Suicidal behaviours comprise significant part of the workload of Accident and Emergency (A&E) departments. In the UK around 140,000 young people present to A&E with self harm, and there are 6000 deaths from suicide each year. Substance misuse is an acknowledged risk factor for suicide and self harm: the mortality of substance misusers is between 9-16 times higher than the general population. The UK has some of the highest levels of substance misuse in young people in Europe, this relationship give rise to particular concern.

Previous self harm is the strongest predictor of subsequent suicide. Thus it is important to detect and treat effectively as it is estimated that approximately 20% of suicides are likely to be preventable. Indeed, reduction of suicide is a key aim of the National Suicide Prevention Strategy which has a specific objective of promoting the mental health of substance misusers.

However, the indications are that self-harmers are not receiving adequate assessment and treatment. Furthermore, while some forms of psychological and pharmacological treatments are effective for self harm, these results are limited. Most studies do not include substance misusers or have substance misuse as an outcome measure. Effective treatment interventions for substance misusers generally do not focus on suicide or self harm. Indeed, such patients are often excluded. Recent epidemiological evidence that that suggests that attendance for substance misuse treatment may impact upon suicide will be outlined, and the clinical practice and policy implications will be explored with reference to young people.