Suicide attempts and suicidal ideation are a challenge for emergency physicians and emergency departments. These disorders are time consuming and often overwhelm staff not familiar with its diagnosis and treatment. The first goal of care is the establishment of a therapeutical relationship which enables a subsequent crisis intervention. Acute pharmacological treatment may be necessary, in many cases only once. First, the danger of continuing self-harm must be evaluated in order to determine whether inpatient psychiatric care is required. If outpatient treatment is deemed sufficient, concrete psychiatric and psychotherapeutic support should be suggested and offered, including the help of family members.