What’s Old Should Be New Again: Family Interventions in the Psychiatric ER

In Emergency rooms we’ve gotten so focused on risk, stabilization, and disposition that we’ve forgotten something essential… human connection.

An 18-year-old woman comes to the ER after a Tylenol overdose. Earlier that day, she told her mother she was pregnant after a college party. Her mother exploded, calling her a “slut” and warning, “Don’t ruin your life.” Hours later, she swallowed a handful of pills.

Thanks for reading! Subscribe for free to receive new posts and support my work.Subscribe

In the ER, the team did what nearly every ER does—focused on safety, stabilization, and disposition. Tylenol toxicity was managed. Suicide risk: high. Plan: inpatient admission. Nobody saw the patient and her mother together. No attempt was made to address the conflict that ignited the crisis. In all likelihood, there was not a family focus as part of the inpatient admission.

When I trained years ago at Albert Einstein Jacobi Psychiatric ER in the Bronx, we always saw families first. The family was the primary focus of treatment, not the identified patient. A case like this would have led to a brief family problem oriented crisis intervention, aiming to de-escalate the conflict…let cooler heads preside, and assist in making the mother-daughter reconnection—often preventing hospitalization altogether.

Today, what was old is coming back new again.

Models like Open Dialogue (Finland) and Family-Focused Crisis Intervention (U.K., U.S.) are reviving the central idea that families belong in the room.

Including them isn’t a luxury—it’s the missing standard.

Brief, structured family interventions can transform a reactive ER encounter into the first step of recovery.

With telemental health, we have even more ways to make that happen.

Safety, stabilization , and disposition save lives.

Connections through family focused interventions heals them.

About the Author

Robert E. Feinstein, MD is a psychiatrist, psychoanalyst, educator, and lifelong student of what makes therapy work. He divides his time between clinical practice in Stamford, CT, working with telemental health companies, teaching at the Northwell/ Zucker/Hofstra School of Medicine, and creating innovative ways to train therapists and strengthen mental health systems. He writes to bring clinical wisdom, human understanding, and practical teaching tools to the next generation of therapists.