title: 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.
authors: Leonie
authors: L
authors: Dodds
authors: Kerin M
authors: KM
authors: Robinson
authors: Leanne
authors: L
authors: Daking
authors: Lindsay
authors: L
authors: Paul
mesh_terms: D001315:Australia / Q000453:epidemiology; D002423:Cause of Death; D059019:Clinical Coding / Q000592:standards*; D003334:Coroners and Medical Examiners; D016208:Databases, Factual; D063025:Health Information Management / Q000592:standards*; D063005:Health Information Systems / Q000592:standards*; D006801:Humans; D062486:Public Health Surveillance; D016728:Self-Injurious Behavior / Q000145:classification* / Q000401:mortality*