In some ways, victims of domestic abuse who die by suicide are the most invisible of all victims. Too often, the impact of the domestic abuse they faced is not properly recognised. A lack of guidance about how best to conduct reviews following a domestic abuse-related suicide means that we may be missing out on crucial learning to prevent future deaths.
Many of these victims have been navigating complex needs and systems in plain sight of professionals and agencies before their death. One way of trying to make sense of these deaths is by trying to understand what happened and learning from such tragedies in an attempt to improve practice, policy, and systems for all victims of domestic abuse.
Since 2016, in England and Wales, domestic abuse-related deaths by suicide have been reviewed under the ‘Domestic Homicide Review’ system. While this extension was welcome, it was accompanied by almost no specific advice on how to undertake reviews of domestic abuse-related deaths.
This lack of guidance was a challenge because, while sharing many similarities to reviews of homicide, there are significant differences in reviewing a domestic abuse-related death by suicide. Notably, for example, retaining the name ‘Domestic Homicide Review’ in the case of a death by suicide – something the Government has recognised and recently consulted on.
Other challenges, documented in a recent article, include when to commission a review, balancing the needs of different stakeholders, intersections with other statutory processes, and managing potentially quite different priorities of different stakeholders.
This is made more complex still given the (alleged) perpetrator is much less likely to be convicted – and behind bars – when the review is undertaken. In a way, this illustrates the problem of domestic abuse-related suicide: we know it is a significant issue and that we need to respond better, but our knowledge of how to do so remains limited.
Our knowledge, though, is increasing. The ‘Learning Legacies’ project focused on learning from withinreviews into deaths by suicide and about the process of commissioning and conducting those reviews. 32 published reports were examined, and 36 stakeholders, all involved in reviews of domestic abuse-related deaths in some way, were interviewed. These stakeholders included independent chairs, Community Safety Partnership (CSP) leads, domestic abuse coordinators, and families bereaved by domestic abuse-related suicide.
The findings were stark. As with intimate partner homicide, the majority of victims were female, and the perpetrators were usually male, most often partners or ex-partners. Almost two-thirds had dependent children, half of whom were living with them at the time of the death and, in 12 of the reviews, there was evidence of concerns over custody of children.
The vast majority of these victims had made attempts to access the support they needed before their death. Just over half the victims had engaged with specialist domestic abuse services, almost two-thirds had mental health or counselling support, three-quarters were known to have regular contact with their doctors, 90% had a history of police contact, and 30% had accessed specialist addiction services.
Across these interactions, there was often a lack of professional curiosity about domestic abuse, suicidality and, indeed, the connection between the two.
In 94% of cases, there was a documented record of victim mental health issues and, in nearly half of cases, a history of self-harm. In two-thirds of the cases, there was also evidence of previous suicidal ideation or attempts to take their own lives.
This means that the victims were in no way invisible; they were disclosing to and (attempting to) access services, but services were not able to respond to them in a way that met their needs.
So, what next? First, we can focus on what needs to change. Across the reviews examined by the Learning Legacies project, recommendations were focused on health providers (especially GPs) and criminal justice agencies (including the police) or directed towards multi-agency working more generally.
Every DHR makes recommendations for change within local and national agencies. When it comes to domestic abuse-related suicide, the recommendations from reviews in this sample are largely similar to those from reviews into homicides. This includes improved training and professional development and greater professional curiosity; better domestic abuse policies; more robust and consistent risk assessment; and more effective information sharing.
But surprisingly and disappointingly, only 3% of all recommendations in these reviews related to improvement to and better engagement with suicide prevention strategies.
Moving forward, making explicit the links between domestic abuse and suicide prevention is vital.
Positively, increasingly, we are seeing public health and suicide prevention colleagues sitting on review panels and lending their expertise. Domestic abuse has also, for the first time, been recognised as a risk factor within the new Suicide Prevention Strategy for England: 2023 – 2028.
Building on these changes, we must work closely and collaboratively with our health and public health colleagues to develop and design interventions that can better assess the self-harm and suicide risk for victims of domestic abuse. The government has also committed to addressing the lack of guidance around the review of domestic abuse-related suicides. This is welcome: a more robust framework for these reviews, addressing when they should be commissioned and helping manage the particular challenges that arise, is needed.
Domestic abuse-related suicide is preventable. With a stronger understanding of the links between domestic abuse and suicide, and stronger connections between domestic abuse and suicide prevention efforts, we have the hope of seeing a future where deaths are prevented, lives are saved, and people can live free from domestic abuse.