Background: The Accident & Emergency Department is an important gateway to psychiatric nursing services for patients presenting following deliberate self-harm. To date, there are few systematic assessments of such services. Aims: To compare routine management enhanced by nurse-led case management with routine management only. Method: Randomised controlled trial. Results: It was estimated that 20% of the study population were likely to be readmitted to A&E within 12 months of the index episode following a subsequent episode of self-harm. A power analysis determined that to show a statistically significant 50% reduction in this rate a minimum sample size of 438 was required. Four hundred and sixty-seven patients were identified over a 12-month period: 220 were allocated to the intervention group and 247 to the comparison group. One hundred and seven (49%) of eligible patients received the intervention being evaluated. Overall, readmission rates did not vary between the intervention group (9%) and the comparison group (10%). Conclusions: The intervention did not result in a significant reduction in the readmission rate overall. Declaration of interest: Funded by the participating health authority.