This study examines the complexities of Emergency Department (ED) practice with specific reference to the care and experience of people who self-harm. Self-harm is a major source of suffering for individuals and their families and requires a targeted cohesive and appropriate response from health care agencies. Bounded in time and place an embedded case study design (Stake 1995) is used to explore this phenomenon in a real- life context (Yin 2003). Known issues associated with the case have formed the conceptual structure from which multiple sources of data have been utilised to gather evidence. Case analysis incorporates data from patient interviews, patient case notes, staff focus groups and interviews, policy documents and media coverage. A process of directed content analysis involving inductive and deductive category application is undertaken. Data are triangulated in an effort to elicit divergent and convergent issues, culminating in the development of two overarching themes. The first theme entitled ‘structural discourse’ provides an understanding of the context in which ED practice and the care of people who self-harm occurs. The second theme, named ‘encountering ED’, structures individual narratives, personal meanings and the relational aspects within the case. The effects and implications of competing discourses and their relevance for ED practice are discussed. The significant impact of overcrowding on patients and staff and the particular issues for people who self-harm are explored. Finally ED practice is examined as a moral performance where the concepts of dignity, regard, generosity and imagination are deemed to have a particular place in emergency practice, and a role to play in reframing the language and questions about emergency department practice.