For many patients with psychiatric illness, the emergency department (ED) is the point of entry into the health care system. For patients with chronic psychiatric illness the ED is an essential treatment resource; for many of these individuals, the ED is their only option for psychiatric care. By all accounts, psychiatric visits to EDs have steadily increased over the past few decades and will continue to do so.
Clinicians who staff psychiatric emergency services need knowledge and skills that go beyond general psychiatric expertise. Techniques for rapidly establishing rapport, gathering essential information, calming the agitated patient (it takes more than haloperidol and lorazepam), and de-escalating violent patient behavior are just the beginning. Rapid assessment of suicide risk, the search for medical illnesses and substances that can produce psychotic states, and sorting through community facilities to come up with a suitable disposition are all in the day's work. Psychiatric residents and others new to the ED require a source of information; psychiatrists with ED experience need a text that provides the bits of information not committed to memory; and psychiatrists responsible for teaching and supervising residents on the emergency service could use a book that provides a comprehensive overview of emergency psychiatry.