Suicide and suicidality in Australian Defence Force veterans: A systematic scoping review.

OBJECTIVE: Increased suicidality and suicide deaths among veterans of the Australian Defence Force have gained recent prominence. A systematic scoping review was conducted to identify, summarise and synthesise the existing literature relating to Australian veteran suicide and suicidality, with the objective of identifying future research priorities. METHODS: We conducted a PRISMA-compliant systematic search on PubMed/MEDLINE, Embase and CINAHL databases for all manuscripts reporting primary data on suicide and suicidality in Australian veterans. The search was supplemented by grey literature and a search of reference lists. Manuscripts of any study type, published in the English language since the Vietnam era, were eligible for inclusion. RESULTS: A total of 26 articles and reports, utilising a variety of mostly quantitative approaches, were included in the review. Findings, especially in larger and more recent studies, indicate increased suicidality in the veteran population. Suicide deaths appeared to increase with transition out of the military. Mental illness was identified as an important risk factor for suicide and suicidality. Current service was identified as a protective factor against suicide. There was mixed evidence regarding the impact of operational deployment on suicide and suicidality. CONCLUSIONS: Gaps were identified in relation to the relative contributions to risk from transition, the various psychosocial correlates (for example, relationships, finances, employment), pre-service factors and the extent to which these are causal or mediating in nature. A better understanding of health service utilisation would also aid in targeting preventive efforts. Future research in these areas is warranted.

A cohort profile of children and adolescents who had a suicide-related contact with police or paramedics in Queensland (Australia).

OBJECTIVE: Suicide is a leading cause of death in children and adolescents worldwide and a major public health concern. While suicidal behaviours place a significant demand on mental health and emergency services, data regarding suicide-related contacts with police and paramedics are an underutilised resource. The aim of the present study was to identify the demographic profile of young individuals (aged 5-17) and had a suicide-related contact with police or paramedics in Queensland (Australia). METHODS: The present study utilised a population-wide linked dataset, including data from police and paramedics and health administrative data, between 1 February 2013 and 31 January 2018. RESULTS: The identified cohort of 7929 children had a median age of 15 years and mainly comprised females (63.2%). Over the study period, 64 children died, most by suicide (76.6%). Less than a third of the cohort were responsible for almost two-thirds of the total number of contacts with police or paramedics. CONCLUSION: Findings provide a comprehensive profile of children and adolescents in suicidal crisis and highlight the substantial number of interactions that occur with police and paramedics. Due to the way the linked dataset was constructed, it must be assumed that the number of young persons in suicidal crisis is higher. Findings highlight the value of considering pre-hospital alternatives to presenting to emergency departments (EDs) for this cohort, to reduce impost on EDs and improve outcomes. Further examination of re-presentations by young persons is warranted to inform prevention and intervention strategies.

Persons with mental disorders and suicidality in crisis or high-risk situations involving police negotiation: a systematic review.

Police negotiators respond to crisis and high-risk situations including mental health crises, but little is known about the nature, frequency and characteristics of these events. This systematic review examined literature about mental disorder and suicidality prevalence in negotiation events from peer-reviewed articles published within the last 20 years. Of 1455 articles identified, 11 met study inclusion criteria. Most contributed only indirect evidence using data on fatal police encounters, case reviews and analysis of communication techniques. Reliable prevalence estimates were not found, though findings suggest suicidality was a precipitating factor in more than half of events and was present during most events. Mental disorder (primarily substance use, mood and psychotic disorders) was also identified as a significant factor prior to and during events. Few articles described frequency or characteristics of these critical events. Further research is needed to inform frontline responses, resourcing and support pathways for police providing this crucial service.

Our Ways, Your Ways, Both Ways - a multi-disciplinary collaboration to develop, embed and evaluate a model of social and emotional wellbeing care for Aboriginal and Torres Strait Islander young people who experience detention - Phase 1.

