It’s 2 am. The patient in bed 7 is manic, delusional, and difficult. There’s nothing organic. There’s nothing I can fix. I go through my psychiatric checklist. Suicidal, homicidal or not. This one is ‘not’. OK, crazy or not crazy. This one is definitely ‘crazy’. That’s pretty much my thought process when I first came to Rochester 11 years ago. I made a mental list of all the arguments why the patient belonged on Psych anticipating a difficult encounter. I was surprised, first because an attending arrived promptly to see and evaluate the patient, and secondly because he was actually interested in the patient. After a relatively brief evaluation the Psychiatry attending eagerly thanked me for this interesting consult, told me what an unusual case it was and even suggested that we write up the case together. Hmmm, I thought he was crazy.

This true story was my first encounter with Emergency Psychiatrists. A few hospitals in this country are blessed with 24/7 coverage by attendings in Psychiatry who are interested in acute disease. This relative handful of professionals have created new treatments such as rapid loading of lithium to control mania with only a short stay, mobile crisis teams that treat the patient in the home and rapid control of aggressive behavior.

Together with Emergency Psychologists and Social Workers, they have formed the American Association of Emergency Psychiatrists. Their mission is to ‘promote timely, compassionate, and effective mental health services regardless of ability to pay in all crisis and emergency care settings’. They’ve created a journal, regional and national meetings and a webpage www.emergencypsychiatry.org. On that website are resources for all professionals dealing with Psychiatric emergencies such as behavioral control without restraints, domestic violence identification and triage of mental health problems. They have fellowship training programs and funded research.

Like general emergency physicians, this group struggles with shift work, system inefficiencies and crowded conditions. In fact there are a lot of similarities between us. At times it is obvious that AAEP and its members have more in common with EM than with the world of Psychiatry. Further, having them around not only is helpful to patient care but also sparks intellectual conversation about the differential diagnosis. No longer am I limited to suicidal/homicidal, crazy/not crazy. Though I am far from being a psychiatrist, I can now actually think critically about a patient and formulate a differential diagnosis. I even read their journal, understand it and am interested in much of the material.

For the last two years I have served on the AAEP Board of Directors to help guide them through their formation. When first asked I was concerned that I would have so very little to offer. But I think it has been helpful for them to understand how various EM organizations have dealt with issues like corporate sponsorship, journal publication and endorsement of outside meetings. Hopefully I helped to guide them on their journey. However, I can never repay them for all I have learned. For one thing they are extremely supportive and tolerant of one another. Even though their views on the world are different, they have not splintered into separate groups over issues. When one member of the board has been overloaded, there was support and understanding, knowing that in the future there would be time for contributions. I have great hopes for AAEP and its relationship with other EM organizations. I have great hopes for the field of Emergency Psychiatry.