Emergency Psychiatry The Past and Future of Psychiatric Emergency Services in the U.S.

A psychiatric emergency is any be-havior that cannot be dealt with as rapidly as needed by the ordinary mental health, social service, or crim-ma! justice system in a community. From this functional definition, it is clear that whether a given behavior is treated as psychiatric emergency is a function not only of the behavior it-self, but also of the human service system in the community where the behavior occurs. The human service system in most U.S. communities has developed over the last 30 years in a way that leaves many gaps between services. People with problems that fall through the cracks often end up being treated as psychiatric emer-gencies. A particular type ofa service generally called a psychiatric emer-gency service has evolved to serve these people. For purposes of this article, a psychiatric emergency ser-vice is defined as a centralized pro-gram that offers face-to-face evalua-tion of patients 24 hours a day. These Dr Hillard, editor of this column, is professor and chairman of the department of psychiatry at th