Definitive treatment in the psychiatric emergency service

This article briefly reviews the history of psychiatric emergency services (PES) in the United States and concludes that the dominant model, the triage model, unnecessarily limits modern PES. Trends in the mental health system and the corresponding development of compensatory PES structures are described. These include observation units, outreach, and crisis residential treatment and other innovations. These new structures have had the effect of increasing the length of stay in emergency services, increasing the number and complexity of services provided in the PES and professionalizing emergency service personnel. A new model, the treatment model, is proposed for this type of PES. Strategies for the rapid initiation of definitive treatment of bipolar disorder, schizophrenia, major depression and opiate addiction are outlined for services with this capability.