Real-Time Suicide Surveillance: Comparison of International Surveillance Systems and Recommended Best Practice

Abstract Objective Some countries have implemented systems to monitor suicides in real-time. These systems differ because of the various ways in which suicides are identified and recorded. The main objective of this study was to conduct an international comparison of major real-time suicide mortality surveillance systems to identify joint strengths, challenges, and differences, and thereby inform best-practice criteria at local, national, and international levels. Methods Five major real-time suicide mortality surveillance systems of various coverage levels were identified and selected for review via an internet-based scoping exercise and prior knowledge of existing systems. Key information including the system components and practices was collated from those organizations that developed and operate each system using a structured template. The information was narratively and critically synthesized to determine similarities and differences between the systems. Results The comparative review of the five established real-time suicide surveillance systems revealed more commonalities than differences overall. Commonalities included rapid, routine surveillance based on minimal, provisional data to facilitate timely intervention and postvention efforts. Identified differences include the timeliness of case submission and system infrastructure. Conclusion The recommended criteria could promote replicable components and practices in real-time suicide surveillance while offering flexibility in adapting to regional/local circumstances and resource availability. HIGHLIGHTS Evidence-informed recommendations for current best practice in real-time suicide surveillance. Proposed comprehensive framework can be adapted based on available resources and capacity. Real-time suicide mortality data facilitates rapid data-driven decision-making in suicide prevention.


INTRODUCTION
Suicide is a significant public health issue globally, with the latest statistics published by the World Health Organization (WHO) indicating an estimated 703,000 deaths annually (WHO, 2020).Although deaths by suicide have reportedly declined worldwide between 2000and 2019(WHO, 2021a)), it is challenging to determine if this trend has continued considering the lag between suicide incidence and published national mortality data by official statistical agencies.Verifying, registering, and classifying deaths by suicide takes several months or even years due to medico-legal or coronial investigations involving legal authorities, certifiers, pathologists, and vital statistics registrars (Hynes, 2012;Ikeda et al., 2014;V€ arnik et al., 2010).Although reliable mortality data are essential for surveillance, research, and targeted prevention efforts, suicide is one of the most underreported vital statistics and is seldom overestimated (de Leo, 2015;Sainsbury & Jenkins, 1982;Tøllefsen, Hem, & Ekeberg, 2012).
The public health prevention model of suicide prevention begins with and relies heavily on surveillance data (Ikeda et al., 2014;Potter, Powell, & Kachur, 1995).Monitoring a public health phenomenon such as suicide requires continuous systematic data collection, analysis and interpretation, and dissemination to those involved in prevention efforts (Thacker, Qualters, & Lee, 2012).Several surveillance systems currently collect and store data on confirmed suicides, including The National Confidential Inquiry into Suicide and Safety in Mental Health (2021) in England, the Norwegian Surveillance System for Suicide in Mental Health and Substance Misuse Services (Walby, Myhre, & Kildahl, 2019), the Suicide Mortality Review Committee (2016) in New Zealand and the Queensland Suicide Register in Australia (Leske, Adam, et al., 2020).These systems facilitate trend analysis, risk profiling, and examining the circumstances surrounding deaths by suicide.However, data recording for such systems is contingent on prolonged coronial or medico-legal processes, which impacts timely reports.Provisional suicide mortality data, verified according to validated criteria, may facilitate timely prevention work (Thacker et al., 2012), which can then be measured against official mortality statistics to determine accuracy, once the latter are released (Leske, Kõlves, Crompton, Arensman, & de Leo, 2020).Accessibility to real-time data is essential for many reasons, including early identification of emerging suicide clusters (Hawton et al., 2020), new methods amenable to means restriction measures, and locations of concern, as well as timely responses to individuals bereaved by suicide, evidence-based policy planning and targeted service provision (Baran, Gerstner, Ueda, & Gmitrowicz, 2021).
Based on recommendations for improving national data systems for surveillance of suicide-related events (Hynes, 2012), The Data and Surveillance Task Force of the National Action Alliance for Suicide Prevention in the United States emphasized the value of collecting real-time data to provide an evidence-based framework for rapid action by decision-makers in suicide prevention (Ikeda et al., 2014).The World Health Organization (2018, 2019, 2021b) has endorsed the value of realtime surveillance frameworks for mental health issues, including suicide, and highlights the need for reliable data to inform decision-making, to determine matters requiring immediate action, and to verify if and where progress has been made.The United Nations Sustainable Development Goals echo this concept through target 3.4, which aims to reduce premature mortality from non-communicable diseases by one-third by 2030 (United Nations General Assembly, 2015).This target identifies the suicide mortality rate per 100,000 people as an indicator of progress and relies on timely monitoring of suicide rates internationally to assess the efficacy of prevention strategies.
While there have been calls for real-time suicide surveillance data in the past, the demand for such data has increased significantly recently.The coronavirus (COVID-19) pandemic has had significant implications for the mental health of the population (O'Connor et al., 2020), however, it remains a challenge to determine whether this has led to a rise in suicide rates globally.Unsubstantiated reports of increasing suicide rates have circulated in the media during this global health crisis (FactCheckNI, 2020), but it is difficult to verify such statements with certainty due to the limited availability of current data in many areas.In some high and middle-income countries, these reports have been verified as untrue (Appleby et al., 2021;Coroners Court of Victoria, 2020;Leske, Kõlves, et al., 2020;Pirkis et al., 2021;Qin & Mehlum, 2020; The Office of the Chief Coroner of New Zealand, 2020), while a rise in suspected suicide cases was observed in Japan following an initial decline during the first wave of the pandemic (Ueda, Nordstr€ om, & Matsubayashi, 2021;Tanaka & Okamoto, 2021).Ultimately, the COVID-19 pandemic has reinforced the need for real-time surveillance data to help track changes in suicide rates occurring alongside the pandemic and to identify risk factors that may be heightened and vulnerable groups that may be disproportionately affected (Gunnell et al., 2020;John, Pirkis, Gunnell, Appleby, & Morrissey, 2020;Niederkrotenthaler et al., 2020).Such data are vital to facilitate timely, targeted, public health responses during and after the crisis (Holmes et al., 2020).
Variations in data collection and dissemination models within and between regions and countries limit a comprehensive approach to real-time suicide surveillance.The main objectives of this study were to review and compare the components and practices of established real-time suicide surveillance systems.Enhanced consistency across realtime suicide surveillance globally will contribute to improved accuracy and comparability of international suicide statistics.

