One of the key goals of the project is to facilitate more timely data on suspected deaths by suicide from all Australian jurisdictions. Prior to the COVID-19 pandemic, suicide registers existed in Queensland (established in 1990), Western Australia (2010), Victoria (2012) and Tasmania (2017). New South Wales established a suicide register in October 2020.
During the COVID-19 pandemic, the AIHW made arrangements with several of these suicide registers to obtain regular and timely data to inform governments' decision making and response to the pandemic. The AIHW has been receiving these data since April 2020 and reporting them to government weekly in 2020 and fortnightly in 2021 (see Regular updates to Government on Mental health-related service use). Data from these registers will only be made publicly available if the relevant jurisdiction decides to release data (see Suspected deaths by suicide). These data exist to inform the deliberations of the Coroner and are extremely sensitive.
The AIHW has been working with State Coroners and Department of Health officials in the Australian Capital Territory, South Australia and the Northern Territory to establish suicide registers in these jurisdictions. Detailed planning with South Australia and the Australian Capital Territory is continuing for registers to be established later in 2021. The AIHW is also working with the Northern Territory Coroners Court to establish a suicide register for the Northern Territory.
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 collects, codes and provides 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 Australian Capital Territory (see Ambulance attendances, self-harm behaviours & mental health for further information). Monthly data are also presented for Victoria for 2020 and comparator years 2018 and 2019 (see COVID-19).
Further data supplies from additional jurisdictions will be reported throughout 2021, with monthly data for all participating jurisdictions expected to be available from mid-2021.
The lack of data on suicidal behaviours from hospital EDs is 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. A review of 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.
The National Suicide and Self-harm Monitoring Project has provided funding until 2022 for the Australian Bureau of Statistics (ABS) to continue the enhancement of the national Causes of Death data set, by coding psychosocial risk factors for all coroner-referred deaths (including deaths by suicide), 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 embed this work in future national mortality data sets.
Coding of 2019 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 2020 data is underway.
The AIHW has analysed 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 analyses are reported in Suicide & self-harm monitoring (see Social factors & suicide). The AIHW is currently undertaking modelling of the MADIP data extract to better identify protective and risk factors for deaths by suicide. This further analysis of MADIP will determine the effect of other social factors such as 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 has been conducted alongside the development and implementation of the system and will continue throughout 2021 to advise and shape the ongoing project and inform future needs and decisions.
As deaths by suicide in Australia are statistically rare events it is difficult to achieve the statistical power that is necessary to identify patterns or draw conclusions about changes in the suicide rate. In 2019-20 the AIHW worked with the Australian National University (ANU) Centre for Social Research and Methods (CSRM) to develop methodologies for determining incidence trends and spatial clustering of deaths by suicide and to conduct complex modelling on deaths by suicide. In 2020-21 the AIHW extended the work with the ANU CSRM to validate the model and undertake analysis of spatial data in the National Mortality Database to investigate geographical areas of persistently higher suicide rates.
In addition, the AIHW collaborated with the ANU CSRM on the design, analysis and reporting of data collected through the Life in AustraliaTM Panel, with a specific focus on tracking mental health (psychological distress), substance use, social and financial outcomes during the COVID-19 pandemic. The AIHW partnered with ANU CSRM on surveys in April, May, August and November 2020. A survey was also completed in January 2021 and further collections are planned for April 2021. This data set will allow for comparisons of outcomes with those of previous and future data collections throughout 2019, 2020 and 2021 (see COVID-19).
The AIHW has engaged the University of Melbourne (led by Professor Jane Pirkis of the Centre for Mental Health) to undertake a research project to determine whether particular risk factors for suicide (e.g. financial stressors, unemployment, homelessness, and relationship difficulties) have been heightened by the COVID-19 pandemic. This project will use data from the Victorian, Queensland and Tasmanian suicide registers. An Expert Advisory Group has been established and ethics approval received. The deliverables for this project will be that the University of Melbourne will prepare policy briefings as findings become available and a final written report at the end of the project.
From 16 April 2020, the AIHW began assisting the Australian Government Department of Health’s Mental Health Division to curate, analyse and report on mental health-related activity data on a weekly basis. Data reported included use of Medicare Benefit Schedule mental health services, Australian Government funded help lines (e.g. Lifeline, Beyond Blue and Kids Helpline) and headspace, and information on suspected deaths by suicide from a number of jurisdictions. These data provided valuable information on the effects of the COVID-19 pandemic and the consequent physical distancing measures on mental health-related activity in Australia. The data were reported within government, including to the states and territories via the Departments of Health and Prime Minister and Cabinet to inform the mental health response to the COVID-19 pandemic.
Throughout 2021, this reporting has continued on a fortnightly basis. The data are provided to the Prime Minister’s Office, the Minister for Health and Aged Care, the Assistant Minister to the Prime Minister for Mental Health and Suicide Prevention, and the National Suicide Prevention Advisor. Selected data are also provided to state and territory health departments.
For more information see Mental health services in Australia.
State and territory health departments have also been monitoring the use of public mental health services during the COVID-19 pandemic. To enhance governments’ ability to monitor the impact of the pandemic across the whole mental health system, the AIHW has come to data sharing arrangements with Victoria and New South Wales, whereby the AIHW provides detailed local level data on the use of Australian government funded services (mental health-related Medicare Benefit Schedule mental health-related items and contacts to crisis and support organisations) and Victoria and New South Wales provide the AIHW with local data on mental health activity in public health services (including emergency departments, admitted specialised mental health units, and community specialised mental health services). The AIHW is seeking interest from other jurisdictions in joining these data sharing arrangements and is working with Queensland and Western Australia to facilitate their involvement.
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