The National Strategic Framework for Aboriginal and Torres Strait Islander Peoples' Mental Health and Social and Emotional Wellbeing identifies building a strong Aboriginal and Torres Strait Islander led evidence-base to inform care as a key priority. Aboriginal and/or Torres Strait Islander adolescents in contact with the criminal justice system are a highly vulnerable group of Australians, with substantial unmet needs. There is limited evidence to inform culturally appropriate models of care that meet the social and emotional wellbeing needs of justice-involved Aboriginal and/or Torres Strait Islander adolescents. This project aims to develop, implement and evaluate an in-reach and community transitional model of social and emotional wellbeing care for Aboriginal and/or Torres Strait Islander adolescents (10-17 years old) who experience detention through close engagement with Aboriginal and/or Torres Strait Islander youth, Elders, researchers, practitioners and community members, and by drawing on culturally informed practice and knowledge systems. The project is based on a multi-level mixed methods design, with a strong focus on ongoing project evaluation (based on the Ngaa-bi-nya framework) and co-design. Co-design is facilitated through culturally safe and trauma informed participatory processes based on development of strong partnerships from project initiative, design, implementation and evaluation. Application of the landscape domain of the Ngaa-bi-nya framework for Aboriginal and Torres Strait Islander program evaluation will be explored in Phase one. Aboriginal and Torres Strait Islander adolescents with experience in detention will be engaged through one-on-one interviews with data collection through the Growth and Empowerment Measure (GEM) Youth (which will be adapted from the adult version and validated as part of this study), the Kessler Psychological Distress Scale (K-10), questions around alcohol and drug use, and narrative interviews exploring experience. Qualitative data will be analyzed using an inductive thematic approach, structured within the framework of the Ngaa-bi-nya landscape prompts. Quantitative data will be analyzed using descriptive statistics to provide a profile of the cohort. Findings from Phase one will be used to inform the development of a model of social and emotional wellbeing care that will be implemented and evaluated in Phase two.

Australian Defence Force Centre for Mental Health Second Opinion Clinic - first ten years of operation.

OBJECTIVES: The aim is to report the operation of the Australian Defence Force Centre for Mental Health (ADFCMH) Second Opinion Clinic (SOC) after its first 10 years of operation. METHOD: Demographic data and clinical data were recorded and analysed for all Australian Defence Force (ADF) personnel (n=209) seen at the clinic from 2011 to 2021. RESULTS: Assessment at the clinic led to a change in diagnosis from that given at the time of referral in 40.7% (n=85) of members seen. Of the total members assessed at the SOC, 55.9% (n=117) had been on an at least one operational deployment. Mood disorders were the most common mental disorders seen among personnel at the SOC. CONCLUSIONS: The ADFCMH SOC is a valuable clinical resource supporting ADF health services nationally and provides an example of an effective mental health tertiary referral service.

Measuring recovery-oriented rehabilitation language in clinical documentation to enhance recovery-oriented practice.

BACKGROUND: Mental health services are encouraged to use language consistent with principles of recovery-oriented practice. This study presents a novel approach for identifying whether clinical documentation contains recovery-oriented rehabilitation language, and evaluates an intervention to improve the language used within a community-based rehabilitation team. AIMS: This is a pilot study of training to enhance recovery-oriented rehabilitation language written in care review summaries, as measured through a text-based analysis of language used in mental health clinical documentation. METHOD: Eleven case managers participated in a programme that included instruction in recovery-oriented rehabilitation principles. Outcomes were measured with automated textual analysis of clinical documentation, using a custom-built dictionary of rehabilitation-consistent, person-centred and pejorative terms. Automated analyses were run on Konstanz Information Miner (KNIME), an open-source data analytics platform. Differences in the frequency of term categories in 50 pre-training and 77 post-training documents were analysed with inferential statistics. RESULTS: The average percentage of sentences with recovery-oriented rehabilitation terms increased from 37% before the intervention to 48% afterward, a relative increase of 28% (P < 0.001). There was no significant change in use of person-centred or pejorative terms, possibly because of a relatively high frequency of person-centred language (22% of sentences) and low use of pejorative language (2.3% of sentences) at baseline. CONCLUSIONS: This computer-driven textual analysis method identified improvements in recovery-oriented rehabilitation language following training. Our study suggests that brief interventions can affect the language of clinical documentation, and that automated text-analysis may represent a promising approach for rapidly assessing recovery-oriented rehabilitation language in mental health services.

