<p>Adult presentations for mental health in the emergency department have been increasing over the past two decades. Despite this trend, there remains a gap in understanding racial and ethnic differences in the care process and outcomes. Our study examined racial and ethnic differences in the evaluation location, diagnosis, and discharge disposition for adults who accessed psychiatric emergency services (PES) in a multi-channel program. We analyzed 61,663 PES encounters with adults ages 22 and over between 2017 and 2021. Almost 50% of adult PES encounters involved clients of color (28.6% non-Latino Black, 13.8% Latino, 3.8% Other). Compared to non-Latino White clients, non-Latino Black and Latino clients were significantly more likely to be evaluated in psychiatric urgent care clinics (UCCs; OR = 1.45 and OR = 1.38, respectively) and private homes (OR = 1.26 and OR = 1.48, respectively). Encounters with clients of color had 2–3 times the odds of receiving a diagnosis of a primary psychotic disorder (ORs = 1.96 to 3.67) and were also less likely to result in admission to 24-hour care (ORs = 0.70 to 0.85). Our findings suggest that when alternative service options are available, individuals of color are more likely to seek treatment in non-ED settings. Our findings also emphasize the need for further investigation into the root causes of racial and ethnic variations in emergency mental health service processes and outcomes</p>