METHODS
Five real-time suicide surveillance systems functioning at various levels of data coverage were selected based on existing knowledge, inquiries within our network, and a systematic internet search of existing systems worldwide that have been pilot-tested and in operation for at least two years, as of January 2021.Information was sourced from key personnel involved in developing and operating each system, using a structured instrument (Appendix A) to gather data on specific components, based on the Centers for Disease Control andPrevention (2001, 2004) guidelines for evaluating public health surveillance systems, including: System description (i.e., purpose and use of the system, and system stakeholders).System characteristics (i.e., data custodians, data items, data format, data security, privacy, and confidentiality).System operation (i.e., data collection, case classification, data processing, statistical and epidemiological analysis).
The selected systems were narratively synthesized, and critical attributes collated in tables to facilitate comparisons between their components and practices.

RESULTS
Five real-time surveillance systems of suicide data were identified and selected for inclusion in this study.Table 1 displays the specific attributes of each real-time surveillance system.Table 2 highlights common data items across the systems.Table B1 lists system experiences.Each system is described below: Coronial Suspected Suicide Data Sharing Service; New Zealand The New Zealand Ministry of Health, Coronial Services New Zealand, and Clinical Advisory Services Aotearoa established the national Coronial Suspected Suicide Data Sharing Service (CDS) in 2014.This implementation actioned section 11.2 of the New Zealand Suicide Prevention Action Plan (2013)(2014)(2015)(2016), to establish a function to analyze and share up-to-date provisional coronial data on suicide deaths with agencies working in local areas to help prevent further suicides (New Zealand Ministry of Health, 2013).Clinical Advisory Services Aotearoa, which delivers the CDS, is responsible for delivering the National Community Postvention Response Service.The Community Postvention Response Service has access to CDS data on suspected suicides to support the early detection of emerging suicide clusters and contagion and the resulting coordination of community responses.The CDS securely and swiftly notifies the 20 regional District Health Boards across the country of recent suspected suicides in their regions.Uniquely, the CDS uses an encrypted email system to securely send data to District Health Boards, of which registered authorized recipients with their unique passwords can decrypt the notifications.The CDS system works within the parameters of an agreed Memorandum of Understanding between the Coronial Services New Zealand, the Ministry of Health, Clinical Advisory Services Aotearoa, and all 20 District Health Boards in New Zealand.The CDS's functions and processes meet the required standards of all relevant New Zealand privacy legislation and frameworks.
The Interim Queensland Suicide Register; Queensland, Australia The Australian Institute for Suicide Research and Prevention (AISRAP) developed the state-based interim Queensland Suicide Register (iQSR) in 2011 to provide real-time information about suspected suicides in Queensland as an addition to the existing Queensland Suicide Register.It is used for trend analysis; regional breakdowns of age, sex, and motives/triggers for suspected suicides; and investigation of suicide clusters and locations of concern (e.g., locations where individuals frequently take their lives, Hospital and Health Service catchment areas, and Primary Health Networks), to inform targeted suicide prevention activities.Queensland Police Service officers share reports of suspected suicides by email while sending them to the Coroners Court of Queensland.
Based on the evidence, two independent assessors examine the probability of each death being a suicide, which a third assessor then validates and resolves any outstanding discrepancies.Most information from the police report is automatically extracted triweekly using macros in Microsoft Word and Excel.Data are then added to a dataset to be cleaned, stored, and analyzed.The Coroners Court of Queensland has custody of the police reports and provides case-by-case approval for data releases outside state government agencies.Upon approval, AISRAP independently prepares and disseminates the requested data in the relevant format, including email communications, spreadsheets, or formal reports.The iQSR contains 107 core variables covering demographic items, "motives/triggers" for suicide, next-of-kin details (dependent on consent to contact for research purposes), circumstances of death, internet use, communications of intent, prior suicide attempts, and incident summaries.
