[PM] · Prevention of Future Deaths report

On 23 June 2025 an investigation was commenced into the death of [PM], aged 44 Years.

The investigation concluded at the end of the inquest on 13 May 2026. The conclusion of the inquest was 'Suicide'.

The deceased was last seen alive at his home address by a friend and a police officer at 21:36 on 18 June 2025, following concerns for his welfare. At about 19:20 on 19 June 2025, the deceased was found partially suspended ████████ ████████. An ambulance was called but sadly a paramedic verified the fact of death shortly thereafter. The deceased died as a result of the ligature around his neck, which was applied after he had taken a ████████ overdose. He took those actions with the intention of ending his life.

1a Ligature Around The Neck

1b

1c

1d

II ████████Overdose

On the 18th June 2025 , Kent Police officers arrested the deceased on suspicion of an offence contrary to section 160 of the Criminal Justice Act 1988. A search of his home address was conducted under section 18(1) PACE and a number of electrical devices were seized. It was acknowledged that those arrested for this type of offence are at a significantly heightened risk of self-harm / suicide, particularly within the first 48 hours following release from police custody.

Police officers undertook a number of risk-assessments on him during his time in police custody and there was also an assessment by the Liaison and Diversion Service. No specific risks were noted.

Once released on bail (late afternoon / early evening of 18 June 2025), police officers understood the situation to be that he had no mobile devices and no home telephone, and he would therefore be unable to contact family members or support services, if he wished. He was advised that he was permitted to purchase another mobile telephone and that his service provider would be able to transfer his current number to a new phone. As it happens, but entirely unknown to police officers at the time, his work mobile telephone and laptop had not been seized. As such, he would have had the means to make contact with others had he wished to do so.

Family become concerned for his welfare on the evening of 18 June 2025. A friend attended his home address but initially got no response and therefore requested police to conduct a welfare check. This was undertaken and the police officer was satisfied that there was no immediate risk and that he had made plans for the following day.

In the early evening of 19 June 2025, he was found deceased inside his home address.

1. Part of the evidence in this inquest was that Kent Police does not have its own policy or standard operating procedure regarding the risk assessing and safety-netting of those arrested for this type of offence. I was directed to Operational Advice from the College of Policing (June 2019) entitled “Managing the risk of suicide for persons under investigation for online child sexual abuse and exploitation” (the Advice). It was confirmed that the Advice is available to officers on the Kent Police intranet. However, the nature of the Advice is such that some of it's content is not suitable for individual officers to make case-by-case assessments and decisions without there being an organisational level policy or procedure in place. While it is accepted, in the particular circumstances of this case, that parts of the Advice (e.g. paragraph 3.9) would not have altered the outcome, the concern remains regarding future risks to others.

2. I heard evidence that, following initial basic training, officers at Kent Police are not required to undertake any face-to-face update or refresher training regarding welfare checks that they undertake regularly in the community. For the avoidance of doubt, I found that relevant officer undertaking the welfare check on the evening of 18 June 2025 was 'kind and compassionate' and did 'her best to conduct the welfare check'; however, it is not difficult to see that a lack of ongoing training raises risk in the future.