Emergency psychiatry encompasses the urgent evaluation and management of patients with active symptoms. The definition of emergency is determined by the ability of the patient or the patient's social environment to tolerate these symptoms. Although these emergency evaluations are most commonly performed in hospital settings, mobile crisis teams permit completion of emergency assessment in community settings.
The goals of emergency psychiatric care are similar to those of emergency medical–surgical care: (1) triage, (2) expeditious, pertinent assessment, (3) accurate differential diagnosis, (4) management of acute symptoms, and (5) appropriate discharge planning.
The triage function determines the degree of urgency of the patient's presentation and the initial pathway for evaluation of the patient. The triage clinician must first distinguish between situations that constitute a genuine emergency and those that, although perceived as such by the patient or others, can safely await later assessment.
Next, the triage clinician must correctly identify, among a variety of emergency situations, those that reflect a need for psychiatric evaluation as a first step. This is a critical decision as patients may have both medical and psychiatric complaints or exhibit behaviorial problems that may originate from a medical, neurological or substance induced disorder. A medical evaluation including a brief history of the presenting complaint and physical assessment including vital signs is a critical component of this triage function.
Lastly, the triage clinician must assure the safety of patients until they can be evaluated by a psychiatrist or other mental health professional. In emergency room (ER) settings where patients often present with severe injuries, it is possible to overlook the needs of a well-groomed patient arriving with no obvious disorder. However, this patient may have suicidal or homicidal ideation that can be as life threatening as any other medical emergency and requires immediate attention to ensure the safety of the patient and others.
While initial triage is most commonly undertaken by nursing personnel, the psychiatrist must assume an active role in the training and supervision of those clinicians and in the formulation of standards and clinical criteria applied during the triage “sorting” function. Triage is only as effective as the quality of the standards and the rigor with which they are applied.
Assessment of psychiatric patients under emergency circumstances focuses on the need to quickly evaluate the pertinent aspect(s) of the patient's presentation, with special attention to potential life-threatening issues. Although the patient may have had an initial brief medical evaluation and triage to psychiatry, the clinician should continue to be alert to the possibility that the patient has a medical disorder or substance induced disorder underlying their presentation.
The clinician should assemble as much data as possible before addressing the patient directly. For example, if information suggests that the patient may be dangerous to themselves or to others, appropriate security arrangements should ...