The authors reported on a prospective follow-up study of 640 teenagers presenting to Perth hospitals after deliberate self-harm. A non-randomised, cohort design was used the evaluate the phased introduction of “better” practice protocols in the hospitals. Limitations of the study design were discussed together with some of the clinical & systemic issues which arose. Findings provided general suppport for efforts to improve hospital practice, & clinician & caregiver awareness, knowledge & skills.