Emergency Psychiatry

Emergency psychiatry is a growing subspecialty within psychiatry, driven in part by rapidly increasing rates of emergency department (ED) visits related to mental illness and substance use disorders (SUDs). Psychiatric emergencies encompass a range of clinical presentations in both children and adults. Patients often present in significant distress, with impairment in functioning, and/or are viewed as increasingly dangerous to themselves or others. Psychiatrists who work in EDs typically require several core skills. In addition to being able to evaluate and treat a broad range of psychiatric conditions and SUDs, emergency psychiatry practitioners must also evaluate and manage suicidal and homicidal thoughts and behaviors, violent behavior or agitation (often of unclear etiology), delirium, as well as substance intoxication and withdrawal. Medical co-morbidity is common; knowledge of the assessment and treatment of medical conditions with prominent psychiatric symptomatology is essential. Emergency psychiatric clinicians are also responsible for knowing the legal regulations and local standards of care related to involuntary containment of patients in the ED, capacity evaluations, confidentiality, release of information, civil commitment, and mandatory reporting for patients with psychiatric symptoms who are treated at the psychiatric emergency service.