Emergency Department Psychiatric Crisis Management

A psychiatric crisis is an acute behavioural emergency in which the patient presents with imminent risk of suicide, homicide or grossly disorganised behaviour requiring immediate evaluation, stabilisation and disposition by the emergency physician with psychiatric liaison.

Initial assessment includes medical clearance to exclude organic causes (intoxication, delirium, hypoglycaemia, encephalitis), focused psychiatric history, mental state examination, and structured risk assessment for suicide (Columbia C-SSRS), violence and self-neglect.

Management combines verbal de-escalation, environmental safety (1:1 observation, removal of ligatures), time-limited pharmacotherapy with oral or parenteral benzodiazepine and/or antipsychotic, treatment of underlying medical disorder and safe disposition: voluntary admission, involuntary detention, crisis team or community follow-up.