The paper by Hurry & Storey (Reference Hurry and Storey2000) raises some important points pertaining to the psychosocial assessment of young people presenting with deliberate self-harm (DSH) to accident and emergency (A&E) departments. It is disconcerting that only 54% of children in the 12-15 age group received a specialist assessment prior to discharge from A&E. Department of Health and Social Security guidelines (1984) state that admission to hospital is desirable in most cases in this age group. It is interesting that the rate of specialist assessment was not dependent upon the existence of on-site psychiatric facilities, which in many cases will be based in the community child and adolescent mental health services (CAMHS). The finding that although senior clinicians believe that admission and subsequent specialist assessment is the rule, in practice nearly half the young people in the 12-15 age group are discharged, highlights the need for good liaison between CAMHS and A&E. As minors, most 12- to 15-year-olds will be accompanied by carers, and will be discharged to their care. It is difficult to envisage a situation where a casualty officer would consider discharging a minor following DSH without the involvement of a responsible carer. In the absence of onsite specialist assessment, and with a favourable short-term risk assessment, a casualty officer may be justified in discharging a young person if he or she can be confident that rapid specialist follow-up has been arranged, and that the carer has given an undertaking to ensure that the young person attends. It is, therefore, important that casualty officers receive training in the assessment of short-term risk following DSH, and in communicating with the families of young people.

Such training, regularly undertaken, is the responsibility of senior clinicians in A&E and their psychiatric colleagues. It should ensure awareness of DSH guidelines and the route to fail-safe follow-up, and address the situation reported by Hurry & Storey (Reference Hurry and Storey2000) of junior doctors who are believed to be “…ill-equipped to make such assessments adequately…”, owing to “… lack of experience or lack of concern with the psychological aspects of treatment”.