Victorian Suicide Register; Victoria, Australia The Victorian Suicide Register (VSR), developed by the Coroners Court of Victoria (CCOV), Australia, commenced operation in 2012.The system consists of a core dataset to collect and record real-time suspected suicide data that is updated each weekday, and an enhanced dataset to record more in-depth data following the conclusion of coronial investigations.The primary purposes of the VSR are to inform coroners' investigations; to identify trends in suicide over time; to disseminate timely information on suicide to government bodies, health services, and the public; and to evaluate the effectiveness of local suicide prevention strategies.Data items recorded in the VSR core dataset include the deceased's demographic information and circumstances of death, which typically take 10 minutes to enter.Deaths based on circumstances consistent with suicide are identified for inclusion primarily via surveillance of all deaths reported to the CCOV.Also, regular, systematic searches of CCOV databases and the National Coronial Information System occur to identify any possible or probable suicides classified as "intentional self-harm," "undetermined intent," or "still enquiring," that may have been missed during initial surveillance.VSR contents are regularly reviewed as coroners' investigations progress.
The VSR is integrated within the CCOV's broader case management system and stored on secure servers accessible to Court employees only, with record editing restricted to VSR coders.Since the VSR is a coronial investigation tool, data is retained indefinitely for this purpose.Access to VSR data is dependent on the approval granted by the CCOV, which considers requests from some community or non-profit organizations, public sector agencies, and researchers.Ethics approval is not required for government bodies and non-government organizations seeking VSR data to inform their work.However, research-based data requests are granted after initial endorsement from the Court's Research Committee and the State Coroner, followed by the approval of an appropriately constituted human research ethics committee.

Thames Valley Police Real-Time Suicide Surveillance System; Thames Valley, United Kingdom
Thames Valley, in the Southeast region of the United Kingdom, established a police-led real-time suicide surveillance system in 2015 to ensure timely support to bereaved families, early identification of suicide clusters, and information gathering to inform local suicide prevention strategies.The Thames Valley Police area comprises three counties (Buckinghamshire, Berkshire, and Oxfordshire), each with separate coroners, public health departments, and healthcare systems.Police leadership of the Thames Valley Police Real-Time Suicide Surveillance System (TV-RT-SSS) is vital as the single police force covers all three counties.Police officers attending the scene of a suspected suicide collect information via a sudden-death form and email this to the TV-RT-SSS police lead.The police lead establishes contact with bereaved families to provide a support resource, refer to relevant local charities, and offer referral to dedicated suicide bereavement support.Data are collated from the sudden death forms using a Microsoft Excel spreadsheet, which is stored confidentially on the Thames Valley Police computer system.The TV-RT-SSS contains 11 variables: the deceased's demographic information, possible triggers, mental health history, health service use, and circumstances of death.Although complete data may not be available at the time of completing the sudden death form, the TV-RT-SSS police lead maintains regular communication with all Thames Valley coroners to assist with data collection and validation, and links with Public Health Suicide Prevention Leads to share and cross-reference data, and to highlight potential cluster concerns within or across county borders.Formal agreements are in place with the region's National Health Service mental health providers to enable additional data sharing where required to understand mental health history, check for possible connections between individuals or identify common service provision issues.