Substance use disorder screening and brief intervention in routine clinical practice in specialist adult mental health services: A systematic review.

BACKGROUND AND OBJECTIVES: Substance use disorders co-occurring with other mental health disorders are common and harmful. Clinical guidelines often recommend substance use screening and brief intervention though evidence about screening practice in mental health services is limited. This systematic review of routine clinical practice in adult mental health services aims to identify (a) proportions of screening and brief intervention, (b) how they are practised and (c) their outcomes. METHODS: We searched MEDLINE, PsycINFO and Embase and relevant Cochrane databases for articles until 31 July 2021 reporting on adults in English, regardless of geographical location. Backward snowball methods were used to locate additional articles. Screening, brief intervention and mental health services were defined. Data were extracted and variables compared related to setting, period, patient cohort, substances routine substance use disorder care pathways, and study quality was assessed. RESULTS: We identified 17 articles reporting routine screening within adult mental health services. Studies in community settings mainly reported on screening for alcohol and other substance use disorders, while studies from inpatient settings reported mainly on tobacco. There was marked variation in methods and screening proportions. Only two studies reported on brief intervention. CONCLUSION: This systematic review shows marked variation in mental health services routine screening practices with early focus on alcohol but more recently tobacco screening. We suggest approaches to enhancing implementation of screening and brief intervention in routine care, particularly using electronic health records.

Suicide crises among women and mothers during and around the time of pregnancy: Prevalence and timing of initial contact with first responders and health services.

OBJECTIVES: Suicide is a leading cause of maternal mortality. Suicidality during and around the time of pregnancy can have detrimental impacts on a child's development and outcomes. This paper examines prevalence, demographic characteristics, and timing of initial contact with first responders and health services for a cohort of women who experienced suicidality during and around the time of pregnancy. METHODS: Findings are drawn from the Partners in Prevention (PiP) study, a population-wide linked data set of suicide-related attendances by police or paramedics in Queensland, Australia. A sub-cohort of women was identified, who were between 6 months preconception and 2 years postpartum at the time of a suicide-related contact with police or paramedics (PiP-Maternal). Findings are compared to other girls and women who had a suicide-related contact with police or paramedics (PiP-Female). Prevalence, demographic characteristics, timing of contact with first responders and health services, re-presentations, and mortality are reported. RESULTS: The PiP-Maternal cohort comprised 3020 individuals and 3400 births. Women in the PiP-Maternal cohort were younger, more likely to be of Aboriginal and/or Torres Strait Islander descent and live outside of a major city than the PiP-Female cohort. There were high rates of out-of-hours calls to police and ambulance, and similar perceived seriousness of the call between women in the PiP-Maternal and PiP-Female cohorts. Women in the PiP-Maternal cohort were less likely to be admitted to an emergency department within 24 hours, even after matching on covariates. Prevalence of suicidality for women who were pregnant and up to 2 years postpartum was 1.32% (95% CI = [1.27, 1.37]). CONCLUSION: Vulnerabilities and high rates of contact with police or paramedics, coupled with lower levels of follow-up, highlight the critical need to improve service responses for women with mental health needs during these phases of life.

Staff Experiences of Integrating Peer Support Workers and Clinical Staff in Community-Based Residential Mental Health Rehabilitation: A Pragmatic Grounded Theory Analysis.

