The objective of this study is to determine the clinical characteristics of people with mental health problems who frequently attend an Australian emergency department (ED). A retrospective clinical audit of presenter characteristics was conducted in a 550-bed tertiary referral metropolitan hospital with data reflecting 12 months of consecutive ED presentations between September 2002 and August 2003. A sample of 868 individuals accounted for 1076 presentations. Patients attending more than once accounted for 12.5% of the total sample. Significant variables associated with frequent attendance included: younger age; English speaking background; and mood and anxiety disorders. Lone arrival of a patient to the ED showed marginal significance. The significant associates of frequent attendance found in this study may be used to identify patients earlier to a multidisciplinary case review process and individual management planning involving clinicians, carers and patients.