Foreword

As Ombudsman, I undertake the important responsibility of reviewing family and domestic violence fatalities. Arising from this work, I undertook a major own motion investigation, Investigation into family and domestic violence and suicide (the Investigation) tabled in Parliament on 20 October 2022. My Office’s investigation into this profoundly serious issue included an extensive literature review, stakeholder engagement and the collection and analysis of 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.

Arising from my findings in the Investigation, I made nine recommendations about ways to prevent or reduce family and domestic violence deaths by suicide. The Western Australia Police Force, the Department of Communities, the Department of Justice, the Department of Health and the Mental Health Commission each agreed to these recommendations.

In 2016-17, I gave a commitment to Parliament that, following the tabling of each major own motion investigation, my Office would undertake a comprehensive review of the steps taken by government agencies to give effect to our recommendations and then table the results of this review in Parliament twelve months after the tabling of the major own motion investigation. Accordingly, I am now pleased to provide Parliament with A report on giving effect to the recommendations arising from the Investigation into family and domestic violence and suicide, November 2023.

Overall, I have found that steps have been taken, or are proposed to be taken, to give effect to each of the recommendations. While it is noted that the Mental Health Commission has commenced work to give effect to Recommendation 8, this work commenced more than eight months after the tabling of the report of the Investigation in Parliament. Given the exceptionally serious, and extraordinarily egregious nature, of men’s violence to women, including the very welcome public attention being in relation to this violence, the fact that an eight-month period elapsed prior to commencing this work is of concern. For this reason, I informed the Mental Health Commission that the Office will review this matter again on 31 December 2023, and it is expected that this work will be significantly advanced, and have a clear timeline for completion, in accordance with, and giving effect to, Recommendation 8. The Mental Health Commission has, pleasingly, now prioritised work to address this recommendation and has committed to providing the Office an update on their progress, including a clear timeline for completion, by 31 December 2023.

In recent months, there have been a number of horrifying deaths of women because of men’s abhorrent violence. These fatalities are rightly at the centre of collective public consciousness. We must all commit to this ending. I commit to continuing to work to ending men’s violence and making women and children safe, including that women never feel as though taking their own life is the only escape from a man’s violence.