**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 Not peer reviewed.** *Generated 21 August 2026 · 12 sources cited, 2012–2026 · Full text read for 5 of 12 sources · Not peer reviewed* **Subject:** management of psychiatric presentations in the emergency department **Question.** What models of assessment and care, and what acute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? **Answer.** Evidence 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] ## Three papers to open - [1] Russell et al. (2026). Mental Health Assessments and Models of Care in the Emergency Department: A Narrative Review. - [4] Katiki et al. (2024). Enhancing Emergency Room Mental Health Crisis Response: A Systematic Review of Integrated Models. - [2] Bouchard-Boivin et al. (2026). Treatment of patients with borderline personality disorder in the emergency room? A scoping review. ## 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.** | 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 1. Russell, S. E. et al. Mental Health Assessments and Models of Care in the Emergency Department: A Narrative Review. *Emergency medicine Australasia : EMA* (2026). 2. Bouchard-Boivin, M. et al. Treatment of patients with borderline personality disorder in the emergency room? A scoping review. *Frontiers in psychiatry* (2026). 3. 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). 4. Katiki, C. et al. Enhancing Emergency Room Mental Health Crisis Response: A Systematic Review of Integrated Models. *Cureus* (2024). 5. 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. 6. 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. 7. Cordina, A. et al. Management of patients with autism spectrum disorder in psychiatric emergency: a single-centre retrospective study. *BMJ open* (2026). 8. Nicks, B. A. & Manthey, D. M. The Impact of Psychiatric Patient Boarding in Emergency Departments. *Emergency Medicine International* (2012). Cited by 191. 9. 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. 10. 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. 11. Isoardi, K. et al. Methamphetamine presentations to an emergency department: Management and complications. *Emergency Medicine Australasia* (2018). Cited by 57. 12. 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; 12 of 12 cited records resolve through the reference links. - **Author contributions.** Drafted by an automated pipeline (articlegen, x-ai/grok-4.6); no human author verified the text. - **Competing interests.** None declared. - **Peer review.** Not peer reviewed; not a publication of record. --- **Not medical or clinical advice.** Machine-generated summary of the cited journal articles, 5 of 12 read in full, the rest from their abstracts, for background only — not a substitute for professional judgement, primary sources, or clinical guidelines. Verify every claim, figure, and dose against the cited papers.