Can integrated care prevent murder? Learning the lessons from statutory reviews of homicides perpetrated by family carers.

Background: Every month there is at least one homicide or homicide-suicide in the UK that involves a family carer killing the person for whom they were caring. These deaths are double-sided tragedies, reflecting our society’s failure to support carers AND to protect vulnerable people. They also undermine public confidence in health and social care services and take a serious toll on the wellbeing of frontline professionals. To date, however, there has been no research on the role of integrated care services in the prevention of these deaths.

 

Approach: As part of a larger study, homicide and homicide-suicides committed by family carers in England and Wales over a 5-year period were reviewed. Sixty-four cases were identified and data about each case was collected from court records, coroners’ reports, media reports, and statutory reviews. This presentation focuses on the thematic analysis of statutory reviews, including but not limited to Safeguarding Adults Reviews, Child Safeguarding Practice Reviews, and Domestic Homicide Reviews.

 

Results: Carer-perpetrated homicides are often described as ‘isolated tragedies that cannot be predicted or prevented’, but the analysis of statutory reviews identified clear patterns across cases, including multiple missed opportunities for prevention. Almost every review noted the absence of ‘joined up’ working across health, social care, and the third sector.

 

Reviews also highlighted a lack of ‘professional curiosity’ about the wellbeing of carers, a failure to uphold carers’ legal right to assessment and support, and a lack of communication between adult and children’s services. Every review provided detailed recommendations or ‘learning points’ for local services, but there was little evidence that these were being implemented and no evidence of national learning across cases.

 

Implications: Five million people in the UK – and billions globally – are family carers. They plug the gaps in formal service provision and save governments millions of dollars each year, but their own needs often go unmet. Carer-perpetrated homicides are the ultimate consequence of a systemic failure to recognise and support carers, and they are not unique to the UK. Growing numbers of homicide and homicide-suicide deaths have been reported around the world. Integrated care services have the potential to prevent these deaths, but that potential has yet to be realised. This study offers clear, practical guidelines – co-produced with unpaid carers – for organisations seeking to improve the support they provide to carers in crisis.