Mental health services are increasingly incorporating the views and expertise of people with a lived experience of mental illness in service delivery. A novel approach to this is the 'integrated staffing model' being trialled at two Australian public residential mental health rehabilitation services (Community Care Units, CCUs) where peer support workers (PSWs) occupy the majority of staff roles and work alongside clinicians. Semi-structured interviews were completed with fifteen staff 12-to-18-months after service commencement. Transcripts were analysed following principles of grounded theory analysis. Key emergent themes were: (1) recovery is a deeply personal and non-linear process; (2) The CCU as a transitional learning environment; (3) the integrated staffing model facilitates an effective rehabilitation team; and (4) coming together under the integrated staffing model required a steep learning curve. The findings suggest that the integrated staffing approach may provide a pathway to facilitate the meaningful inclusion of PSWs in rehabilitation settings.

Understanding and enhancing responses to distress in the construction industry: protocol for a data linkage study.

INTRODUCTION: Past research has shown that construction industry workers are at an elevated risk of suicide, however, to date, no study has examined in detail the characteristics of individuals who work in the construction industry and experience distress. This research aims to understand the characteristics, including sociodemographic characteristics, health services utilisation and contacts with non-clinical services, of individuals working within the construction industry and who experience distress, and to quantify the costs and benefits of different help-seeking pathways. METHODS AND ANALYSIS: This study is a data linkage study, based on routinely collected administrative data from construction industry organisations and Queensland Health (QH). Expected outcomes include prevalence of distress, articulated to non-clinical construction industry agencies, descriptive findings on characteristics and help-seeking pathways and health economic analysis. Individuals who experienced distress but who did not contact any of the participating construction industry organisations will not be part of this research. ETHICS AND DISSEMINATION: This data linkage study was approved by Human Research Ethics Committee of The University of Queensland (2021/HE001885). Findings will be presented descriptively to describe the cohort as a whole and stratified by key demographic characteristics, and to provide estimates of prevalence of distress, including timing, frequency and type of contacts. In addition, health economic analysis will be undertaken. Dissemination of findings will be undertaken following consultation of all project investigators, construction industry organisations and peer-led interest groups and lived-experience organisations to ensure translation merit of all findings. Results will be published as peer-reviewed journal articles and publicly available reports.

Optimal Care Pathways for People in Suicidal Crisis Who Interact with First Responders: A Scoping Review.

BACKGROUND: First responders play a vital role in attending to people in suicidal crisis and influencing their care. AIMS: To examine existing care pathways and models of care that could be used for people in a suicidal crisis who have come to the attention of first responders. METHODS: A scoping review of academic and grey literature published between 2009 and 2019 was conducted, supplemented by consultation with experts, service providers and people with lived experience. RESULTS: The search identified 703 studies. Twenty-three peer reviewed and grey literature articles, as well as one personal communication, were considered eligible for inclusion. Six models, covering 22 programs, were identified. No studies were identified that described care pathways, per se. Co-responder and safe haven models were associated with reduced hospital use and police detentions. Aftercare models were associated with improved well-being and reduction in symptoms. Co-responder, safe haven, and aftercare models were all rated positively by service users. No studies measured the impact on longer term suicidality. LIMITATIONS: Inclusion criteria were broad resulting in heterogeneity of studies and designs, limiting comparisons. Few studies employed standardised measurement protocols, reducing the ability to draw sound conclusions. CONCLUSION: Several novel programs have the potential to support individuals in crisis who encounter first responders.

Suicide crisis calls to emergency services: Cohort profile and findings from a data linkage study in Queensland, Australia.

