The Concept of ‘Intent’ within Australian Coronial Data: Factors Affecting the National Coronial Information System's Classification of Mortality Attributable to Intentional Self-Harm

Abstract

Within Australia all unexpected deaths are investigated by the Coroners Court; specifically, the coroner investigates the identity of the deceased and the cause and circumstances of death. This 'unexpected death' category inevitably includes cases of self-harm and suicide. Concerns regarding the accurate reporting of national suicide statistics resulted in a review of the coding process undertaken by the Australian Bureau of Statistics (ABS), which produces the national statistics, and a formal Commonwealth Government Senate Inquiry in 2009. This article reflects data and opinions collected prior to the Senate Inquiry or the adjustment of the ABS coding processes, and explores the role of the Coroner in determining the intent of the deceased person and the role the National Coronial Information System (NCIS) 1 database plays in the provision of this information. At the Case Notification and Case Closure stages of the coronial process, administrative coders abstract from the coronial file the 'intent' of the deceased and enter the data into relevant administrative systems (which upload to the NCIS). The relevant intent code in the NCIS is 'Intentional Self-Harm', which incorporates deliberate actions of self-harm and suicide. A mixed-method study was employed to investigate anecdotal reports of a problematic coronial coding process surrounding this category of cases. A sample of Australian coroners (n=16), and of the national population of NCIS coders (n=36), were surveyed using separate instruments, and an unobtrusive case review of sampled NCIS cases (n=127) reflecting nine key mechanisms-of-death, was undertaken. Each Australian state and territory has its own Coroners Act, none of which provides legislative direction regarding the determination of intent by the coroner. Neither the coroner-respondents nor the coders favoured a standard proforma to record 'intent'. In order to inform their classificatory decision-making regarding the deceased's 'intent', the coders need to abstract extensively from the entire case file, scrutinising documentary materials from different investigators. They rely primarily on the police report at Case Notification and the coroner's finding at Case Completion. Coders do not generally perceive the classification of 'intent' to be problematic; however, despite NCIS-provided coder (technical) support materials, there exist inconsistent coder work practices and, sometimes, absent documentary evidence reflecting lack of information for ascertainment and interpretation by the coroner, investigators, and forensic experts on the 'intent' of the deceased. The gap between what a coroner is legally required to document regarding 'intent' and what society needs to know for statistical and preventive purposes, seems problematic to bridge.

Exploring coronial determination of intent for poisoning-related deaths in Australia, 2001–2013

“…As with countries like the US and UK, there is a lack of standardisation of the procedures for determining intent, with Australian jurisdictions (i.e., state or territory coronial office) having different legislation and coroners not typically legally required to determine intent. Coders for the National Coronial Information System (NCIS), who categorize cases of coroner reported death nationally, have previously reported difficulties in coding intent, particularly for overdose deaths, and coders vary in the documentation and procedures they rely on for this classification [ 18 ]. This suggest the likelihood of variability between jurisdictions [ 19 ] impacting on injury surveillance of pharmaceutical poisoning by intent.…”

Standing Your Ground: The Importance of Health Information Managers Sharing What They Do

“…Australian Coronial data highlighted the lack of standards that result in disparity between what the coroner is legally required to document and what is needed to inform suicide prevention programs in the community (Dodds et al 2014). Steenkamp (Steenkamp 2014) highlighted the need to consider the implications of cluster effects when analysing and interpreting perinatal data.…”

Deaths after police contact in England and Wales: the effects of Article 2 of the European Convention on Human Rights on coronial practice

“…With ninety-nine coronial areas and little oversight or collation of data at a national level, the effectiveness of these outputs in terms of learning lessons that might prevent future deaths must be questioned. In Australia, where the coronial system is organised on a state basis, there is a national overview of outputs from the coronial process in the form of the National Coroners Information System (NCIS) (Dodds, Robinson, Daking and Paul, 2014). It is also notable that whilst Article 2 of the ECHR affects all signatories, the only two jurisdictions which use coronial systems to fulfil its obligations are Ireland and the UK.…”