Objective: To develop a working model that provides an understanding of the processof deliberate self-harm and a framework for psychological intervention in anemergency department setting.Method: A retrospective clinical audit of a consecutive series of 51 deliberate self-harmpatients referred to the liaison psychiatry service by the emergency departmentof an inner city hospital.Results: Patient characteristics were diverse. The age range was 17?92 years, with79% between 15 and 35 years. Most were single and unemployed and the majorityhad a psychiatric disorder. Characteristically, there was at least one immediate stressorand intoxication immediately before the attempt.Conclusions: The diversity of deliberate self-harm patients requires strategicintervention in a setting such as the emergency department. The working model forintervention presented here may be transferable to other settings such as generalpractice or community mental health centres using an educational and skillsdevelopment approach with ongoing supervision.