Ambulance attendances resulting from self-harm after release from prison: a prospective data linkage study
Incarcerated adults are at high risk of self-harm and suicide and remain so after release into the community. The aims of this study were to estimate the number of ambulance attendances due to self-harm in adults following release from prison, and to identify factors predictive of such attendances.
Baseline surveys with 1309 adults within 6 weeks of expected release from prison between 2008 and 2010 were linked prospectively with state-wide correctional, ambulance, emergency department, hospital and death records in Queensland, Australia. Associations between baseline demographic, criminal justice and mental health-related factors, and subsequent ambulance attendances resulting from self-harm, were investigated using negative binomial regression.
During 4691 person-years of follow-up (median 3.86 years per participant), there were 2892 ambulance attendances in the community, of which 120 (3.9%) were due to self-harm. In multivariable analyses, being Indigenous [incidence rate ratio (IRR): 2.10 (95% CI 1.14–3.86)], having previously been hospitalised for psychiatric treatment [IRR: 2.65 (95% CI 1.44–4.87)], being identified by prison staff as being at risk of self-harm whilst incarcerated [IRR: 2.12 (95% CI 1.11–4.06)] and having a prior ambulance attendance due to self-harm [IRR: 3.16 (95% CI 1.31–7.61)] were associated with self-harm attendances.
Ambulance attendances resulting from self-harm following release from prison are common and represent an opportunity for tertiary intervention for self-harm. The high prevalence of such attendances, in conjunction with the strong association with prior psychiatric problems, reinforces the importance of providing appropriate ambulance staff training in the assessment and management of self-harm, and mental health problems more broadly, in this vulnerable population.
KeywordsSelf-injurious behaviour Prisons Emergency service Ambulance Data linkage
- 12.NICE (2011) Self-harm: longer-term management. National Clinical Guideline 133. National Institute for Health and Clinical Excellence, LondonGoogle Scholar
- 13.Lloyd B, Gao CX, Heilbronn C, Lubman DI (2015) Self-harm and mental health-related ambulance attendances in Australia: 2013 data. Turning Point, FitzroyGoogle Scholar
- 19.Snooks H, Evans A, Wells B, Peconi J, Thomas M (2012) What are the highest priorities for research in pre-hospital care? Results of a review and Delphi consultation exercise. Australas J Paramed 6(4):2–4Google Scholar
- 20.Emond K, Furness S, Deacon-Crouch M (2015) Undergraduate paramedic students’ perception of mental health using a pre and post questionnaire. Australas J Paramed 12(5):1–5Google Scholar
- 21.Lloyd B, Gao C, Heilbronn C, Lubman D (2015) Self-harm and mental health-related ambulance attendances in Australia: 2013 data. Turning Point, FitzroyGoogle Scholar
- 26.OESR (2008) Australian standard offence classification (Queensland extension). Brisbane, Australia: Office of Economic and Statistical Research, Queensland GovernmentGoogle Scholar
- 27.ABS (2008) National Health Survey: summary of results, 2007–2008. Australian Bureau of StatisticsGoogle Scholar
- 28.Madge N, Hewitt A, Hawton K, De Wilde EJ, Corcoran P, Fekete S et al (2008) Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. J Child Psychol Psychiatry 49(6):667–677CrossRefPubMedGoogle Scholar
- 31.Stata (2013) Stata Release 13.0. Stata Corporation. 13.0 ed. Texas, USAGoogle Scholar
- 42.Kouyoumdjian FG, McIsaac KE, Liauw J, Green S, Karachiwalla F, Siu W et al (2015) A systematic review of randomized controlled trials of interventions to improve the health of persons during imprisonment and in the year after release. Am J Public Health 105(4):e13–e33CrossRefPubMedPubMedCentralGoogle Scholar
- 43.Kinner S, Burford B, van Dooren K, Gill C, Gallagher C (2013) Service brokerage interventions to improve health outcomes in ex-prisoners (protocol). Cochrane Database Syst Rev 36(1):198–206Google Scholar