Emergency Psychiatry

Matthew E. Peters, M.D., Cynthia Major Lewis, M.D., Pat Triplett, M.D.
Emergency Psychiatry is a topic covered in the Johns Hopkins Psychiatry Guide.

To view the entire topic, please or purchase a subscription.

Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Explore these free sample topics:

Johns Hopkins Guides

-- The first section of this topic is shown below --


  • Emergency departments (EDs) are increasingly utilized by patients in need of psychiatric assessment and care. This trend is due in part to[1]:
    • Shortages of psychiatrists and other mental health professionals
    • Limited and often fragmented systems of outpatient psychiatric care
    • Lack of other sources of support for persons with chronic mental illnesses
    • Steadily diminishing inpatient psychiatric beds, both acute and long-term
  • This combination of increased utilization of ED services with decreased safe disposition options has resulted in skyrocketing rates of ED "boarding" of psychiatrically ill patients[2]
  • The most important consideration in emergency psychiatry is the safety of all parties[3]:
    • A systematic approach to assessment, stabilization, and disposition is the most effective means to create a safe and effective treatment environment for acute psychiatric conditions.
  • The American Psychiatric Association’s Task Force on Psychiatric Emergency Services assembled in 2002 and defined a psychiatric emergency as[4]:
    • An acute disturbance of thought, mood, behavior or relationships that requires an immediate intervention as defined by the patient, family or the community
    • Might also be defined as a set of circumstances in which:
      • The behavior or condition of an individual is perceived by someone, often not the identified individual, as having the potential to rapidly eventuate in a catastrophic outcome AND
      • The resources available to understand and deal with the situation are not available at the time and place of the occurrence.
    • Central to the concept of an emergency include the following, all of which contribute to the need for immediate access to a higher level of care:
      • A lack of prior assessment or adequate planning, with resultant uncertainty
      • Unscheduled, severe, or urgent symptoms
      • Failure of natural or professional supports

-- To view the remaining sections of this topic, please or purchase a subscription --

Last updated: January 29, 2017