Ombudsman’s Foreword

As Ombudsman, I undertake the important responsibilities of reviewing family and domestic violence fatalities and child deaths. Arising from this work, I identified the need to undertake a major own motion investigation into family and domestic violence and suicide.

To undertake this investigation, in addition to an extensive literature review and stakeholder engagement, my office collected and analysed a comprehensive set of state-wide data relating to those who died by suicide in circumstances where family and domestic violence had previously been identified by one or more State government departments or authorities. This included an examination of 68 women and child victims of family and domestic violence who died by suicide in 2017.

I have found that a range of work has been undertaken by State government departments and authorities to administer their relevant legislative responsibilities to support the safety of women and children experiencing family and domestic violence. I have found, however, that there is important further work that should be done. This work, detailed in the findings of this report, includes a range of important opportunities for improvement for State government departments and authorities, working individually and collectively, across all stages of the service spectrum to improve the identification of, and responses to, family and domestic violence in Western Australia.

In addition, this investigation has identified the need for State government departments and authorities to use a trauma informed approach when working with people who have experienced multiple circumstances of vulnerability, including in responding to family and domestic violence and suicidality.

There is much good work being done by State government departments and authorities to prevent men’s vile and criminal violence against women and the trauma and tragedy that results from this violence, but we can and must do more.

Arising from my findings, I have made nine recommendations to four government agencies about ways to prevent or reduce family and domestic violence related deaths by suicide. I am very pleased that each agency has agreed to these recommendations and has, more generally, been highly co-operative, responsive and positively engaged with our investigation.

The work of my Office in ensuring that the recommendations of the Investigation are given effect does not end with the tabling of this report. My Office will continue to monitor and report on the steps taken to give effect to the recommendations arising from the Investigation.

I acknowledge the ongoing effort of State government departments and authorities, our first responders, including police officers, child protection workers and health professionals, as well as non-government organisations, who work to keep victims safe and hold perpetrators accountable.

Finally, I extend my deepest personal sympathy and condolences to all Western Australian families, friends and communities impacted by the tragic and immeasurable loss of life of a loved one who has died by suicide. It is my sincerest hope that the recommendations of this investigation will contribute to preventing these tragic deaths in the future.

Chris Field
OMBUDSMAN