Ambulance attendances, self-harm behaviours & mental health

This, the first delivery of coded ambulance attendance data, includes 1-month per quarter snapshots from Victoria (Vic), Tasmania (Tas) and the Australian Capital Territory (ACT) for 2019, and from the second quarter of 2019 for New South Wales (NSW).

See About to learn more about the ongoing developments relating to ambulance attendance data funded through this project. Data from other participating jurisdictions will be available over the remainder of 2020 and 2021, with monthly data for all jurisdictions available from mid-2021.

How many attendances for self-harm and mental health?

In 2019:

  • ambulances attended a total of around 10,300 incidents involving suicidal behaviours (suicidal ideation, suicide attempt, death by suicide) in Victoria, Tasmania and the Australian Capital Territory during the months of March, June, September and December
    • 89% of which occurred in Victoria, in line with the population distribution between those jurisdictions.
  • ambulances attended a further 8,100 incidents in NSW during June, September and December
  • together these 4 jurisdictions account for 62% of the Australian population.

Taking into consideration the population differences of the 3 jurisdictions that provided data for all 4 quarters of 2019, the rate of ambulance attendances for suicidal ideation (thinking about killing oneself without acting on the thoughts (Klonsky et al. 2016) ranged from:

  • 84.6 per 100,000 population in Victoria (nearly 5,600 attendances) to 51.8 in Tasmania (about 280 attendances) with the ACT reporting a rate of 80.6 (about 340 attendances) (Supplementary table NASS S.1).

Attendance rates for suicide attempts (non-fatal intentional injury with suicidal intent, regardless of likelihood of lethality (Klonsky et al. 2016) by comparison, were lower than ideation in all 3 jurisdictions. Rates of attendances for suicide attempts ranged from:

  • 64.0 per 100,000 population in the ACT (about 270 attendances) down to 40.1 in Tasmania (about 210 attendances), with Victoria reporting a rate of 53.5 (over 3,500 attendances).

For comparison, the most recent ABS Causes of Death release reports the age-standardised death rate for death by suicide over the period 2014–2018 as being 10.1 per 100,000 for Victoria, 15.4 per 100,000 for Tasmania and 10.7 for the ACT (ABS 2019). The numbers of ambulance attendances for suicide attempts for the 3 months in 2019 in each of these three jurisdictions are substantially higher than the number of deaths by suicide for the entire 12 months in 2018. See Suicide deaths by states and territories.

Ambulances do not attend all deaths therefore fatal suicide (fatal intentional injury with suicidal intent; Klonsky et al. 2016) is under-represented. Rates of deaths by suicide have not been calculated because of small numbers, affecting the reliability of the estimates (see Technical notes for details).

Ambulance attendances for self-injury were the least common among the self-harm and mental health related incidents, likely in part, reflecting differences in the method of harm. In 2019:

  • ambulances in Victoria, Tasmania and the ACT attended a total of around 1,400 incidents involving self-injury during the months of March, June, September, December; 87% of which occurred in Victoria
  • around another 1,400 self-injury related ambulance attendances were recorded in NSW during June, September and December.

Self-injury related ambulance attendances may include a small number of suicidal behaviour attendances (see Technical notes for definitions).

In 2019, the rate of ambulance attendances for self-injury ranged from:

  • 27.0 per 100,000 population in the ACT (nearly 120 attendances) down to 12.5 in Tasmania (nearly 70 attendances), with Victoria reporting a rate of 18.3 (over 1,200 attendances) (Supplementary table NASS S.1).

Mental health related ambulance attendances are classified by the presence of a mental health symptom preceding (24 hours) or during the ambulance attendance. See Technical notes for definition.

During a mental health related attendance if there is evidence of self-harm (suicidal ideation, suicide attempt, death by suicide or self-injury) the co-occurrence of these symptoms and behaviours are recorded. The following data report only mental health incidents, some of which will have co-occurring self-harm behaviours.

In 2019:

  • ambulances attended around 12,000 mental health related incidents in Victoria, Tasmania and the Australian Capital Territory, with the majority occurring in the more populated state of Victoria (88%)
  • another 11,700 attendances occurred in NSW during June, September and December.

In 2019, the rate of mental health related ambulance attendances ranged from:

  • 160.0 per 100,000 population in Victoria (nearly 10,600 attendances) down to 135.1 in Tasmania (around 720 attendances); the ACT recorded a rate similar to Victoria (158.4; nearly 680 attendances) (Supplementary table NASS S.1).

