Suicidal self-poisoning is a medical emergency but it is also a psychiatric one. Yet before a psychiatrist can be engaged it is often necessary for a physician or paediatrician to set the scene. Young people who have just taken a massive risk with their lives are in a turmoil of rage, fear, grief and shame. Though some will be keen to talk, others may be harder to reach. ‘The fact that young people who have self-harmed arrive at A&E feeling like ‘rubbish’ may predispose them to perceive staff attitudes and behaviours as hostile and punitive, even when staff do not intend them as such.’1 An attentive and careful medical assessment conveys that the problem is taken seriously by the hospital, for which patients will often in time be grateful.. To read the full article, log in using your NHS OpenAthens details.