The rate of suicide for people who have had an episode of parasuicide is 100 times higher in the year following the episode than that of the general population. 1 Providing a high standard of care to patients who deliberately harm themselves could help to reduce this rate. 2 Long term follow up studies show that the increased rate of suicide persists. 3 However, the long term risk of suicide in patients in the United Kingdom is uncertain. We traced a consecutive sample of patients 22 years after they presented to a central London teaching hospital after an episode of parasuicide in the late 1970s.