BACKGROUND AND AIMS: Police and paramedics play a crucial role in responding to suicide crises in the community. However, little is known about the nature, extent, precipitating factors, pathways and outcomes of a suicide-related call to emergency services and what responses will most effectively and compassionately meet the needs of those in crisis. Partners in Prevention: Understanding and Enhancing First Responses to Suicide Crisis Situations (PiP) was established to address these knowledge gaps. METHODS: This article describes (1) the methodology used to construct the PiP dataset, a population-wide linked dataset that investigates the characteristics and health pathways of individuals in Queensland who were the subject of a suicide-related call to police or paramedics; and (2) preliminary findings on service demand, demographics and health services utilisation. RESULTS: We identified 219,164 suicide-related calls to Queensland Police Service or Queensland Ambulance Service that were made over the 3-year period 1 February 2014 to 31 January 2017. A total of 70,893 individuals were identifiable via records linkage. The cohort linked to more than 7,000,000 health records. We estimated that police or paramedics in Queensland received on average 209 calls per day, with increases year on year over the study period. Analysis of demographic data highlighted the heterogeneous nature of this cohort and important demographic variations between individuals in contact with police versus ambulance services. DISCUSSION: The PiP dataset provides a strong foundation for a multi-modal dataset that can be built on over time, both cross-sectionally and longitudinally. Further linkages to Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and social care datasets are planned. CONCLUSION: Detailed population-level analysis that data linkage can provide is critical to improving understanding and responses to suicide crisis situations. The PiP study is a world first and provides a unique opportunity to improve responses to this public health problem.

The Acceptability and Effectiveness of Videos Promoting Smoking Cessation Among Australians Experiencing Mental Illness.

There are high rates of tobacco smoking among people who experience mental illness (MI). While videos are an effective method of disseminating health-related information, there is limited research investigating the effectiveness of video-delivered education promoting smoking cessation among people living with MI. This formative study aimed to investigate the effectiveness and acceptability of targeted video resources providing smoking cessation information and advice to smokers with MI. This study used a mixed-method design; 29 Australian smokers living with MI completed a preinterview survey including 12 questions assessing knowledge about smoking cessation, watched six videos developed by the research team providing information about smoking cessation, took part in semistructured interviews about the videos' quality, content, and format, and then completed a postinterview survey identical to the preinterview survey to assess changes in smoking cessation-related knowledge. A Wilcoxon signed rank test was used to calculate changes in cessation-related knowledge, and thematic analysis was used to identify common themes in qualitative data. We found a statistically significant increase in participants' smoking cessation-related knowledge scores after watching the videos. Participants indicated an overall high level of acceptability of the videos' quality, content, and format, and findings from the semistructured interviews reflected these favorable views. This study's findings provide a new understanding of the effectiveness and acceptability of customized video-based education to promote smoking cessation among people living with MI, and can be used to inform the content and focus of video resources aimed at increasing knowledge about smoking cessation for people experiencing MI.

Comorbidity between mood and substance-related disorders: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Evidence indicates that mood disorders often co-occur with substance-related disorders. However, pooling comorbidity estimates can be challenging due to heterogeneity in diagnostic criteria and in the overall study design. The aim of this study was to systematically review and, where appropriate, meta-analyse estimates related to the pairwise comorbidity between mood disorders and substance-related disorders, after sorting these estimates by various study designs. METHODS: We searched PubMed (MEDLINE), Embase, CINAHL and Web of Science for publications between 1980 and 2017 regardless of geographical location and language. We meta-analysed estimates from original articles in 4 broadly defined mood and 35 substance-related disorders. RESULTS: After multiple eligibility steps, we included 120 studies for quantitative analysis. In general, regardless of variations in diagnosis type, temporal order or use of adjustments, there was substantial comorbidity between mood and substance-related disorders. We found a sixfold elevated risk between broadly defined mood disorder and drug dependence (odds ratio = 5.7) and fivefold risk between depression and cannabis dependence (odds ratio = 4.9) while the highest pooled estimate, based on period prevalence risk, was found between broadly defined dysthymic disorder and drug dependence (odds ratio = 11.3). Based on 56 separate meta-analyses, all pooled odds ratios were above 1, and 46 were significantly greater than 1 (i.e. the 95% confidence intervals did not include 1). CONCLUSION: This review found robust and consistent evidence of an increased risk of comorbidity between many combinations of mood and substance-related disorders. We also identified a number of under-researched mood and substance-related disorders, suitable for future scrutiny. This review reinforces the need for clinicians to remain vigilant in order to promptly identify and treat these common types of comorbidity.

