A damning report into Queensland police responses to domestic and family violence has delivered a reckoning for the organisation.
From highlighting problems with misogyny and racism to pointing out failures of leadership, the commission of inquiry's 400-page report, which made 78 recommendations, has been called "disturbing" reading by Queensland's premier.
Here are some of the main takeaways of the report:
Promotion system 'flawed'
The report said a "failure of leadership" allowed a culture of sexism, misogyny and racism within the Queensland Police Service (QPS) to continue largely "unchecked" for many years.
"Much of the problem of the persistence of sexism and misogyny within the QPS lies at the feet of the organisation's senior leaders who set the ethical tone for the organisation," the report found.
It said Police Commissioner Katarina Carroll and other senior leaders failed to "call out or denounce" the conduct of two senior officers who made "casually sexist comments" at leadership conferences "in the days or weeks after the incidents".
"When the QPS fails to denounce sexism exhibited by its senior leaders, negative attitudes towards women may thrive, including among junior officers."
Both of the officers were dealt with by "local managerial resolution", with one later promoted to chief superintendent.
The commission of inquiry report said this showed the promotion system was "flawed" and that poor behaviour was "no barrier to promotion in the QPS".
"Commissioner [Carroll] could have shown strong leadership by promoting the next person and publicly standing against the recommendation," the report said.
During the inquiry's hearings, Commissioner Carroll said it was "probably an understatement" to say she was upset and appalled over the two incidents, and that one of the officers "disputed" the wording, but was "remorseful".
The report found there were "strong perceptions" among QPS members that "the leadership lacks integrity" and was ultimately responsible for a culture of fear and silence.
Racism in the ranks
Racism is a "significant problem" within the QPS, the report found.
Examples of racist language and attitudes levelled at police officers and the public included "stupid black c****," "we should just napalm Aurukun," and "bring out the black shiny shinys for NAIDOC so we can take photos for workplace", it said.
The report noted that in August 2020 a group of officers who identify as First Nations peoples and People of Colour met with the police commissioner and other senior leaders to discuss their experiences of racism in the organisation.
Their experience spanned decades.
The following month, protesters marched over the death of an Indigenous woman in custody.
Commissioner Carroll told the media at the time she was upset that some protesters had described the organisation as racist, saying "we are in no way racist".
The commission of inquiry's report said while it was "a complex situation to handle", Commissioner Carroll's comments were likely to have caused distress to the officers she met the previous month and may have deterred them from speaking out again.
"The commissioner let down the people she had met with, and the organisation as a whole, when she declared that the QPS was "in no way racist", the report said.
"Words and actions of the organisation's leaders which fail to recognise and acknowledge racism in the organisation inhibit change."
The report said another issue was a "lack of organisational response to complaints about racism".
One of the case studies was a First Nations off-duty senior constable who was at night near her home when a police car stopped and accused her of breaking into cars and houses.
"She did not disclose that she was a police officer. The woman felt harassed and racially profiled. She did not observe anyone else being stopped by police."
"She raised the issue with her Officer in Charge who said that the officers were just doing their job and she should forget about it. This matter was reported to Ethical Standards Command, who determined the allegations were not capable of being substantiated."
The inquiry found the QPS "has not consistently provided a culturally safe workplace for First Nations employee".
It has recommended that within six months the QPS establish an additional complaint code to explicitly capture complaints involving allegations of racism.
Shortcomings in family violence response
The report found QPS responses to domestic and family violence matters fail to consistently meet community expectations.
The commission of inquiry found many victim-survivors were not believed when they tried to make a report of domestic and family violence to police and can be blamed by officers for the violence they report.
The commission highlighted a concerning practice by some officers — recording victim-survivors on body-worn camera footage stating that they did not want to proceed with any criminal charges at the point of crisis and prior to the start of an investigation.
"This has serious implications for the sufficiency of evidence later gathered by the police and reduces the likelihood of victim-survivors being able to pursue criminal charges at a later date," the report found.
It noted many victim-survivors told the commission about apparent failures by police to commence domestic violence investigations or gather evidence, apply for protection orders or pursue criminal charges.
"Police reluctance to apply for protection orders appears to be driven by several factors, including poor understanding of the law and the dynamics of domestic and family violence, along with cultural issues within the QPS," the report noted.
The report said QPS leadership had "failed to implement effective long-term improvements" and that "improved police responses will require improvement to fundamental cultural issues".
"Change in this regard will be difficult because of the culture of fear and silence which prevents the membership from speaking up about those issues and the changes that need to be made.
"The QPS leadership is responsible for that culture of fear and silence, but it is so ingrained that changing it will be hard to do."
The report's recommendations include improving training in relation to domestic and family violence, as well as developing and implementing a mechanism for measuring domestic and family violence demand and the effectiveness of police responses.
Cultural aversion and burnout
The report highlighted that QPS members were experiencing burnout and fatigue in relation to family violence call-outs.
"The result is a cultural aversion within the QPS to domestic and family violence matters, leading to a reluctance by QPS members to respond to domestic and family violence related calls for service or attend to requests for help at station front counters," the report said.
The commission noted that police found the burden of paperwork associated with family violence matters overwhelming.
Four recommendations aim to improve this, including that within 12 months QPS establish a joint committee to address burnout and build the organisation's psychological health and wellbeing, based on evidence.
What now for Commissioner Carroll?
Commissioner Carroll said she intended to stay on in the top job and that she was the best person to oversee the implementation of the commission's 78 recommendations.
"I am 100 per cent committed to seeing this reform through, " she said.
"I am the person that will the enact the reforms and change what you have read in the report."
She announced that Deputy Commissioner Steve Gollschewski has been appointed special coordinator to lead the recommended police reforms.
Commissioner Carroll was sworn in as Queensland's first female police commissioner in 2019. Prior to that, she was head of Queensland Fire and Emergency Services.
Premier Annastacia Palaszczuk was repeatedly asked during a press conference if Commissioner Carroll was fit to lead the service after the scathing findings on leadership in the Commission's final report.
Ms Palaszczuk said Commissioner Carroll had her full support, with her position also endorsed by cabinet.
Commissioner Carroll said Julie McKay, chief diversity, inclusion and wellbeing officer with PriceWaterhouseCoopers, along with a special team, will support the QPS in implementing the reforms.
