Abstract
Self-harm and mental health are inter-related issues that substantially contribute to the global burden of disease. However, measurement of these issues at the population level is problematic. Statistics on suicide can be captured in national cause of death data collected as part of the coroner's review process, however, there is a significant time-lag in the availability of such data, and by definition, these sources do not include non-fatal incidents. Although survey, emergency department, and hospitalisation data present alternative information sources to measure self-harm, such data do not include the richness of information available at the point of incident. This paper describes the mental health and self-harm modules within the National Ambulance Surveillance System (NASS), a unique Australian system for monitoring and mapping mental health and self-harm. Data are sourced from paramedic electronic patient care records provided by Australian state and territory-based ambulance services. A team of specialised research assistants use a purpose-built system to manually scrutinise and code these records. Specific details of each incident are coded, including mental health symptoms and relevant risk indicators, as well as the type, intent, and method of self-harm. NASS provides almost 90 output variables related to self-harm (i.e., type of behaviour, self-injurious intent, and method) and mental health (e.g., mental health symptoms) in the 24 hours preceding each attendance, as well as demographics, temporal and geospatial characteristics, clinical outcomes, co-occurring substance use, and self-reported medical and psychiatric history. NASS provides internationally unique data on self-harm and mental health, with direct implications for translational research, public policy, and clinical practice. This methodology could be replicated in other countries with universal ambulance service provision to inform health policy and service planning.
Highlights
Each year suicide claims the lives of more than 800,000 people globally, with numbers increasing each year [1]
National Ambulance Surveillance System (NASS) provides unique and timely monitoring of acute self-harm and mental health morbidity and covers more than 90% of Australia’s population
NASS data have already been utilised as part of a major mental health initiative, Beyond the Emergency, to inform the development of low-cost mental health interventions that could be provided by ambulance services as well as core mental health training for paramedics [37]
Summary
Each year suicide claims the lives of more than 800,000 people globally, with numbers increasing each year [1]. In Australia, suicide is the leading cause of death for those aged from 15 to 44 years [2], costing the economy $551 million annually [3]. Despite the Australian government spending over $50 million on suicide prevention over the past decade [4], suicide rates have not declined [5]. For each suicide in Australia, there are 11 hospitalisations for intentional self-harm [6] (defined as deliberate self-injury regardless of the degree of suicidal intent [7]), and these presentations are increasing [8,9,10]. The World Health Organisation (WHO) has identified that monitoring morbidity-related harms as an indicator of progress towards suicide prevention is imperative [11]
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