A preventable death? A family’s perspective on an adult safeguarding review regarding an adult with traumatic brain injury

The purpose of this paper is to review the care management of a man with a traumatic brain injury (TBI) from a family member’s perspective.

The paper provides a case history of “Tom” both prior to his TBI and after.

Tom was the subject of a safeguarding adults case review in Somerset following his death in 2014. Ultimately the paper highlights the shortcomings and failures in the care Tom received by various organisations which ultimately contributed to his suicide.

The paper highlights the need for more effective communication between professionals managing the care of those with TBI. Furthermore, professionals need training in the need for mental capacity assessments and improved safeguarding and risk assessments with adults with TBI.

This paper provides insight into the needs of an adult with TBI from the perspective of a family member who is also a trained psychologist.