Nearly a decade on from her daughter's death while in police custody, a grieving mother has spoken of her unwavering determination to secure justice.
Kelly Hartigan-Burns, from Darwen, was detained on the evening of December 3, 2016, following allegations she had assaulted her partner Colette at their home in Barley Bank Street. A member of the public had dialled 999 after witnessing her acting in a disturbed manner on nearby Bright Street.
Less than an hour after being placed in Cell C2 at Greenbank Police Station in Blackburn, where she was subject to half-hourly checks, the 35-year-old was discovered unconscious at approximately 1.30am. She was rushed to the Royal Blackburn Hospital where she passed away the next day, reports Lancs Live.
Inquest findings
A four-week inquest conducted in 2022 concluded with a jury determining that multiple police failures had contributed to Kelly's death. Among these was the conduct of PC Simon Haigh, who had neglected to alert his colleagues about Kelly's suicide risk.
During the inquest, jurors heard evidence from numerous witnesses, including police specialists and officers - both current and former - who were involved in Kelly's arrest and detention. The 999 call to police, made after Kelly was spotted acting erratically in public, was classified as the highest priority "Grade One" incident. PC Simon Haigh, with 16 years' service, and PC Rebecca Price, who was still in training, were sent to the scene in a police car.
They discovered Kelly seated and smoking a cigarette. PC Price described her as distressed and intoxicated, while PC Haigh remembered her being composed and speaking clearly. Although a suicide marker appeared on records viewed by PC Price, the inquest heard that PC Haigh chose not to request further details about this, and as she seemed alright, they escorted her to her residence on Barley Bank Street.
Upon arriving at Kelly's home, her partner Colette told PC Haigh that Kelly had struck her earlier that evening, leading to Kelly's arrest on suspicion of assault. PC Andrew Sarchet and Special Sergeant Megan Dawson, a volunteer officer, were assigned to transport her to Greenbank Police Station in Blackburn. However, they weren't briefed about the original reason for the callout or her mental health background, with notes taken by Dawson during her handover with PC Haigh only mentioning a domestic abuse incident. They collected Kelly's medication, which clearly indicated it was prescribed to treat psychosis.
The jury determined there was no indication that PC Haigh had briefed the special sergeant about any circumstances or potential danger of self-harm or suicide. This, they concluded, was "an extremely serious omission which contributed to the death of Kelly".
While Kelly was being removed, Colette discussed with PC Haigh her worries regarding Kelly's mental wellbeing and the possibility she might self-harm or take her own life. PC Haigh failed to relay this crucial information to personnel operating in the custody suite. That breakdown in communication concerning Kelly's mental state and suicide risk was judged to have played a part in Kelly's death.
The jury determined that PC Haigh, identified in the verdict as the senior arresting officer, ought to have sought additional details from the control room about the documented suicide marker.
Kelly was transported to Greenbank Police Station and processed by Sergeant Jason Marsden without conducting a comprehensive risk evaluation - notwithstanding her documented suicide attempt nine months prior and despite the incidents from earlier that evening. The inquest was told that Mr Marsden, who retired weeks before a police misconduct hearing found him guilty of gross misconduct, failed even to enquire about Kelly's name before rapidly questioning her and dispatching her to a cell within minutes.
Mr Marsden confessed he 'should have declined detention' considering Kelly's documented history of mental health problems and prior instances of self-harm and suicide attempts on her police file. He also disclosed that upon seeing medication Kelly had with her at the station - prescribed for those with mental health conditions - he was aware of its purpose, and labelled her an 'alcy' after spotting thiamine; a medication frequently given to tackle deficiency in alcoholics.
Barrister Kate Cornell, representing Lancashire Constabulary at the inquest, put it to Mr Marsden that his custody documentation was 'incomplete and contains basic errors'. She added: "Your attitude to her on the desk that we can see on the CCTV shows a total failure to engage with her in any way. Your decision-making was flawed and unreliable."
Following his instruction to officers to put Kelly in a cell, Mr Marsden left for home - two hours before his shift ended - but was summoned back after she was discovered unresponsive. Sergeant Julian Wilkinson, one of three officers who assumed the shift from Mr Marsden, stated that his former colleague appeared 'really worried' when called back to the station following the discovery of Kelly unresponsive in her cell.
