Repeat Deliberate Self Harm is a recognised risk factor for completed suicide and therefore reduction by effective healthservice response represents a valid contribution to suicide prevention. However, only a small fraction of people withdeliberate self harm presentations to general health settings actually reach specialist mental health follow-upappointments. Therefore, even if responses at that point are known to be effective they do not make a significantcontribution to reducing repeat self-harm overall. We describe health system organisational change strategies to improvehealth service engagement for the target group, and present data demonstrating the effectiveness of these strategies.