The MATES Case Management Model: Presenting Problems and Referral Pathways for a Novel Peer-Led Approach to Addressing Suicide in the Construction Industry.

MATES in Construction (MATES) is a multimodal, peer-led, workplace suicide prevention and early intervention program developed to reduce the risk of suicide among construction industry workers through active facilitation of appropriate support. The MATES case management model provides an example of a nonclinical service for meeting the needs of individuals in the construction industry who, while at elevated risk of mental health problems and suicidality, are traditionally less likely to seek help. The aim of this research was to conduct an evaluation of the MATES case management database to quantify service demand, and to examine the demographic, occupational profile, presenting issues, referral pathways, and perceived benefit of case management among individuals who used this service. The research reports on routinely collected data from the Queensland MATES case management database, which contains records on 3759 individuals collected over the period 2010-2018, and findings from a small and opportunistic exit survey undertaken with 14 clients in 2019. Overall, findings suggest that the demand for case management through MATES has increased significantly and that clients felt that their needs and concerns were appropriately addressed. The most common presenting issues were relationship, work, and family problems, suicide, and mental health concerns. Findings confirm that causes of distress extend beyond the realm of mental disorder and span a range of psychosocial issues. Significantly, it offers an approach that may divert individuals in crisis away from presenting to over-run emergency departments, and towards services that are more equipped to meet their individual needs.

Suicidal behaviours in the peripartum period: a systematic scoping review of data linkage studies.

The purpose of this scoping review was to summarize research that uses linked data to examine peripartum suicidal behaviours and critically appraise studies to identify evidence gaps and future research priorities. A systematic search of PubMed, Scopus, and grey literature was undertaken to identify data linkage studies that examined suicidal behaviours among women in the peripartum period. All articles available through PubMed and Scopus up until the search date of 26 September 2019 were deemed eligible for inclusion. A grey literature search was also undertaken, through the Google search engine, on 11 November 2019. Studies were analysed descriptively and synthesized qualitatively. Eighteen studies were identified that met inclusion criteria. All studies examined the incidence of suicidal behaviours. Twelve studies examined sociodemographic correlates, associations, or risk factors, and nine studies examined mental health. There was a high degree of variability regarding how both peripartum status and suicidal behaviours were defined. Few studies used data linkage to examine suicidal behaviours from a health services or social services perspective. The evidence base could benefit from conceptual clarity and standardization of constructs regarding suicidal behaviours in the peripartum period, to enable meaningful synthesis of results across studies. Data linkage can be used to improve understandings of risk factors and pathways. It can also be harnessed to examine both health and social services utilization, to inform coordinated multi-sectoral interventions and care pathways for women and their children.

Consumer experiences of community-based residential mental health rehabilitation for severe and persistent mental illness: A pragmatic grounded theory analysis.

Semi-structured interviews were used to explore the consumer experience of community-based residential mental health rehabilitation support at Community Care Units in Australia. These clinical services provide recovery-oriented residential rehabilitation to people affected by severe and persistent mental illness. Typically, nurses occupy the majority of staff roles. However, two of the three sites in the study were trialling a novel integrated staffing model where the majority of staff were people with a lived experience of mental illness employed as peer support workers (PSWs). The interviews explored consumers' experiences of care 12-18 months after admission. Fifteen interviews were completed with an independent interviewer. Most participants were diagnosed with schizophrenia or a related psychotic disorder. The analysis followed a pragmatic approach to grounded theory. Consumers viewed the CCU favourably, emphasizing the value of the relationships formed with staff and co-residents. No major differences in consumers' experience under the traditional versus integrated staffing models were identified; however, those from the integrated staffing model sites valued the contributions of the peer support workers. The understanding of the consumer experience emerging through this study aligned with their expectations of the service at the time of commencement.

