BACKGROUND & AIMS:
BACKGROUND:Asylum seekers are at elevated risk of self-harm, and the personal and public health costs of self-harm are high; yet the monitoring and reporting of self-harm has been limited and lacking in transparency. This study aims to evaluate the quality of self-harm incident reporting across the Australian asylum seeker population, including by processing arrangements (i.e. community-based, community detention, onshore detention, Nauru, and Manus Island).
METHODS:All self-harm incidents reported across the entire Australian asylum seeker population between 1 August 2014 and 31 July 2015 were obtained via the Freedom of Information Act. We assessed the quality of self-harm incident reporting according to the World Health Organization (WHO)'s self-harm reporting guidelines.
RESULTS:A total of 949 self-harm incident reports were assessed. Date, location (processing arrangement), and time of self-harm were routinely reported. Gender was recorded in less than two thirds (62.1%) of all incidents. Method(s) used to self-harm was reported in 81.5% of all incidents, though IDC-10 codes were not reported in any episodes. Psychological or psychiatric assessments were recorded after 4.0% of all incidents, most frequently on Manus Island (10.9%), and in Nauru (10.0%), and least frequently in community-based arrangements (1.7%) and in onshore detention (1.4%), and not at all in community detention. Ambulances were reported as attending 2.8% of all episodes. Hospital attendances were reported following 6.0% of all self-harm incidents, with attendances most commonly reported in incidents occurring in community detention (30.3%), and in community-based arrangements (19.4%). Medevac (air ambulances) were recorded as being utilised in 0.4% of all incidents (2.1% of episodes on Nauru, 1.8% on Manus Island).
CONCLUSIONS:The findings of our study indicate that the accessibility and quality of self-harm data is substandard and inconsistent with WHO self-harm reporting guidelines. Such variable reporting makes the identification of self-harm trends, the implementation of prevention strategies - including those at a policy level - and the clinical management of self-harm, extremely challenging. Improved self-harm reporting and monitoring is urgently needed for mitigating and responding to self-harm risk among asylum seekers.
背景与目标:
背景:寻求庇护者的自我伤害风险较高,自我伤害的个人和公共卫生成本很高;然而,对自我伤害的监测和报告受到限制,并且缺乏透明度。这项研究旨在评估整个澳大利亚寻求庇护者群体中自我伤害事件报告的质量,包括通过处理安排(即基于社区的拘留,社区拘留,在岸拘留,瑙鲁和马努斯岛)。
方法:2014年8月1日至2015年7月31日在澳大利亚寻求庇护者中报告的所有自残事件均通过《信息自由法》获得。我们根据世界卫生组织(WHO)的自我伤害报告指南评估了自我伤害事件报告的质量。
结果:共评估了949起自残事件报告。例行报告日期,地点(处理安排)和自残时间。在所有事件中,不到三分之二(62.1%)记录了性别。尽管所有事件中均未报告IDC-10代码,但所有事件中有81.5%报告了用于自残的方法。在所有事件的4.0%之后记录了心理或精神病学评估,最常见的是在马努斯岛(10.9%)和瑙鲁(10.0%),在基于社区的安排(1.7%)和在岸拘留中最不频繁(1.4%) ),而根本不在社区拘留中。据报道,救护车占所有事件的2.8%。据报告,在所有自残事件中,有6.0%的人出院了,其中以社区拘留(30.3%)和基于社区的安排(19.4%)中发生的事件最为普遍。记录在所有事件中有0.4%使用了Medevac(空中救护车)(瑙鲁发生率2.1%,马努斯岛发生率1.8%)。
结论:我们的研究结果表明,自残数据的可访问性和质量不合标准,并且与WHO的自残报告指南不符。这种多变的报告方式使自我伤害趋势的识别,预防策略的实施(包括在策略级别上的预防策略)以及自我伤害的临床管理变得极具挑战性。迫切需要改善自我伤害报告和监测,以减轻和应对寻求庇护者的自我伤害风险。