A novel suicide surveillance system using ambulance data

In Australia, there were over 3000 suicide deaths in 2018, with suicide remaining the leading cause of death for those aged between 15-44 years. Although the human cost of suicide to family and friends is significant, the impact on community and society is also substantial. Suicide is estimated to cost the Australian economy over $550 million each year, and despite the Commonwealth government committing $50 million dollars to suicide prevention over the past decade, the numbers aren’t showing any significant decline.

Research has shown that the best predictor of suicide is a previous suicide attempt and deaths are really the ‘tip of the iceberg’. For each suicide, there are 11 hospitalisations for self-harm, and these too are on the increase. 

In order to develop effective national and international policy and public health responses, it is imperative that we have data systems that can identify potential points for intervention in a timely manner. 

The most common data source that is currently used to inform policy around suicide is coronial data, however this can take up to 3 years to become available, and, importantly, these systems do not capture the multiple suicidal attempts that also occur across the community, nor episodes of suicidal thinking that necessitates emergency care. Although hospital data can be used to identify presentations related to self-harm, it is limited in the information it can provide and there is also a significant time lag before it becomes available. 

In addition, while self-harm, mental health and alcohol and drug issues are known to be inter-related, measurement of these issues at the population level remains challenging. 

Interrogating routine information that paramedics record for every ambulance attendance offers a reliable and novel avenue for capturing information related to mental health and self-harm. Indeed, ambulance attendances for such presentations are common in many countries around the world, with paramedics frequently the first, and sometimes only, health professional to respond to acute mental health and self-harm presentations in the community. 

Just released in the international journal PLOS One, is Australian research describing the development of the National Ambulance Surveillance System, a novel and world-first public health monitoring system for mental health, self-harm, including suicidal behaviours, and alcohol and drug harms. 

This internationally unique surveillance system, a partnership between Turning Point, Monash University, and jurisdictional ambulance services across Australia, draws on the vital and life-saving work paramedics do every day responding to health emergencies in the community. Paramedics meticulously document the work they do, and this information is coded by Turning Point staff to provide rich data related to the context and pattern of self-harm, as well as related mental health and alcohol and drug harms.

At a population level, the National Ambulance Surveillance System provides a cost-efficient resource that can inform suicide prevention, as well as the effectiveness of changes in policy and practice. With future work focussing on utilising artificial intelligence (AI) to assist in screening, coding and analysis of data, funded through Google’s AI Impact Challenge, the National Ambulance Surveillance System is focused on ensuring critical data insights are able to reach policy makers in a more timely and comprehensive manner so as to inform the development of effective policy and public health responses.