Abstract: Hanging is one of the commonest methods of suicide. It is an expression of despair and powerlessness. Young Australian Indigenous men from remote communities are over represented in the suicide statistics and the care provided to them when they are expressing suicide ideation or have a near hanging injury in most cases is inadequate. Discussion The national recommendations for the management of alcohol-related problems in Indigenous primary care do not reflect the national reality. This article proposes that Australia is developing an underclass in remote Australia where the life chances of remote Indigenous people are being compromised by the lack of access to appropriate primary health care services, education and employment opportunities and that young men are communicating their despair both in life and death. Conclusion Improving the rates of suicide amongst young remote Indigenous men requires more than adequate resuscitation.