Recurance · prevention of future deaths reports
Pre-inquest brief
The earlier warning
Linda Gillchrest · 4 Jan 2021 · Richard Travers, County of Surrey
“A publication such as , that contains detailed instructions as to how to end a human life, is available to be purchased online without restriction.”
judiciary.uk/prevention-of-future-death-reports/linda-gillchrest
What was promised
Stated action 1 · response to Linda Gillchrest (4 Jan 2021) · stated timescale: none stated
“I am advised that suicide prevention policy leads in the health system, at the Department of Health and Social Care, Public Health England (PHE), and NHS England and NHS Improvement (NHSEI), are alert to the risk posed by websites promoting suicide methods, and their direction on the use of certain chemicals in completing suicide, including the substance taken by Mrs [name redacted]. These organisations, along with key stakeholders and academics, are looking at what data is available on suicides by this”
judiciary.uk/…/2021-0002-Response-from-Dept-of-Health-and-Socia…
What recurred
- 28 Dec 2023 · Adrian Gallagher · Victoria Davies · Identical hazard · confidence 0.90 (high)
- 30 Jul 2024 · Bethany Langton · Laurinda Bower · Identical hazard · confidence 0.92 (high)
The clearest link, quoted from both reports:
Earlier · Adrian Gallagher · 28 Dec 2023
“[REDACTED] is available to anyone to purchase online, directly from the company. The company appears to have some link to the UK as there is a UK helpline number.”
Later · Bethany Langton · 30 Jul 2024
“The continued ease of availability of [REDACTED] to members of the public.”
What happened next
No evidence found either way · stated action 1
“National Strategy for Suicide Prevention. Washington, DC: HHS, April 2024.”
2024 National Strategy for Suicide Prevention · hhs.gov/…/national-strategy-suicide-prevention.pdf
“Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities.”
Preventing suicides in public places – A practice resource · assets.publishing.service.gov.uk/…/Preventing_suicides_in_publi…
“An evidence-based systems approach to suicide prevention: guidance on planning, commissioning, and monitoring.”
An evidence-based systems approach to suicide prevention · health.gov.au/…/an-evidence-based-systems-approach-to-suicide-p…
No evidence found does not mean the action did not happen.