophrenic repeatedly and fatally stabbed friend. Many failings – serious incident was ‘foreseeable’
Published January 2026 The executive summary of an independent investigation into the care and treatment given to Adult 1, a mental health service user, who fatally attacked a family member, Adult 2, …
This review should be read in conjunction with the report above, ‘An independent investigation into the care and treatment of Mr A in Devon’. NHS England has published a review looking at …
This review should be read in conjunction with the report below, ‘Multi-agency systems review to identify the learning following five homicides in Devon (2018-2019); with a focus on mental health care and …