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One of the key goals of the system is to facilitate more timely data on suspected deaths by suicide from jurisdictions. The AIHW has established arrangements with jurisdictions to supply regular, up-to-date data on suspected suicides. Data from these registers will not be publicly available unless the relevant jurisdiction decides to release data. These data exist to inform the deliberations of the Coroner and may be provided to Commonwealth, State and Territory government officials for the purposes of tailoring interventions, policy and program settings. Such data are incomplete and extremely sensitive.
Registers currently exist in Queensland (established in 1990), Victoria (2012), Western Australia (2010) and Tasmania (2017). The AIHW has been obtaining timely data from several suicide registers to inform reporting within Government.
New South Wales will have established a suicide register by October 2020. The AIHW is working with State Coroners and Department of Health officials in South Australia, the Australian Capital Territory and the Northern Territory to establish suicide registers in these jurisdictions. If all of these jurisdictions establish registers then registers will exist in every state and territory. Detailed planning with South Australia and the Australian Capital Territory include the establishment of project teams within their Coroners Courts to progress this work.
A lack of national ambulance attendance data has been a significant gap in service-level data for populations at risk of suicide. The AIHW has contracted Turning Point through Monash University to develop the National Ambulance Surveillance System (NASS) for self-harm and mental health related attendances. The NASS is a novel and world-first public health monitoring system for mental health, alcohol and drug harms, and self-harm (including suicidal behaviours) with components funded by the Department of Health, Department of Health and Human Services (Victoria) and the AIHW. For this project, Turning Point will collect, code and improve nationally consistent data on ambulance attendances to self-harm (deaths by suicide, suicide attempts, suicidal ideation and self-injury) and mental health-related incidents, including demographics (age, sex), mechanism of injury, mental illness symptoms, alcohol and drug intoxication, transport to hospital status and history of self-harm. Importantly, coding of historical data from 2018 and 2019 for available jurisdictions will be undertaken to provide baseline data for ongoing quarterly reporting. Quarterly collated data will flow back to states and territories to assist with service planning and program delivery and will also be used for regular monitoring on Suicide & self-harm monitoring.
Suicide & self-harm monitoring includes the initial results of the National Ambulance Surveillance System (2019) from New South Wales, Victoria, Tasmania and the ACT (see Ambulance attendances, self-harm behaviours & mental health for further information). Data for 2020 are also presented for Victoria (see COVID-19). Data supplies from additional participating jurisdictions will be available over the remainder of 2020 and 2021, with monthly data for all jurisdictions available from mid-2021.
The lack of data on suicidality from hospital EDs is also a key data gap. The AIHW is working with states and territories via the Mental Health Information Strategy Standing Committee (MHISSC) to explore strategies for improving the consistency and quality of ED data, without adding undue reporting burden to medical staff.
The work of the AIHW and MHISSC aims to develop a national ED data collection that is capable of identifying presentations relating to suicide attempts. A piloted methodology to identify presentations related to suicide attempts currently in use in jurisdictional data systems has been completed. These current reporting practices and their context identified a number of opportunities and challenges. A number of recommendations to progress towards the improvement of reliable national data on suicide attempts in ED presentations over the short- and longer-term are currently under consideration.
Suicide & self-harm monitoring includes information from a pilot study that enhanced the national Australian Bureau of Statistics (ABS) Causes of Death data set, by coding psychosocial risk factors for all coroner-referred deaths (including deaths by suicide) registered in 2017, via a comprehensive manual review of reports included in the NCIS (see Psychosocial risk factors & suicide for more information). The AIHW is working with the ABS to code and embed psychosocial risk factors in future national mortality data sets.
Coding of 2018 risk factors included in police, autopsy, toxicology and coroner’s reports for deaths where the underlying cause of death is Intentional self-harm, has been completed. Coding of 2019 data is underway.
The AIHW has begun analysing data obtained from the Multi-Agency Data Integration Project (MADIP) to evaluate whether educational attainment or employment status are associated with deaths by suicide. Initial summary analysis are reported in Suicide & self-harm monitoring (see Social factors & suicide). Further analysis of MADIP will include determination of the effect of other social determinants (for example, housing tenure, household composition or income) on suicide risk.
The AIHW has also been working with the Australian Government Department of Health along with state and territory health departments to develop the National Integrated Health Services Information Analysis Asset (NIHSI AA). This data asset includes mortality data together with information from hospital admissions, Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS) and residential aged care data. This analysis asset will enable examination of service-use patterns and the demographic profiles of those using (and, by inference, those not using) health services. The AIHW will analyse the NIHSI AA to report on the service use of people in their last 12 months of life, including those who died by suicide. The potential insights from this project and analysis of other integrated data assets will greatly enhance our understanding of people-centred service use and modifiable risk factors for suicide.
The AIHW has engaged the University of Melbourne (led by Professor Jane Pirkis of the Centre for Mental Health) to evaluate the National Suicide and Self-harm Monitoring Project. The evaluation will be conducted alongside the development and implementation of the system from 2020 to 2021 to advise and shape the ongoing project and inform future needs and decisions.
The AIHW has engaged the Australian National University (ANU) Centre for Social Research and Methods (CSRM) to provide advice on the methodological challenges and statistical issues of monitoring suicide and self-harm and to conduct complex modelling on deaths by suicide. The ANU CSRM will also, in collaboration with the AIHW, undertake data analysis of existing data on suicide and self-harm to identify trends, differences by population sub-group and opportunities for improvements in data collection.
In addition, the AIHW has collaborated with the ANU CSRM on the design, analysis and reporting of data collected through the Life in Australia Panel, with a specific focus on tracking mental health, substance use, social and financial outcomes during the COVID-19 pandemic. The AIHW is partnering with ANU CSRM on surveys in May, August and November 2020. This data set will allow for comparisons of outcomes with those of previous data collections throughout 2019 and 2020 (see COVID-19).
AIHW has been assisting the Australian Government Department of Health’s Mental Health Division to curate, analyse and report COVID-19 mental health-related activity data on a weekly basis since 16 April 2020. The data are reported within Government, including to the States and Territories via the Departments of Health and Prime Minister and Cabinet. Data reported include Medicare Benefit Schedule, Australian Government funded Help Lines, headspace, suspected suicide information from a number of jurisdictions and analysis of emerging research and key messages. This reporting will expand to include more detailed data from the states and territories.
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