Man found dead after concerns for his welfare were reported - Sussex Police, June 2018

Published 03 Sep 2019
Investigation

At 1.17am on 16 June 2018, a hospital mental health unit reported to Sussex Police that one of their voluntary patients had not returned from an agreed period of leave. The caller disclosed that the man may consume alcohol or take illegal drugs and would be a risk to himself if he did. The caller also explained the man had made previous attempts to take his own life. However, they also stated the man had failed to return previously and noted he had left the hospital calm and pleasant.

The initial contact handler at Sussex Police logged and reviewed the incident and graded the call as high risk, requiring police response within a maximum of 15 minutes. Subsequently, others reviewed the log and various conflicting decisions were made in respect of the most appropriate police response. The call was downgraded, closed, re-opened and then held until the morning for the next shift of officers to action.

At approximately 8.30am, an officer was tasked with making enquiries to locate the man. However, the man was found dead by a member of the public less than two hours afterwards. The post-mortem report stated the man had died of heroin toxicity.

During the investigation, investigators obtained a written account from a supervisor in the force communications department regarding allegations that their decision to close the call without any further police action was inappropriate in the circumstances.

They also spoke to witnesses, reviewed information held on Sussex Police computer systems, CCTV, airwave recordings and relevant policies, procedures and legislation.

Evidence indicated that the supervisor had considered the man to be absent without leave (AWOL), rather than missing, and asked the hospital to make further checks. The force’s AWOL policy notes other factors needed to be present for a person to be considered as ‘missing’ in the first instance. We did not consider that there was sufficient evidence of risk to suggest that the supervisor’s decision to treat the man as AWOL was inappropriate in the circumstances. However, it appeared that no review period was agreed with the hospital to reassess the man’s status. We were of the opinion that it was inappropriate to close the call without setting this. We were of the opinion that the supervisor would benefit from management action to familiarise themselves with the AWOL policy and their responsibilities.

We were also of the opinion, based on the evidence, that the high-risk initial grading was not appropriate or necessary. We suggested that the initial contact handler may benefit from learning or training in this respect. We also identified individual learning for a sergeant who had not classified the man as ‘missing’, and for a police constable regarding risk assessment

Our investigation also highlighted a number of officers and a member of staff with differing understanding on missing persons and/or the AWOL policy and suggested that Sussex Police should remind all staff of these and/or offer additional training.

We completed our investigation in March 2019.

After reviewing our report, the force agreed that the supervisor would receive management action. They also agreed with the recommendations of the IOPC and provided evidence of how they had been addressed through the circulation of two force briefings.

IOPC reference

2018/104957
Tags
  • Sussex Police
  • Death and serious injury
  • Welfare and vulnerable people