It is ironic that one of the most difficult tasks confronting the psychiatrist is to assess a parasuicidal patient, while the conditions under which he is commonly obliged to do so may be the least favourable that can be imagined. Often he is asked to see the patient, who as likely as not is drunk and just getting over a stomach wash-out, in a crowded corner of a teeming Casualty Department; this is analogous to asking a surgeon to operate in the lavatory. Even if the patient has been admitted, he or she is likely to have been grudgingly lodged in an emergency ward with harassed staff whose hostility surfaces all too easily. It might be a valuable use of time to explore with medical colleagues how to provide the optimal environment for the patient and psychiatrist alike, and to review policy constantly. But the parasuicide violates all the rules of the medical game and rarely fits the culture of the general hospital. Attempts to change staff attitudes will probably have limited success if the social realities remain unaffected. A ward designed for patients with perforated ulcers and broken limbs generates its own values; mores reflect function as well as vice versa.