While at university, a friend of mine attempted suicide for real - planned it, hid the necessary paraphenalia around their room, locked the door, wrote the note, did the deed, and didn't let anyone know. Fortunately, they hadn't factored in the chance of me rocking up drunk to invite them out, and banging the door down (halls of residence, what can you say) once I realised what had happened. Off they went to hospital, where the on-call pysch was "too busy" and friend was sent home with a letter to the GP being sent "at some point" and no referral to a CMHT. Same friend had an acute episode recently, and self referred to A&E. This time seen by the psych (having had the F1 make her recount the traumatic history that lead to the condition, then stating that she "probably didn't need the medication anyway") after lots of fighting, who did actually refer on to the CMHT this time. The CMHT promptly refused to accept her. Apparently, being sane enough to know you need help means that you don't need help. Haven't I read this concept before? From the other side, working in acute medicince I see an awful lot of "pretend" ODs and other parasuicides. In almost all of the cases, when the pt is lucid enough to talk to them, they describe it as a cry for help. One or two have the "moment of madness" described above, but for the majority it is a way of getting attention. I'm not saying than in the negative way that "cry for help" is normally interpreted. It's a very sad thing, that someone has to deliberately damage their body (often without realising what the long term damage they're doing is) so that they can get seen by psych services and get the help they need. Often, the pts are discharged once the bag of Parvolex has finished with a letter to their GP, only to be back weeks, or even days, later as they're still not getting the help they need. But then, what's the other option? Refer yourself before things get that back? I've just told you how well that works out... The worst is when the parasuicide goes wrong. The pt doesn't realise just how little paracetamol or antifreeze is required to permenantly screw over their kidneys. Ok, so they're not going to die tomorrow, and they might even get the help they need in relation to their mental health. But what will they think a few years down the line when they're on dialysis...