Suicide and Self-Harm Observatory, Southwest Ireland
The Suicide and Self-Harm Observatory (SSHO) was established in County Cork, Ireland, by the National Suicide Research Foundation (NSRF) and the School of Public Health, University College Cork (UCC), in 2018.The SSHO collates real-time data on suspected suicides to identify emerging clusters, provide a timely response to people affected by suicide, and verify unfounded statements on suicide and self-harm disseminated via media outlets.It comprises a core database of 16 variables that capture demographic information relating to the deceased, circumstances of the death, history of abuse, and mental health service use.The SSHO captures all deaths of which the circumstances are consistent with a suspected suicide, based on operational screening criteria (Rosenberg et al., 1988).NSRF-UCC researchers collect data fortnightly from the Coroners of the Cork and Kerry counties via onsite manual data entry to an encrypted Microsoft Excel spreadsheet.Coded, de-identified data are transferred to SPSS for trend analysis purposes.Both data files are stored on an encrypted laptop in the NSRF offices.The Resource Officer for Suicide Prevention in the Health Service Executive provides data relating to service user deaths by suspected suicide from the Health Service Executive Patient Mortality Register via fortnightly telephone contact with the researchers.A two-way pathway exists with the Health Service Executive, as data captured by the SSHO are shared with the Resource Officer for Suicide Prevention to initiate a crisis response plan for emerging suicide clusters and provide timely support to bereaved communities.

Comparative Real-Time Suicide Surveillance System Components
Both commonalities and differences exist between the components of the five systems, as presented in Table 1.All systems have an electronic database, typically a passwordprotected Microsoft Excel file, with one system collating data at the national level, employing an encrypted web-based portal to store data and automatically notify key stakeholders of a death.The number of data items per system ranges between 8 and 107, and averages at 31.Common data items among the systems are listed in Table 2.A high level of data security is applied to the systems, ensuring compliance with all relevant data protection legislation and access limited to trained and ethically cleared personnel in the organizations that operate the systems.The terminology varies considerably between the systems, from "suspected suicide," "suspected self-inflicted death," "intentional selfharm," "probable suicide," or a suicide "beyond reasonable doubt," and a death of "undetermined intent" or "still enquiring," depending on the availability of evidence at the time of case submission to the database.Data collated by all the systems is either primarily or secondarily sourced from the coroner.One system, embedded within the police force, directly extracts the data from the police report and cross-checks this information with the coroner.Another system verifies data coming from the coroner with a health service patient mortality register for suspected suicide deaths of service users.Data collection approaches vary between systems from onsite manual data entry or telephone communication with the source to email notification.Data dissemination predominantly occurs on a need-to-know, periodic basis via aggregated-level data reports shared with relevant stakeholders, with ad hoc reports and briefings prepared in the event of emerging clusters, contagion, or concerning trends to inform a timely response.However, one system reports to both state and national health departments on a weekly, fortnightly, and quarterly basis and has recently commenced monthly public reports.

