Emergency Psychiatric Care: Emergency Medicine Will Usually See You First

Most people who are looking for emergency psychiatric care will likely present to a full-service medical emergency room. The reason is logistical. It is one of the few settings in US medicine that is open 24 hours a day and accepts patients with all sorts of concerns. Not every emergency room has a staff psychiatrist 24 hours a day. Many rely on a 'consultant" model, where the emergency room physician is your main doctor, and the psychiatric consultant comes to help guide care. This happens for a number of reasons. Many emergency rooms have psychiatrists who round only during the daytime. Emergency rooms are also accessing psychiatric consultants remotely as videoconferencing technology improves. In my experience, emergency rooms staffed with subspecialty psychiatrists (ie, child psychiatrists, geriatric psychiatrists, addiction medicine specialists) are far more rare and are usually associated with universities and physician training programs. So overwhelming chances are that, after arriving to the emergency room, you will first be evaluated by an emergency room physician who specializes in emergency medical care. Very simply stated, their initial goals will be to determine:

1. Is there concern that a non-psychiatric condition could be causing your symptoms? 2. Do your needs require psychiatric hospitalization? Or can they be addressed in the emergency room only? 3. Are they going to need the help of a psychiatrist to figure out how to best proceed?

Remember, psychiatric emergencies are medical emergencies. Therefore, an emergency room physician will likely require a physical exam and frequently will also run blood tests to screen for multiple reasons why people may experience changes in their mood, behaviors, and thoughts. If there is a staff psychiatrist available, they will often see you only after the emergency room physician has completed their physical exam, ordered their imaging or lab tests, and those tests have resulted. Usually that information is needed to be helpful in providing guidance as a consultant.