Substance use and help-seeking among justice-involved young people in Queensland and Western Australia: A cross-sectional survey of 14-17-year-olds.

INTRODUCTION: This study investigated substance use and help-seeking among justice-involved young people to inform and improve service provision during and after contact with the justice system. METHODS: Young people (14-17 years) in the community with current or prior contact with the justice system were recruited in Queensland and Western Australia, Australia using purposive sampling between 2016 and 2018. A cross-sectional survey was delivered by computer-assisted telephone interview. Information was collected on sociodemographic and health factors; lifetime and frequency of use of alcohol, tobacco and other drugs; and use of health services related to substance use and mental health. RESULTS: Of the 465 justice-involved young people surveyed, most had used alcohol (89%), tobacco (86%) or other drugs (81%). Of the latter, cannabis use was most prevalent (79%), followed by ecstasy (26%) and amphetamine (22%). Young people engaging in higher risk drug use (daily use, injecting use) were more likely to also have an alcohol use disorder, be disengaged from education, unemployed, have attempted suicide and experienced incarceration. Of the cohort, 24% had received treatment at an alcohol and drug service in the past year and 30% had seen a health professional about emotional/behavioural problems. Males and Aboriginal and Torres Strait Islander young people were less likely to have sought professional help. CONCLUSION: The high levels of substance use and disproportionate levels of help-seeking observed in this study illustrate the importance of delivering tailored, comprehensive and coordinated trauma-informed and culturally safe alcohol and drug services to justice-involved young people.

Examining the Use of Police and Ambulance Data in Suicide Research.

Background: Police and paramedics are often the first to respond to individuals in suicide crisis and have an important role to play in facilitating optimal care pathways. Yet, little evidence exists to inform these responses. Data linkage provides one approach to examining this knowledge gap. Aim: We identified studies that examined suicide behaviors and linked to police or ambulance data. Method: A systematic search of PubMed and Scopus was undertaken to identify data linkage studies that: (1) examined suicide behaviors, and (2) included police or ambulance data. Studies were reviewed to identify: aims; suicide behaviors examined; how these were measured; how the cohort was defined; topic area; and what datasets were linked. Results: Eight studies met the inclusion criteria. Six studies included police data, and two studies included ambulance data. No study included both. Two topic areas were identified: (1) suicide-related contact with police or ambulance services; and (2) associations between suicidal behaviors and violence, victimization, and criminality. Limitations: Limitations to the review include the potential to have missed studies that investigated or reported on suicidality under the guise of mental health problems; complexities and nuances arising from the role of police data in coronial investigations; and limitations in the number of databases searched. Conclusion: Police and ambulance data represent a currently underutilized source of valuable information relevant to suicide crises, and further research should aim to address this gap.

The sexual behaviours of adolescents aged between 14 and 17 years involved with the juvenile justice system in Australia: A community-based survey.

OBJECTIVES: To overcome key knowledge gaps in relation to justice involved and vulnerable young people and their sexual health and to compare this group with their peers from other youth health surveys in Australia to determine the extent of the issues. METHODS: Young people, aged between 14 and 17 years, who had ever been or were currently involved with the criminal justice system were purposively sampled. The survey was anonymous and delivered using Computer Assisted Telephone Interview (CATI). RESULTS: A total of 465 justice involved MeH-JOSH young people, aged between 14 and 17 years, participated in the study: 44% Aboriginal and/or Torres Strait Islander (Indigenous) and 37% not attending school. Of the total valid responses, 76% (n = 348) reported having ever had sex, with sexual initiation at a median age of 14 years. We compared these data with their peers in other Australian surveys and found that young people in our study had a higher engagement in sex and start having sex at a younger age, reporting more sexual partners at all ages. CONCLUSIONS: The sexual behaviours of young people involved in the justice system in this study suggest they may be at a greater risk for sexually transmissible infections than their age-matched peers in the general population. Policymakers should elevate them to a priority population for targeting sexual health services and health promotion.