The review report found that Creswell was subjecting her to a “brutal regime of grooming, coercive control, verbal degradation and physical abuse”.
A review has found that “institutional misogyny” contributed to “clear warning signs” being missed in the initial PSNI investigation following the death of showjumper Katie Simpson.
The independent review led by Dr Jan Melia, commissioned by the Department of Justice, found that “not one officer thought seriously about abuse/control” in the police investigation in 2020.
It cited “systematic failures” and also criticised other bodies, including social services and the health service, over safeguarding, as well as within the equestrian sector.
It has made 16 recommendations, with many focused on training.
The 21-year-old from Tynan, Co Armagh, died in Altnagelvin Area Hospital almost a week after an incident in Gortnessy Meadows, Lettershandoney.
Police originally thought she had taken her own life.
It was not until the following year that Jonathan Creswell, the partner of Ms Simpson’s sister, was arrested on suspicion of murder.
The trial of Creswell, 36, for the murder of Ms Simpson ended in April 2024 after he took his own life following the first day of proceedings.
The report found that 37 people, both female and male, have come forward to say they were abused by Creswell.
It found officers failed to identify inconsistencies in Creswell’s account, neglected to preserve vital evidence, overlooked forensic scenes and opportunities, dismissed key witness statements and failed to secure/examine crucial digital communications such as text messages and phone records that might have revealed patterns of abuse.
It went on to find that police officers demonstrated a striking lack of professional curiosity, failed to employ an investigative mindset or consider the possibility of abuse/control, in spite of clear warning signs.
Ms Simpson had been going to a horse yard close to her home in Tynan from the age of eight up to three times a week to ride and care for horses. Creswell worked at that yard and was dating her sister.
The review report found that Creswell had groomed her from the age of 10, subjecting her to a “brutal regime of grooming, coercive control, verbal degradation and physical abuse”.
The report found the grooming and abusive behaviour was concealed behind a “charming facade”.
The report examined 16 hospital visits by Ms Simpson between 2003 and 2020 with increasingly severe injuries, which were explained as being due to horse riding, and found the pattern should have prompted closer examination.
Meanwhile, Creswell was found to have had a long-term pattern of persistent and escalating offending that included motoring offences, dangerous driving, animal abuse, indecent exposure, suspected fraud and domestic abuse.
Previously, a Police Ombudsman report concluded the initial police investigation into Ms Simpson’s death was “flawed” and “failed the Simpson family”.
The Police Service of Northern Ireland (PSNI) apologised to Ms Simpson’s family in 2024.
The independent review found a series of failings, from failing to treat her death as suspicious, deficiencies in scene management, neglect of forensic evidence, oversight of suspect history, inadequate witness strategy, fragmented leadership and accountability and limited disciplinary action for the officers identified for misconduct.
The review also found discrepancies in information given by Creswell, a lack of investigation into evidence given by members of the public and poor communication with Ms Simpson’s family.
It also found “institutional misogyny”, with examples given of referring to Creswell as a “bad boy” rather than “acknowledging him as a violent perpetrator”.
The review concluded this choice of language “trivialises male aggression, dismissing harmful behaviour and ultimately protects male perpetrators, simultaneously undermining the credibility of female victims”.
“Seeing this kind of language use by police, draws attention to the concerns raised in the Angiolini Review and highlights how institutional cultures and communication practices perpetuate misogyny,” it found.
“There is no doubt that this kind of language is normalised, seen as a bit of laugh or banter, but this is part of the problem. Euphemistic or dismissive language, such as referring to a perpetrator as a ‘bad boy’ obscures the harm done by men like Creswell, denying women’s experience of abuse.”
It continued: “The use of this kind of language is misogynistic because it protects male perpetrators at the expense of female victims.
“Creswell’s misogyny was a risk factor for both women and for others who have come forward because of this case. When police endorse misogyny, as they do here, risk to women escalates.
“Institutional misogyny reinforces risk, allowing it to be minimised; it dismisses women’s experiences, creating and sustaining a culture where female victims are disbelieved, and perpetrators are given credibility and power.
“This was precisely the case for Katie: not one officer thought seriously about abuse/control.
“Katie’s lived experience was disregarded, clear warning signs were ignored, established protocols were treated as optional/discretionary, and police chose to privilege Creswell’s account.”
It found an “urgent need for trauma-informed training, gender-sensitive risk assessment, and a cultural shift within the PSNI, that challenges and changes its own institutional misogyny”.
In a foreword to the review’s report, Ms Simpson’s mother, Noeleen Mullan, said it had been “hard to read”, noting “so many things were missed, not done properly and it felt like there was a “lack of care for Katie from the police”.
Making an oral statement in the Assembly, Justice Minister Naomi Long said a “debt of gratitude” was owed to all who raised concerns about the circumstances surrounding the death of Ms Simpson.
She said the independent review “makes for uncomfortable reading” and announced that Dr Melia will co-ordinate and chair an implementation group for the 16 recommendations.
“My department and our partners will act on the recommendations contained in Dr Melia’s report and ensure lessons are not simply learned but embedded,” she told MLAs.
The Katie Trust, set up in Ms Simpson’s memory, welcomed the review as representing a “significant and necessary step toward transparency and accountability”.
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