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What Good Psychiatric Emergency Management Actually Looks Like
Apr 20, 2026
Why emergency care starts long before the crisis.
In the first post, I argued that “Go to the emergency room or call 911” voicemail is not an emergency safety plan that benefits patients — it’s an avoidance strategy dressed up as a safety plan.
So what should clinicians do instead?
Managing mental health emergencies in is not difficult or complicated. It requires proactive planning. Improvisation, during a crisis, add to the chaos. A good plan includes simple steps you can take beforehand, so you’re emotionally available to your patients at some of their worst moments.
Step One: The Emergency Contract at Intake
The first evaluation should include an explicit conversation about emergencies. This is more than just office policy; it’s part of setting the treatment frame for each patient.
What is a psychiatric emergency?
Define what you mean. Many patients have never heard a clear definition from their clinician, A mental health emergency occurs when there is immediate risk of harm to the self or others. It requires urgent actions to protect life. It is not just a bad day or an interpersonal conflict with a lover or family member. It is not a return of familiar symptoms. Offering examples of what it is not — and with compassion — is itself a clinical intervention.
A mental health emergency occurs when there is immediate risk of harm to the self or others.
You can define what constitutes an emergency with your patient.
Decide together when you want to be called. In addition to be called for suicide or violence risk you may choose to be called for acute trauma, critical illness, or a death in the family. Ensure you have a shared understanding with your patients of when to ask for emergency help.
State your availability.
Make clear guidelines about when you’re reachable. If you have emergency support, explain how it works. If you’ll be away, discuss who will cover for you. For patients who struggle with long absences, have them meet with the covering clinician before you leave. Let them share that experience.
Patients accept reasonable limits when you explain them upfront. This way, they won’t discover them in a moment of need.
Outline the patient’s responsibilities.
A good emergency contract is mutual. Discuss what steps patients can take before calling you. What coping strategies do they have? Who else can they reach out to? This isn’t about limiting access; it’s about helping patients build skills to manage life’s urgencies.
What happens if the agreement breaks down?
If patients abuses you or misuses their emergency contact, have a direct conversation. Don’t just change guidelines without a discussion. Anticipate this issue and plan to address it together if it comes up.
Step Two: Two Emergency Contacts, Properly Collected
Every intake should yield two emergency contacts. One who is close to the patient and another living nearby.
Ask for the full name, relationship to patient, phone number, and patient’s consent to use these numbers in an emergency. This matters both ethically and legally. Obtaining consent at intake protects everyone.
Note: During a life-threatening imminent emergency, you do not need the patient’s consent to call their contacts. HIPAA Rules do not apply during a true emergency.
Also, ask the patient to share a bit about each contact. Is that person trustworthy? Have they helped in past crises? Is there anyone who should not be called, and why? Assess the quality of their support with three questions:
- Is the person available to help?
- Are they interested in helping?
- Are they capable of managing an emergency?
If a patient cannot name two contacts, or has strong objections to naming anyone, take that seriously. Plan for community support and document it, as part of your risk assessment.
Step Three: Know How to Work with Emergency Responders
Understand how to contact police or refer to an emergency room. When an emergency arises, you may need to involve emergency services.
When calling 911 or police
Start by stating the situation. “I’m a licensed clinician calling about my patient, Mr. Jones, who is actively suicidal or violent.” This is different from a wellness check. Ask if a Crisis Intervention Team (CIT)-trained officer is available. They can significantly change the outcome.
Be ready to provide the patient’s:
- Full name
- Date of birth
- Location
- Physical description
- Nature of the emergency
- Report any known history of violence or access to weapons
Also,
- Mention if the patient knows help is coming
- And everyone forgets this – Get the officer’s name and badge number!
Stay on the phone as long as possible. If the patient is still with you, your presence can help stabilize the situation.
Documentation in real time
Document everything during a crisis. Note the time, actions taken, and who you called. This protects your patient and you.
The emergency doesn’t end when the ambulance leaves.
Follow up with the ER or the hospital
The emergency doesn’t end when the ambulance leaves. Speak with the ER doctor before the patient arrives. Update family members and stay in touch with the patient’s inpatient psychiatrist. Participate in discharge planning. When the patient returns, review what happened and what comes next. This is vital work that can help prevent future crises.
The Real Issue: Emergency Preparation is Essential Clinical Work
Discuss how to handle emergencies with your patient. Plan how you will manage them. Most importantly, be there when your patients desperately needs you.
As I outlined in my last piece, don’t leave a message saying, “In an emergency, go to the ER or call 911.” https://substack.com/home/post/p-193270887
If there were 3 things I hope you takeaway, it’s this:
- Discuss how to handle emergencies with your patient.
- Plan how you will manage them.
- Most importantly, be there when your patients desperately needs you.
Build your guidelines, discuss crisis management, and know how the system works.
That’s the job.
This is the second post in a two-part series on crisis management in mental health practice.
About the Author:
Robert E. Feinstein, MD
Professor of Clinical Psychiatry, Zucker School of Medicine at Hofstra/Northwell
Psychiatrist, Psychoanalyst, Educator, and Supervisor Contact: Feinster@RobFeinsteinMD.com
Owner & Founder Empathian LLC ( An Online Mental Health Education Company) Empathian.com
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