Comparative Real-Time Suicide Surveillance System Practices
The range of timeliness of case submission varies across the systems from immediately upon notification to fortnightly and averages between 24 and 72 hours after a death has occurred (Table B1, Appendix B).The disparity in system infrastructure (integrated into legislated organization vs. unintegrated) impacts data quality given that unintegrated systems rely on the completeness of externally sourced death reports.Using secondary data sources has demonstrated the benefits of cross-checking data completeness.Furthermore, the review of cases collated by most systems ranged from continuous to bimonthly to capture any missing cases that meet inclusion criteria.
Common uses were identified among the systems, particularly the ability to identify emerging trends, locations/suicide methods of concern, and opportunities to implement means restriction.The systems have collectively reported value in refuting unfounded claims and concerning reports within the media and community by establishing the facts, as well as informing provision of support and other postvention services to the bereaved and outreach to those identified as vulnerable.
Crossover exists in system practices based on applicability to suicide prevention and their utility, with additional reported benefits including offering the most reliable and evidence-based source of data to inform postvention activities, target prevention initiatives, and inform response plans by identifying potential contagion, clusters, or linked incidents, thereby supporting those at-risk.
Accessibility varies across the systems depending on their infrastructure, with integrated systems facilitating access to personnel within their legislated organization and external bodies on a need-to-know basis.Most systems disseminate aggregated data to stakeholders, governmental bodies, and researchers upon request.Two systems notify health service providers in affected districts to facilitate timely bereavement support and outreach to impacted communities, with one system adopting an automated notification approach and the other designing an encrypted web-based interface to store and display the data for those with authorized access.
A high level of flexibility exists among most systems, with three declaring adaptations to the original model to meet the needs of the system and the stakeholders for whom the system exists to service.Such adjustments include the expansion of the surveillance area, modifications to IT infrastructure, and the addition of further data items.
The systems collectively reported a high level of sensitivity, with comparisons of provisional data captured by the systems against official mortality statistics reported to average between five to seven percent by the two systems.Stakeholder feedback relating to the systems detailed high levels of satisfaction, a model that is fit-for-purpose and worthy of replication elsewhere.

DISCUSSION
This study identified more similarities than differences exist among the systems.The shared purpose of all systems is to inform suicide prevention efforts, particularly by providing an evidence-based data source to invalidate misinformation, inform response plans, and detect emerging trends, links, and clusters, thereby mitigating further detrimental impacts on affected communities.These common aims demonstrate consistency within the primary functions of the systems.Most systems collate geographical data based on residential address, location of death, or in some cases, both.This data informs aberration detection which often involves an algorithm that evaluates the presence of spatial, temporal, and spatio-temporal clusters, typically using scan statistic software (Kulldorff, 1997).
All systems apply a legal approach whereby data is sourced from a coronial service.Most systems include the coronial service as the primary data source, with two systems sourcing data from the police primarily and incorporating coronial data as a secondary crosschecking source.A health service patient mortality register was documented as an alternative cross-checking source; however, data is limited to service users at the time of death.Despite some systems involving a secondary source, one is evidently sufficient when case reporting to the data source is mandatory under the legislation and thereby data is of high quality and complete.Fundamentally, suicide registration isn't always based on a coronial system, with many countries implementing a medico-legal system (V€ arnik et al., 2010).Thus, surveillance should be based on the most reliable and comprehensive source available.
Though the terminology applied across all systems to capture relevant cases lacks consistency, the classifications demonstrated homogeneity in their recognition of the provisional status and limitations of this determination, since the coronial investigation is ongoing at the time of case identification.Review of case classification, either on a continuous or periodical basis depending on capacity, can improve data quality, completeness, and sensitivity by ensuring only those correctly classified deaths are detailed in the system.Standardized guidelines and training on criteria to identify relevant cases for inclusion are required to inform staff involved in determining cases to be recorded in a system of this kind.Caveated information relating to the interpretation of provisional data is typically included in reports and presentation slides, highlighting the possibility of changes to the death classification at the conclusion of the cause of death investigation.While the information on deaths by suspected suicide is not routinely publicized in the media, the added value of the real-time suicide surveillance systems is the ability to confirm minimal details relating to case numbers or verify unsubstantiated reports relating to suicide rates upon request.The systems include a fact-checking function whereby unsubstantiated reports may be verified in advance of publication; however, individual case details are not disclosed.In addition, aggregated data from some systems have contributed to international projects examining the impact of the COVID-19 pandemic on suicide (Pirkis et al., 2021), with opportunities to compare data with other countries, although data from some regions and countries have been accessed from preliminary data sources on an ad hoc basis.Comparative research at a national level has been possible for one regional system in this study which feeds into a recently developed national real-time suicide surveillance system that is being used to examine differences in rates of suspected suicide between both areas and countries within the UK (Appleby et al., 2021).
Timeliness, the cornerstone of real-time surveillance, tends to be influenced by system infrastructure.The most significant difference identified between the systems was the case submission interval, ranging from immediately upon notification of a death to fortnightly routine submission.Those systems embedded within the original data source agency have the advantage of instant data access, while external systems typically rely on added resources and capacity to ensure timely data collection.The speed of data entry impacts system utility due to the need for prompt notification to inform the rapid response.Case submission for a suicide surveillance system averages at 2 hours, but can range between 15 minutes and 8 hours, depending on the size of the database and the information available (Sutherland et al., 2018).As evidenced, a core database facilitates the objective of real-time suicide surveillance by collating minimal data, swiftly.Flexibility in adapting system components, such as the inclusion of additional variables if required, is crucial to ensure a system continues to meet the needs of those it exists to serve.

