Chapter 58.Treatment of Psychiatric Emergencies

Psychiatric emergencies occur in many different situations and settings. While often managed in specialized crisis stabilization units, psychiatric emergencies occur in other locations, such as general medical/surgical units, outpatient clinics, general emergency departments, and other, nonclinical areas. The effective practice of emergency psychiatry requires a broad range of knowledge and clinical skills, including general and psychosomatic medicine, behavioral neurology, psychopharmacology, individual and family psychotherapy, and addiction medicine. In addition, a basic knowledge of forensic and legal issues is essential. With recent large-scale changes in mental health care delivery, including deinstitutionalization and downsizing of inpatient mental health facilities, the role of an emergency psychiatrist has expanded dramatically. These changes impact not only psychiatric facilities but also general emergency medicine departments, with at least 6.3% of all emergency room visits being for psychiatric issues (Larkin et al. 2005). There were on average 420,000 emergency room visits per year for attempted suicide and self-injurious behaviors between 1993 and 2008. Ominously, the annual number of ED visits for suicide-related behaviors more than doubled from 1993–1996 (244,000/year) to 2005–2008 (538,000/year) (Ting et al. 2012). This trend continues unabated; the Centers for Disease Control and Prevention (2015) reports that there were 836,000 emergency department visits for self-inflicted injury in 2011.