Modern Psychiatric Emergency Care

Modern psychiatric emergency care has roots from the 1950s. Similar to today, the goal was to allow for 24-h care by a psychiatrist to those in crisis. This forerunner of the modern psychiatric emergency service treated exacerbations of chronic mental illness as is done now, but it emphasized brief “dynamically oriented supportive psychotherapy” and electroconvulsive therapy (ECT) rather than medications, the efficacy of which was just being established. Psychiatric emergency services (PESs) have been evolving since the beginning of community-based care. Early on, psychiatric patients overwhelmed emergency departments (EDs) that had few staff and little space appropriate for psychiatric emergencies. Teams began to form inside hospitals to include psychiatrists, psychologists, nurses, and social workers to work more specifically with the mentally ill population. EDs and community outpatient providers saw recidivism at alarming rates. Teams became more proactive and met patients in the community to try to prevent the need for ED and inpatient treatment. Where there was once only the medical ED, now there are hotlines, mobile crisis services, crisis stabilization units, and even psychiatric emergency departments. Care has become more specialized for the treatment of psychiatric emergencies. This chapter explains the history that has led to modern emergency psychiatry practice and details the models of care, goals in emergency care, and expected future endeavors in emergency psychiatry.