Age and sex patterns

There are distinct differences between the sexes when examining deaths by suicide and intentional self-harm hospitalisations; higher rates of deaths by suicide are seen in males compared with females (see Deaths by suicide over time) while females have higher rates of hospitalisations for intentional self-harm—with and without suicidal intent (see Intentional self-harm hospitalisations. Ambulance attendances capture intent (see Technical notes on evidence) and therefore can provide information on the extent of these behaviours in the community.

In general:

  • rates of ambulance attendances for suicide attempt and self-injury were higher for females than males.
  • attendance rates for suicidal ideation and mental health showed less variation between the sexes.

The interactive data visualisation shows ambulance attendances for males and females by each attendance type and for each of the four states and territories. See how ambulance attendance types vary between the sexes.

Ambulance attendances for self-harm behaviours and mental health, by age and sex, selected states and territories, 2019.

The vertical bar graph shows the crude rate of ambulance attendances for suicidal ideation, suicide attempt, self-injury and mental health for males and females in Victoria for the combined quarterly snapshot months in 2019. Users can also choose to view crude rates and numbers of attendances for New South Wales, Tasmania or the Australian Capital Territory for all or selected self-harm behaviours and mental health. Across the 2019 snapshot months in Victoria, the highest crude rates of ambulance attendances for males and females were for mental health, at around 160 attendances per 100,000 population, followed by suicidal ideation, suicide attempt and self-injury. Crude rates for attendances for self-injury were around 14 for males and around 22 for females.

Rates of ambulance attendances for suicide attempt and self-injury were between 1.5 and 2.1 times higher for females than males. Ambulance attendance rates for females involving a suicide attempt were:

  • 85.3 per 100,000 population in the ACT, 64.6 in Victoria and 46.7 in Tasmania.

By contrast, the corresponding rates in males were:

  • 40.8 per 100,000 population, 41.0 and 32.1, respectively.

Attendance rates for both males and females were highest for incidents relating to mental health. Rates ranged from:

  • for females—192.3 per 100,000 population (about 420 attendances) in the ACT, and 144.1 in Tasmania (about 390 attendances) with Victoria reporting a rate of 161.8 (around 5,400 attendances).
  • for males—156.8 per 100,000 population in Victoria down to 121.8 in the ACT.

Age and sex variation

The interactive data visualisation illustrates the distribution of self-harm and mental health related ambulance attendances for both males and females by age. For this visualisation, ambulance attendance data from 2019 in NSW, Victoria, Tasmania and the ACT have been combined.

In general, there were higher numbers of attendances in the younger age groups for both males and females for incidents involving:

  • suicidal ideation and suicide attempts, in particular, ages 15–19 (about 930 and 800 attendances for females, respectively; around 740 and 310 attendances for males, respectively) and 20–24 years (Supplementary table NASS S.2). 

By contrast, mental health related attendances for males were more common in older age groups spanning 25–39 years while those for females tended to be younger (15–29):

  • for males the highest number of attendances in 2019 was over 1,300 involving males aged 25–29 years
  • for females the highest number of attendances was in the 20–24 age group (over 1,300 attendances).

Due to the low number of ambulance attendances for deaths by suicide these data cannot be reported by age and sex.

Ambulance attendances for self-harm behaviours and mental health, by age group and sex, selected states and territories, 2019.

The butterfly chart shows the distribution of the number of ambulance attendances for suicide attempts by age group for males and females for quarterly snapshot data collected in Victoria, Tasmania and the Australian Capital Territory in March, June, September and December 2019 and in New South Wales in June, September and December 2019. Users can also choose to view ambulance attendance numbers by age group for suicidal ideation, self-injury and mental health. The number of attendances for suicide attempts generally decreased with increasing age group from 15–19 for both males and females.  Females aged 15–19 had the highest number of ambulance attendances for suicide attempts, 793 attendances across the snapshot months for the selected states and territories.

References

ABS (Australian Bureau of Statistics) 2019. 3303.0–Causes of Death, Australia, 2018. Viewed 24–08–2020.

Klonsky ED, May AM, Saffer BY 2016. Suicide, Suicide Attempts, and Suicidal Ideation. Ann Rev Clin Psychol. 12:307–30.

Lubman DI, Heilbronn C, Ogeil RP, Killian JJ, Matthews S, Smith K, et al. 2020. National Ambulance Surveillance System: A novel method using coded Australian ambulance clinical records to monitor self-harm and mental health-related morbidity. PLoS ONE 15(7): e0236344.