Sir : We wish to report our experience of developing a help card for patients who commit deliberate self-harm (DSH) attending a general hospital. A previous local study identified difficulties with assessments and planning interventions (Reference Gordon and BlewettGordon & Blewett, 1995). In Bristol the effectiveness of offering access to specialist telephone help following DSH has been examined with variable outcome between subgroups (Reference Evans, Morgan and HaywardEvans et al, 1999) demanding further study and replication. We propose a slightly different intervention as part of a broader strategy. We asked casualty doctors to offer a pocket-sized card with numbers and hours of availability comprising the Samaritans, Relate, a local alcohol and drugs agency, a line for young people, Rape and Incest crisis, and the National Debt line.

As a first step to understanding its impact we wrote to people discharged from an accident and emergency department after committing DSH. Forty-eight patients returned a questionnaire, of whom 20 reported receiving a card. Of these, 15 thought it a good idea, and six of the seven who used a line said that they found it helpful.

If a voluntary sector based card could be shown to be effective, the implications for joint working are obvious : currently there is a paucity of evidence for voluntary sector DSH interventions generally, and a variety of arrangements between statutory and voluntary sectors have grown up in different localities. The objective value of our findings is limited to an impression of user acceptability. In an attempt to examine the effect on repetition of DSH, the card is now subject to a randomised controlled trial, and forms part of our patient's management delivered by a specialist DSH team. We would value the opportunity to share our experience with others interested in treating this patient group.