Children and adolescents who come to the emergency department (ED) with a psychiatric crisis are a concern for all ED professionals. The disposition plan for the suicidal child or teen should include mental healthcare referral. The substance use may represent an incidental finding in the ED, or the substance use can cause directly a youth's presentation in the ED due to symptoms of intoxication. Schizophrenia and bipolar disorder, two common and severe psychiatric disorders arising in young adulthood, can occur with an earlier onset if there is strong familial genetic loading for the condition. Post-traumatic stress may emerge in children and teens who are exposed to overwhelming experiences: accidental trauma; physical or sexual abuse; repeated or prolonged medical or surgical hospitalizations with difficult procedures to endure. Some ethnic and racial minority patients are at increased risk for traumatic experiences, including child abuse.