"He looked really worried after Kelly had gone to hospital and was blaming the organisation saying he was stressed enough without this," Mr Wilkinson said. "He said it was down to custody being short-staffed but I remember thinking to myself it wasn't understaffed that night. I remember thinking he couldn't blame the organisation for that."
Expert witness Chris Hampshire, a temporary inspector from Surrey Police involved in a national inquiry into deaths in police custody, described Mr Marsden's treatment of Kelly as 'totally unacceptable'. "It must have been extremely frightening," he told the jury. "She must have felt hopeless. [In terms of policing practice] it's very poor. It makes a significant contribution to Kelly's risk and it shows poor leadership."
Inquest conclusion
The jury determined that the failure of the senior attending officer to notify the transporting officer or custody staff that Ms Hartigan-Burns posed a suicide risk "contributed" to her death. They further concluded that the haste with which she was processed, coupled with the absence of any explanation of the custody procedure, heightened the likelihood of self-harm or suicide.
"If officers of Lancashire Constabulary involved in this incident had shown more compassion, acted diligently, practiced common sense, followed guidance and procedure from the moment they found Kelly in the church yard and throughout her detention there may have been a different outcome," the jury concluded.
Police 'truly sorry'
Deputy Chief Constable Sacha Hatchett, of Lancashire Constabulary, said after the inquest concluded: "Our thoughts first and foremost today are with the family of Kelly Hartigan-Burns and with all of her loved ones.
"Lancashire Constabulary owes a duty of care to all of those in our custody and they should be able to rely on us to keep them safe. We failed to do that with Kelly and for that we are truly sorry.
"Since that night we have taken a number of steps to minimise the risk of such a tragedy being able to ever happen again. This includes a number of system changes to strengthen our processes when booking people into custody and increasing training for staff on how to recognise when people are vulnerable and how they should be looked after when in our care.
"Following Kelly's death, the matter was referred to the Independent Office of Police Conduct who looked into the actions of five officers and two custody detention officers. One officer was taken to a gross misconduct hearing but retired before that hearing took place. The hearing determined that he would have been dismissed had he not retired. Another officer was subject to unsatisfactory performance procedures and management action.
"We are grateful to HM Coroner for examining this matter in such detail during the course of the inquest and to the jury for their careful consideration. As Lancashire Constabulary is a learning organisation, we will of course study their findings in detail and take on board any further lessons that we can.
"Once again, our thoughts and sympathies are with all of Kelly Hartigan-Burns' loved ones at this time."
Mum's fight for justice
LancsLive can exclusively reveal that Kelly's mum June, who lives in Poulton-le-Fylde, is still awaiting answers from the police watchdog about the investigation into PC Haigh.
She said: "I cannot understand why it is taking so long for anyone to make a decision on this matter.
"Since my daughter's death we are now on our sixth Prime Minister, the Grenfell Tower Fire was in 2017 but the enquiry, which was much more involved, concluded in 2024.
"It seems individual families that are not in the limelight as such don't matter, can wait forever until you have a spare moment, our feelings are irrelevant in the grand scheme of things."
Police watchdog response
An IOPC spokesperson said: "Our thoughts remain with Kelly's family and loved ones, as well as all those affected by her death.
"Our independent investigation into a complaint regarding some of the evidence heard during the inquest concluded in 2023 and found one officer had a case to answer for gross misconduct.
"Lancashire Constabulary, which is responsible for arranging the disciplinary hearing, shared further information, which was not available to us during the investigation, in October 2025 and we shared this with the complainant.
"We have since explored further lines of inquiry raised by this additional evidence to determine what impact, if any, it may have on our decision making.
"Our review of the new information is almost complete, and we await one further statement before we will be in a position to share our draft findings with the complainant and Lancashire Constabulary.
"We recognise the impact on all those involved to have matters unresolved, so long after Kelly's death, and have been assured that we will soon have the information we require in order to reach our decision."
Lancashire Constabulary said the investigation remains with the IOPC.
