Data development activities
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 and South Australia launched a register in January 2022.
During the COVID-19 pandemic, the AIHW partnered with several register data custodians to obtain up-to-date data on suicides across the jurisdictions. The AIHW has been receiving data on suspected suicide deaths since April 2020. The AIHW subsequently reports the data to government on a weekly basis in 2020, fortnightly basis in 2021, and monthly basis in 2022. The data is used to inform governments' decision making and response to the pandemic (visit Regular updates to Government on Mental health-related service use). Due to the highly sensitive nature of coronial investigations, the AIHW will not publicly release jurisdictional data unless they have been published by the relevant data custodians (visit Suspected deaths by suicide).
A key aim of the National Suicide and Self-harm Monitoring Project is for suicide registers to exist in all Australian jurisdictions. The AIHW has been 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 their jurisdiction. The South Australian government launched their Suicide Registry in January 2022 with funding from the AIHW. Detailed planning with the Australian Capital Territory is continuing for a register to be launched in 2022.
National ambulance data
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) 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 has been 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 results of the National Ambulance Surveillance System (1- month per quarter snapshots 2018 to 2021) from New South Wales, Victoria, Tasmania and the Australian Capital Territory, and Queensland from March 2020 to March 2021. AIHW began receiving monthly data for NSW, Vic, Qld, Tas and the ACT from January 2021 (see Ambulance attendances: suicidal & self-harm behaviours for further information). Monthly data are also presented for Victoria for 2021 and comparator years 2018, 2019 and 2020 (see COVID-19).
Emergency Department (ED) data
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 Strategic Committee for National Health Information (SCHNI) 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 SCHNI aims to develop a national ED data collection that is capable of identifying the external events contributing to an injury which has caused a person to present to an ED. These external events include information relating to suicide attempts.
Embedding of psychosocial risk factors in the National Mortality Database
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 and 2020 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 2021 data is underway.
Linked data assets are built by matching records from multiple datasets together by a common entity such as a person or business. They provide valuable sources of information for the analysis of health and welfare issues while also maintaining the privacy of the individual.
The AIHW has used the ABS Multi-Agency Data Integration Project (MADIP) to analyse the relationship between socioeconomic factors and deaths by suicide in Australia, including whether educational attainment, employment status, household composition or income are associated with deaths by suicide. Analyses are reported on Social and economic factors and deaths by suicide.
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 into 2021. The final evaluation report shall be published in 2022 and evaluation findings shall inform future quality improvements of the System.
Collaboration with the Australian National University
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. Surveys were undertaken in April, May, August and November 2020, January, April, July and October 2021 and January 2022, with funding from the AIHW for the May and November 2020 and August 2021 surveys. This dataset will allow for comparisons of outcomes with those of previous and future data collections throughout 2019, 2020, 2021 and 2022 (see COVID-19).
Collaboration with the University of Melbourne on the effect of COVID-19 on risk factors for suicide
The AIHW 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 used data from the Victorian, Queensland and Tasmanian suicide registers. An Expert Advisory Group was established and ethics approval received. The University of Melbourne prepared policy briefings as findings became available and a final written report Patterns of suicide in the context of COVID-19: Evidence from three Australian states has been published.
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 continued on a fortnightly basis and monthly as of 2022. 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.
Commonwealth and State data sharing arrangements
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.