Evidence briefing

Assessment and acute management of psychiatric presentations in emergency departments

Written by a language model from the cited research, from 5 full texts and the abstracts of the other 7. No human author wrote or checked this text. Not peer reviewed.

Generated 21 August 2026 · 12 sources cited, 2012–2026 · Full text read for 5 of 12 sources · Not peer reviewed

Subjectmanagement of psychiatric presentations in the emergency department

QuestionWhat models of assessment and care, and what acute pharmacological and organisational strategies, have been evaluated for people presenting with psychiatric crises or mental health concerns to emergency departments?

AnswerEvidence on management of psychiatric presentations in the emergency department appears sparse and is mostly observational. Dedicated assessment units and short-stay models may have been associated with shorter length of stay in limited evaluations. For borderline personality disorder, scoping work appears to support brief, goal-directed crisis care and adjunctive medication for agitation only. Integrated models including collaborative care, consultation-liaison teams and telepsychiatry have been associated with shorter stays and improved access. Consensus guidance for agitation recommends cause-specific pharmacotherapy rather than a uniform regimen. Validated screening tools, tested first-episode psychosis pathways and high-quality trials of population-specific protocols appear to be lacking. Psychiatric boarding may be associated with substantially longer emergency stays, and interventions for frequent users may have reduced subsequent visits in heterogeneous observational studies.

Keywords emergency psychiatry; mental health crisis; agitation; short-stay unit; borderline personality disorder; psychiatric boarding; consultation-liaison; autism spectrum disorder

What the evidence shows

Every figure in this review was checked against the material read for the cited sources — their abstracts, and the open-access full text where one was retrieved. ‡ marks one found only in a source other than the one cited. See Limitations.

In a narrative review searching four databases to July 2025, five studies of mental health models in emergency departments were included; psychiatric assessment and planning units appeared to be associated with reduced length of stay in two Australian evaluations, with mixed results in a third.¹
A PRISMA-ScR scoping review of twelve studies on adults with borderline personality disorder in emergency settings suggested three domains: structured suicide-risk assessment, preference for brief crisis hospitalisation, and cautious short-term pharmacotherapy for agitation.²
An Australian scoping review of fifteen studies of mental health short-stay units reported typical admissions of 72 hours^‡ or less for medically stable patients and described possible improvements in emergency department flow, with limited comparability across models.³
A systematic review of 18 studies of collaborative care models, consultation-liaison teams and telepsychiatry suggested associations of these approaches with shorter hospital stays and greater access to psychiatric treatment, while noting heterogeneous designs.⁴
The 2012 American Association for Emergency Psychiatry consensus statement proposed that pharmacologic treatment of agitation might be based on the most likely cause and that underlying medical conditions such as delirium be treated before antipsychotics or benzodiazepines.⁵
A 2016 research consensus workgroup using nominal group technique identified six high-priority questions on psychosis in the emergency department, including the apparent lack of a validated triage tool and of tested linkage protocols for first-episode psychosis.⁶
In a retrospective study of 484 patients^‡ aged 15 years and older with autism spectrum disorder (0.7%^‡ of 69447 psychiatric emergency attendances), hetero-aggressive behaviour was reported as the leading complaint at 37.0%^‡ and mechanical restraint was used in 6.2%^‡.⁷
A retrospective study of 1438 psychiatry consultations reported mean emergency length of stay of 1089 minutes^‡ for the 505 patients^‡ needing inpatient psychiatric placement, compared with 340 minutes^‡ for non-psychiatric admissions.⁸

What remains open

Randomised trials of psychiatric assessment units, short-stay models or integrated care versus usual emergency pathways do not appear to have been identified.
Diagnostic overshadowing of physical illness among people with mental illness has been described in qualitative interviews with emergency and liaison staff, apparently without subsequent controlled evaluation of mitigation strategies.⁹
Management of stimulant-related behavioural disturbance and of methamphetamine intoxication appears to rest on observational series, with no comparative trials against other drug-related presentations.^10,11
Case-management and related interventions for frequent emergency users appear to lack agreed definitions of the target population, constraining interpretation of visit reductions.¹²

Methods

Search strategy. Candidate records were retrieved on 21 August 2026 from OpenAlex, Europe PMC and arXiv, using the search strings ‘psychiatric presentations emergency department management’; ‘ED psychiatric emergencies protocols’; ‘acute mental health crises emergency department’. Records without a retrievable abstract were discarded, leaving 48 for screening. Each remaining record was assessed for how directly it addresses management of psychiatric presentations in the emergency department and labelled direct, related or background; 12 were cited here and are listed in Table 1. A second, targeted search then looked up 1 work named in the most relevant abstracts (‘Twelve study’), which added 8 further records to the pool.

Evidence handling. Titles and abstracts were read for every record, and the open-access full texts of 5 sources were retrieved from their open-access copies and read alongside them (marked in Table 1); claims resting on the remaining sources draw on no data beyond an abstract. Decimals, percentages, effect estimates and quantities carrying a clinical unit were then checked automatically, each against the sources its own sentence cites, within exactly the material shown to the model — the abstracts plus those full-text excerpts. A figure that could not be located, or that appears only in a source other than the one cited, is flagged under Limitations.

