Self-harm is a major worldwide concern (Griffin et al., 2017), and research has demonstrated that 20-25% of individuals who die by suicide have engaged in an act of self-harm within the 12 months before their death (Bergen et al., 2010). Emergency departments (ED) are increasingly recognised as a significant location for the introduction of suicide and self-harm prevention measures (Boudreaux et al., 2013). In Ireland in 2019, the National Self-Harm Registry logged 12,465 presentations to hospital due to self-harm. The rate for males was 187 per 100,000, which is 5% higher than when economic recession hit in 2007. Cork city, where the current study was located, had the highest rate for males, 1.9 times higher than the national average (Joyce et al, 2020). Guidance on clinical best practice (Isacsson & Rich, 2001; Royal College of Psychiatrists, 2004) recommend that psychosocial assessment in ED is a central component in the management and prevention of selfharm. The assessments are deemed to be of benefit on both a practical and therapeutic level. It may increase the likelihood of attending follow-up care (Barr et al., 2005) and the assessment itself can be therapeutic (Whitehead, 2002). In 2019, 72% of Irish patients received a psychosocial assessment after presenting to hospital, unchanged from the previous two years (Joyce et al., 2020)...

Participants Eligible participants were males over 18 years of age who presented to ED in the study hospital following an act of self-harm and who left before next care recommendations. Service users were excluded if they could not be contacted on discharge or if they did not give consent to be further contacted by the researcher. There was a protocol in place to exclude participants if they were deemed to be significantly impacted by substances at the time of the interview, if they presented as severely emotionally dysregulated, or appeared to be in a dissociative or psychotic state. None of these issues arose...

Our sample was representative of this population and in line with Arensman et al. (2018) study. The impact of alcohol and drug use on early self-discharge was also considered to be central in the process (Horrocks et al., 2005). While alcohol was present for some of the participants in this study, there were numerous other reasons cited for leaving. It is interesting to note that previous studies sought to explain the self-discharge with factors related to the patient and almost never with factors related to the service. The current study reveals a more complex interplay of person and the environment...