Chloe Macdermott
19 Dec 2023 · Coroner Paul Rogers · Inner West London
This report repeats 1 earlier warning, and was raised again 3 times later. See the linked reports.
The coroner's concerns
1. forum that encourages suicide and provides suicide methods
“[REDACTED], is a forum that permits material to be exchanged and viewed within its open chatrooms whereby suicide is encouraged, assisted, counselled and procured through the provision and exchange of information and methods.”
2. lack of age restrictions
“No age or other restrictions are in place to prevent access to children, vulnerable teenagers and vulnerable adults.”
3. absence of suicide help signposting
“No prominent signposting is in place to organisations from whom help is available to prevent suicide.”
4. unremoved suicide method posts
“Posts are made by users containing details of methods of suicide without any effective administration to remove such harmful content.”
5. uncontrolled import of suicide-related product
“The ability for UK users to purchase [REDACTED], through Amazon in the United States and to take delivery in the United Kingdom without effective border and/or custom controls.”
Linked reports
Closely relatedConfidence 0.90 · high
Earlier report
“[the deceased] was using an online suicide forum, (the forum now appears under the internet address .Through the forum she was able to engage in discussions with other pro-suicide members and obtain advice how to”
This report
“(3) [REDACTED], is a forum that permits material to be exchanged and viewed within its open chatrooms whereby suicide is encouraged, assisted, counselled and procured through the provision and exchange of information and methods.”
Closely relatedConfidence 0.90 · high
This report
“The ability for UK users to purchase [REDACTED], through Amazon in the United States and to take delivery in the United Kingdom without effective border and/or custom controls.”
Later report
“[REDACTED] can be purchased from abroad and imported to Great Britain with no restrictions;”
Identical hazardConfidence 0.90 · high
This report
“(3) [REDACTED], is a forum that permits material to be exchanged and viewed within its open chatrooms whereby suicide is encouraged, assisted, counselled and procured through the provision and exchange of information and methods.”
Later report
“[the deceased] accessed an online 'suicide forum' where she was able to access information on how to take her own life”
Identical hazardConfidence 0.90 · high
This report
“(10) The ability for UK users to purchase [REDACTED], through Amazon in the United States and to take delivery in the United Kingdom without effective border and/or custom controls.”
Later report
“[REDACTED] can be purchased from abroad and imported to Great Britain with no restrictions;”
Responses
2023-0534-Response-from-Amazon-UKv3.pdf ↗· Amazon UK
2023-0534-Response-from-British-Transport-Policev2.pdf ↗· British Transport Police
2023-0534-Response-from-DHSCv2.pdf ↗· Department for Culture
Stated action
“seeking to tackle at source the suppliers of harmful substances for the purposes of suicide”
2023-0534-Response-from-DSIT.pdf ↗· Amazon UK
Stated action · once these duties are in force
“The act's illegal safety duties will apply to all in-scope 'user-to-user' services which allow users to post content online, or to interact with each other - including online forums. This means that once these duties are in force, they will be required to have systems and processes in place to proactively prevent users from encountering priority illegal content via their service and to minimise the length of time for which such content is present.”
2023-0534-Response-from-Ofcom.pdf ↗· Ofcom
Stated action
“We are currently in the process of putting in place regulation to implement the Online Safety regime. Until the relevant procedural steps outlined below are completed, the duties on regulated services are not yet fully in force. Further detail on Ofcom's planned approach to online safety regulation is set out below. Whilst the regime is at this early stage, we are supporting all in scope services to be compliant with the provisions of the Act and intend to seek to engage constructively with services”