Background:  Deliberate self harm (DSH) by adolescents is a major problem at both hospital and community levels although little is known about the factors associated with hospital presentation. Method:  Using a community survey a comparison was undertaken of adolescents in 41 schools who reported DSH and presented to hospital with those who reported DSH but did not attend hospital. Results:  While hospital presentation following DSH was associated with several factors, multivariate analysis indicated that the most important were method of DSH (overdose, methods other than self‐cutting and multiple methods) and help‐seeking before the act. Conclusions:  The few differences between adolescents who present to hospital following DSH and those who do not, other than in method of DSH and prior help‐seeking, highlight the need for primary preventive initiatives.