Postcards from the hospital may lead to fewer episodes of self harm

England and Wales's recent national guideline about the early care of people who have deliberately harmed themselves1 was launched to the media with the sorry admissions that “170,000 people a year attend emergency departments because they have self-harmed, of those an estimated 80,000 never receive a psychological assessment or follow-up even though the risk of committing suicide after self harming one or more times is 100 times greater than the average risk in the population” and “few people providing care in casualty understand why people self harm and don't know how to help them effectively.” People who harm themselves also have an increased morbidity and mortality not related to suicide.2

The report by Carter and colleagues in this issue (p 805) describes one of the largest trials in self harm so far carried out.3 In a largely unselected sample of people attending the emergency department because of self poisoning in Newcastle, Australia, the researchers randomly allocated half to a simple, low cost procedure—sending them a series of postcards …