To determine the rate of presentations for suicidal ideation and deliberate self-harm in the Kimberley region of Western Australia, characterized in terms of age, gender, rates of repetition and engagement with community mental health services.

An observational study of health service presentations over 12 months. Setting: 10 sites across the region with police services were included, capturing the overwhelming majority of self-harm presentations in the region. Participants: all Indigenous presentations were analyzed. Of the 433 individuals who presented, 361 were Indigenous. Main outcome measures: suicidal phenomena, including suicidal ideation and any type of deliberate self-harm regardless of intent.

Analysis suggests a broadly similar age and sex stratification of self-harm in this population compared with international reports. The rates, however, are 5–20 times higher than those reported in non-Indigenous populations in Australia and abroad, depending on whether the comparison rate is calculated from population surveys or hospital presentations.

Prevalence of suicidal phenomena is very high and is likely to be much higher than estimated by this hospital based study. Such high prevalence suggests that a population level intervention is required in addition to interventions involving clinical services.