Strengths and Limitations
This study compared and synthesized information from national and regional systems, demonstrating the international adaptability of the recommended best practice criteria.It involved a systematic assessment of existing established real-time suicide mortality monitoring systems, examining their practices and components in close detail to identify joint strengths and challenges that contribute to a system of this kind.This study is timely due to the limitations in the availability and accuracy of current suicide data, particularly in low-and middle-income countries, as previously highlighted by the WHO (2021).It is further well-timed in providing an experience-based template in response to a call for real-time surveillance of suicide data to monitor the ongoing impact of the COVID-19 pandemic on suicide and the effects of natural populationbased experiments and exposures.Member States of the UN may adopt the comprehensive approach outlined in this study to evaluate their progress in achieving a significant reduction in the suicide rate, as per target 3.4 of the SDGs (United Nations General Assembly, 2015).This study is limited by a lack of representation of systems outside developed countries.However, while recent data has been sourced from 21 countries to monitor suicide trends during the early months of the COVID-19 pandemic (Pirkis et al., 2021), information on established real-time suicide surveillance systems that have been either piloted or evaluated in low-and middle-income countries was unavailable.Future research should address the impact of real-time suicide surveillance systems on prevention practices in the relevant areas to determine the usefulness of such systems from a broader stakeholder perspective.Furthermore, the surveillance systems included in this study are inadvertently restricted to English-speaking countries.Efforts were made to include the Japanese real-time suicide system and contact was made directly with individuals involved in the operation of the system who indicated that the system was undergoing modifications at the time of the data collection for this study and the information would be soon outdated.

CONCLUSION
To establish a real-time suicide surveillance system in line with current international best practices, we conclude that the following criteria should be met: a rapid, routine collection of provisional data sourced from at least one reliable data source to facilitate timely prevention efforts, ongoing data review to ensure high sensitivity; the development of a core, automated machine learning system to assist rapid data entry and quick transition to analysis, visualization, and reporting of emerging spatial, temporal or spatio-temporal clusters, as well as risk factors and vulnerable populations on a need-to-know basis.

DISCLOSURE STATEMENT
No potential conflict of interest was reported by the author(s).
School of Population and Global Health, The University of Melbourne, Melbourne, Australia.R.

APPENDIX A. STRUCTURED QUESTIONNAIRE
Please include all relevant details relating to each aspect of the real-time suicide surveillance system operated by your organization.

System practices
Name of surveillance system Purpose of the system Use of data collected by the system Dissemination of outputs Personnel granted access to the system Level of data collection, i.e., national, regional, etc.Data custodians, i.e., sources from where original data is obtained Number and description of data items comprising system Terminology, classification, definitions used to select cases Data format, i.e., email, hard file, etc. Ethical considerations in developing system Data storage, i.e., data security, access to database Data ownership and retention; existence of protocols and agreement with data custodians

TABLE 1 .
Attributes of existing real-time surveillance systems of suicide mortality data.
AIHW: Australian Institute for Health and Welfare; CCOV: Coroners Court of Victoria; CDS: Coronial Suspected Suicide Data Sharing Service; CPU: Coroners Prevention Unit; DHBs: District Health Boards; EU GDPR: General Data Protection Regulation; HSE: Health Service Executive; MHAoDB: Mental Health, Alcohol and Other Drugs Branch; NIIO: National Initial Investigation Office of Coronial Services; QMHC: Queensland Mental Health Commission; ROSP: Resource Officer for Suicide Prevention; SSIS: Suicide Support and Information System; SSIDs: suspected self-inflicted deaths; TV-RT-SSS: Thames Valley Police Real-Time Suicide Surveillance System.a https://www.nspa.org.uk/wp-content/uploads/2017/10/TVP-Sudden-Death-Form.pdf.

TABLE 2 .
Data items in real-time surveillance systems of suicide data.