Long-term follow up studies of deliberate self harm (DSH) are one method of improving suicide predictability & clinical management. Data was collected from a suburb of Sidney, Australia, each time a patient with DSH was assessed. A progressive increase in the cumulative portion of suicide over 18 years was found. Teenage males who overdose on narcotics are at high risk. Risk after DSH declines with time, but is a life time risk. Planned or repeated episodes of DSH are at high risk.