Generation. Search planning, source curation and drafting were performed by a large language model (x-ai/grok-4.6). Source retrieval, relevance tabulation, citation numbering, Table 1, Fig. 1 and the statistical check are deterministic and were not model-generated.

Evidence assessment

Of the 12 sources cited, 7 address the review question directly, 5 are related and 0 provide background only; they were published in 2012–2026. The composition of the evidence base is shown in Fig. 1.

Limitations. This synthesis was prepared from the open-access full texts of 5 cited sources and the abstracts of the remaining 7. Where only an abstract was available, effect estimates, methodological detail, and the limitations that authors report only in a full text were unavailable, so the strength of those studies could not be appraised here. 8 numerical values reported above (72 hours, 484 patients, 0.7%, 37.0%, 6.2%, 1089 minutes and 2 other(s)), each marked ‡ where it appears, are found in cited sources other than the ones their sentences credit. The figures are present in the evidence base, but the attributions do not hold and should be checked before they are quoted. The text below should therefore be read as a working draft rather than a finished review.

Table 1 | Characteristics of the cited evidence. Design is inferred from each record's title, journal and index metadata and is left blank where it could not be inferred; no quality appraisal was performed. Relevance is the curation label for how directly each source addresses the review question. Read records whether the model saw the source's open-access full text or its abstract only.

Ref.	Study	Year	Source	Design	Relevance	Read
1	Russell et al.	2026	Emergency medicine Australasia : EMA	—	Direct	Full text
2	Bouchard-Boivin et al.	2026	Frontiers in psychiatry	—	Direct	Full text
3	Bhatti & Mitra	2026	Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists	—	Direct	Abstract
4	Katiki et al.	2024	Cureus	Reviews	Direct	Full text
5	Wilson et al.	2012	Western Journal of Emergency Medicine	—	Direct	Abstract
6	Peltzer-Jones et al.	2019	Western Journal of Emergency Medicine	—	Direct	Full text
7	Cordina et al.	2026	BMJ open	—	Direct	Full text
8	Nicks & Manthey	2012	Emergency Medicine International	—	Related	Abstract
9	Shefer et al.	2014	PLoS ONE	Qualitative	Related	Abstract
10	Suen et al.	2022	BMC Emergency Medicine	—	Related	Abstract
11	Isoardi et al.	2018	Emergency Medicine Australasia	—	Related	Abstract
12	Moe et al.	2017	Academic Emergency Medicine	Reviews	Related	Abstract

Glossary

psychiatric assessment and planning unit: A dedicated area within or adjacent to an emergency department staffed by mental health clinicians and providing brief assessment and stabilisation beds.
diagnostic overshadowing: Misattribution of physical symptoms to a pre-existing mental illness, which can delay medical diagnosis and treatment.
collaborative care model: A multidisciplinary arrangement in which emergency, psychiatric and primary-care clinicians share responsibility for mental health follow-up after an emergency visit.
psychiatric boarding: The practice of holding a patient in the emergency department for a prolonged period while awaiting an inpatient psychiatric bed.

References

Russell, S. E. et al. Mental Health Assessments and Models of Care in the Emergency Department: A Narrative Review. Emergency medicine Australasia : EMA (2026).
Bouchard-Boivin, M. et al. Treatment of patients with borderline personality disorder in the emergency room? A scoping review. Frontiers in psychiatry (2026).
Bhatti, O. & Mitra, S. Mental health short stay units in Australia: a scoping review. Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists (2026).
Katiki, C. et al. Enhancing Emergency Room Mental Health Crisis Response: A Systematic Review of Integrated Models. Cureus (2024).
Wilson, M. P. et al. The Psychopharmacology of Agitation: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychopharmacology Workgroup. Western Journal of Emergency Medicine (2012). Cited by 398
Peltzer-Jones, J. et al. A Research Agenda for Assessment and Management of Psychosis in Emergency Department Patients. Western Journal of Emergency Medicine (2019). Cited by 24
Cordina, A. et al. Management of patients with autism spectrum disorder in psychiatric emergency: a single-centre retrospective study. BMJ open (2026).
Nicks, B. A. & Manthey, D. M. The Impact of Psychiatric Patient Boarding in Emergency Departments. Emergency Medicine International (2012). Cited by 191
Shefer, G. et al. Diagnostic Overshadowing and Other Challenges Involved in the Diagnostic Process of Patients with Mental Illness Who Present in Emergency Departments with Physical Symptoms – A Qualitative Study. PLoS ONE (2014). Cited by 288
Suen, L. W. et al. Emergency department visits and trends related to cocaine, psychostimulants, and opioids in the United States, 2008–2018. BMC Emergency Medicine (2022). Cited by 43
Isoardi, K. et al. Methamphetamine presentations to an emergency department: Management and complications. Emergency Medicine Australasia (2018). Cited by 57
Moe, J. et al. Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review. Academic Emergency Medicine (2017). Cited by 224

Additional information

Data availability. No new data were generated. All evidence cited is published and openly indexed; 12 of the 12 cited records resolve through the links in the reference list.

Author contributions. Search planning, source curation and drafting were carried out by an automated pipeline (articlegen, x-ai/grok-4.6). No human author wrote or verified the text before publication of this draft.

Competing interests. None declared.

Peer review. This article has not been peer reviewed and is not a publication of record.