Psychiatry in the emergency department

Up to 5% of patients attending emergency departments (EDs) present with primary psychiatric problems, and a further 20–30% have psychiatric symptoms in addition to physical disorders. This article discusses the commonest psychiatric presentations to EDs, including self-harm, acute psychosis, and alcohol and substance misuse. It also describes common clinical problems in EDs, including frequent attenders, patients who do not wait to be seen, violence and aggression, and psychological responses to trauma. Issues of service delivery and safety are also discussed. The key to a successful ED psychiatric service is a good working relationship between ED and mental health staff.